Angela Smith, MD is an Associate Professor of Urology, Vice Chair of Academic Affairs and Director of Urologic Oncology at the University of North Carolina at Chapel Hill. In this episode we discuss taking time away from work, managing your calendar, your email and other communications while away. Tons of practical tidbits for providers of all levels are shared. (Music Credit: Sunshine, Simon Jomphe Lepine.)
Angela Smith, MD is an Associate Professor of Urology, Vice Chair of Academic Affairs and Director of Urologic Oncology at the University of North Carolina at Chapel Hill. In this episode we discuss taking time away from work, managing your calendar, your email and other communications while away. Tons of practical tidbits for providers of all levels are shared. (Music Credit: Sunshine, Simon Jomphe Lepine.)
My name is Phil Pierorazio and I'm a urologic oncologist, a surgeon. Like many of you, I absolutely love what I do, and I would not choose another profession. But I've struggled professional identity practice efficiency and wellness over the years. operate with Zen is a podcast designed to explore a mindful approach to surgery and to being a surgeon. By discussing these struggles and mindful solutions, I hope together we can create a community of strong and healthy surgeons enjoy. Welcome to operate with Zen. Today with me, we have Dr. Angela Smith from the University of North Carolina Chapel Hill, Angie, introduce yourself for the people who may not have listened or may not know you from the first season.
Angela Smith, MD:Yeah, well, it's good to be here. I'm Angie Smith them from University of North Carolina. I'm a urologic oncologist, and I'm Vice Chair of Academic Affairs. They're very interested in faculty development, lots of work life balance topics. So I'm really pleased to join you again, fill on this topic today.
Phillip Pierorazio:Great. So last time, we talked about habits and today we're going to talk about a very specific habit. We're going to talk about vacations and managing vacations, and vacation time. So I will start pretty easy. So tell us about your last vacation what you do, where'd you go?
Angela Smith, MD:Sure. I love vacation, love talking about it. And my last vacation was in August, we're recording this right now in the fall. So as a few few months ago, and it was a great vacation was a little bit atypical because I split the week. I in my introduction, I should have mentioned that I'm a mom, a wife, you know, we all have lead many lives. And and so I have two girls five and seven. And and so the first half of the week, we actually my husband and I went to Boston. And we left the kids at home with our neighbors who are really good friends sort of like I always say we have a village, but they're certainly part of our village. And and so for first first half the week, I actually just, you know, hung out with some old friends, and just stayed around in Boston, picnicking in the comments and just really true relaxation. And then came back and did our true family vacation. We actually packed up the minivan Yes, we have minivan and drove to Indiana, Indianapolis where my sister lives, because she had a baby during the pandemic. And we were the her godparents. And we just again, hung around the house, but got to see her and spend time with her spend time with the kids and then drove home driving just you know, to avoid any, you know, I know three exposures. And it was a great vacation. But I think with every vacation, you'll learn a lot. So I'm happy to talk a little bit about it. And my next vacation is actually just two weeks away. So I'm excited. We're going to the mountains and going to recharge there.
Phillip Pierorazio:That's really exciting. Yeah, our I'm trying to remember now our last vacation was actually in Florida, during COVID. Yep, Don't roll your eyes at me. There. We it was my grandmother's 100 and first birthday party. And so we split time between the birthday party and, and a little bit of time in the keys, which was nice and socially distance as best we could in Florida. And we actually have vacation in a week, we are going to Turks and Caicos which has been changed four times because we're supposed to be March of 2020. So very much looking forward to getting away and celebrating in the Caribbean a little bit. Yeah, it's a great
Angela Smith, MD:destination. And I've been and I would love to go back. So making me jealous.
Phillip Pierorazio:So let's just talk now a little more generally, why is vacation and time away so important for a surgeon, a physician for anyone?
Angela Smith, MD:Yeah, I think it comes back to the idea of work rest cycles. You can look at work rest cycles in like small, very specific instances like in you know, just this day, maybe I would maybe take some five minute breaks here and there if I was working on a grant or but then you could really expand it out to the year and think through having these large chunks of time vacation where you really step away from work. So I see vacations, it's like the macro level of Work rest cycles. And I think it's necessary because we do need to have large chunks of time where we step away. And remember all the other things we might do. It's also a really great time to reflect on what you've been doing. You know, because it's, it gives you some, hopefully some time to, if some thinking time, which you might not have when you're really in the thick of it at work.
Phillip Pierorazio:Yeah, a couple great concepts you bring up. The first is kind of that micro versus macro concept. Right? During the day, micro breaks really help they just help our mind recharge and refresh. That could be, as you said, five minutes away from grant writing. It could be a short walk outside, some people like nap some people like coffee, whatever you need to kind of recharge. I think those are really important at a micro level through every course of the day. But we kind of find, I'm sure, you know, Paul Maroney, Colorado, Paul's an awesome guy talks a lot about wellness and burnout. Paul has this great analogy of the battery, and how we all kind of run our battery down and we look for ways to recharge it. And I see you know, those micro breaks are little ways to pick that battery up. But every so often, it keeps going down no matter what we do on a daily basis. And you need that weekend, week, two weeks, whatever it may be to get that battery fully up again. And those are the macro breaks you talked about?
Angela Smith, MD:Definitely.
Phillip Pierorazio:So a lot of people have a hard time managing vacation. I do sometimes. And it starts sometimes we just planning the vacation. So tell me about your planning of vacations. How many vacations do you plan on a year? How long do you go for some of the destinations? Perhaps let's kind of talk through some of the bigger planning of vacations?
Angela Smith, MD:Yeah, well, I'll start with just you know, scheduling them. Such a simple concept, it's actually the most important. So if there was one takeaway, it's like, you got to schedule the vacation. And a lot of us, you know, listening, I'm sure that we work in medicine. And we have clinics scheduled and or scheduled, and they often are scheduled months in advance. Our call schedules are in place. So if you don't actually plan for when you're gonna take the vacation, it's very hard to book that vacation last minute when you might actually need it. Because you realize, let's say their six months, 12 months have gone by without a vacation. You know, for those who have heard a couple of talks I've given on just, you know, work life balance and time efficiency and so forth. I always start with a story. And I'm happy to share it because I think it should be out there. And we talk about burnout. But I had my own experience with this. It really changed my perspective on vacation and others, and that is about two years into my faculty position. I remember, I was just continued working like I normally do seven days a week I was, you know, maybe doing research on the weekends, clinical things. On the weekdays, I had had a new baby. Yes, I had maternity leave, but you know, was just kind of working and keep in mind my head down and didn't think much of it. Met with a colleague. And I remember, I sat with him and he just started out said, How are you doing? And I surprised myself I burst into tears. I was crying. And I didn't even know why I was so confused. Like, where's this coming from? And I realized I was actually burnout. And his very next question was, When was your last vacation? And I I paused and I thought about it. And the last one he's like and I mean a week off, like when was your last week off. And I realized I hadn't had a whole single week off that two years, I had taken a day or two and convinced my mind that that was a vacation because it was a long weekend. I had taken you know, 10 or so weeks off for maternity leave, but let's face it, that's not a vacation. And I had been doing some research during it as well. So I realized I just hadn't had any vacation. And he was like, Listen, you know, you just need to take a day, you know, week off and you need to think through this. And so I left that meeting and it really changed my perspective. I was like, Okay, I need to prioritize this. Like just like I would schedule, you know, my clinics and my Oh, ours I need to schedule my vacation. And so I for that whole year I like booked out, I was like I'm gonna take this many weeks. You know, it depends on what you get for your your work, we get like four to six weeks. So like I just take them all I say okay, I'm going to do it here, here. Here. I have kids. So it's very easy and natural to do them during their spring breaks or their fall breaks or, you know, or the holidays if you celebrate Christmas or something like that. You could take it during that time, whatever works for your family. But now I do that and I have a recurring reminder to do it a whole year ahead. And I know I'm gonna take those breaks and I'm So I think that's the first the first piece of it. I don't know how you feel about that. But I do think that you just got to have a system to like, plan ahead to have to know exactly when you're taking them. And then once you have all of that, then you can get into the nitty gritty, like, what do you want to do? Um, I think they're, I have a family. So I'm always thinking, okay, am I gonna do a family vacation? I have wonderful in laws and parents who love watching the kids. So we do what's called grandparents summer camp. And they go and see them. It's like Win win, because it's a different relationship when I'm there, than when I'm not there. And my kids and my, my, my parents are together. And so that allows us to take an adult only vacation. And so that would be like Turks and Caicos, maybe, or I've been many places like we've gone to Africa, we've gone to Morocco. I mean, Thailand, Cambodia, I mean, you name it. We've been many, many places through these, like, you know, adult only vacations, then we've planned some family vacations. And so that's the second is just figuring out like, what kind of vacation you want, what you need to recharge, and we alternate that. And then the last is like the nitty gritty, like, what are you actually planning? And who are you like, Are you a type that likes to just kind of wing it, that's cool. Just know who you are. I know, I like to at least have some kind of framework. I don't plan every minute. But I plan generally, here are the activities I'd like to do. Some of these activities do require pre planning, so I might put those in. But then I leave the rest is a framework and we work within it. So that's sort of how I approach vacation now. But it's an iterative process. So you know, it's always changing and hopefully improving. Yeah, and,
Phillip Pierorazio:and thanks for sharing kind of your, your burnout story. I mean, I think it's important, the more people acknowledge these things and talk about them, it just lowers the stigma about talking about these things, and recognizing that it is a normal part of a professional career, especially in medicine, especially in surgery. And it's important to recognize when those symptoms happen, and I'm sure I had a very similar experience. Now, you know, when burnouts coming because you had that kind of seminal event. But until that happens, you often don't realize that you're cycling in and out of burnout for an extended period of time. So, so thanks for sharing that, that part of the story. You know, I think my vacation experience is actually very similar to yours. Thankfully, my yearly reminder is my wife, who is a wonderful person, for many reasons, not the least of which is just dealing with me, but she is our Vacation Planner, in terms of timing. And to be honest with you, we're pretty modest people, we're not car people, we live in a nice house where we don't do anything much absorbent, but we love to travel. And we love to travel with our kids, and we love to travel with each other. And so the way we tend to do it is kind of the Spring Break time is when we do the family vacation. And that ends up being a beach destination, or Disney or something where we can be really active with the kids and have a lot of fun and give them an experience because they're still pretty young. My kids are at this time seven and four. So it's mostly entertainment throughout the day, not so much sightseeing. And then in the fall, we try and do usually a week long summer to adult adult week, and we call it a cold weather trip. And we try and do things that the kids wouldn't enjoy. So we've been to Iceland, and Ireland and we were supposed to go to Scotland during the, the pandemic and they're places where you can hike and you can do all of the things that you're not going to drag a seven and four year old to do. And we get to see the world and spend time with each other and kind of reconnect. So I think those are really nice themes of kind of the family vacation and the the spousal vacation, let's call it a your significant other to kind of recharge and reconnect because those those relationships are just as important, if not more important than what we do for work.
Angela Smith, MD:Absolutely. I couldn't agree more. You have to cultivate whatever is your, your personal life, that could be just friends that could be just your husband or your spouse, your partner. It could be your kids. It could be your parents. I mean, it doesn't matter what it is just know what those priorities are and use your vacation I think to recharge with them. Most people recharge by tapping into that. And so I think that's why it's really important to plan ahead of like what where do you want to recharge and how I didn't mention it but I have a couple women who I've known for 20 years and we basically we have a dinner we call it Ladies Night, once a month. The three of us we have kids around the same age now. We went we actually ran undergrad med school together know them very well very comfortable with them. And that's a form of recharging. And occasionally we take a vacation together When we feel the need to just just the three of us go somewhere. So again, just know who your priorities are. And it's great to use your vacation to cultivate those relationships and like recharge with them.
Phillip Pierorazio:Yeah, that's a great example. And brings us to the next thing I wanted to bring up. So we talked about kind of these week long, two week long vacations. But we also need kind of shorter recharge weekends, every once in a while stuff that may happen on the fly. What's your kind of philosophy and thought process for how often do you do that? When does that happen? What are your kind of go twos for that?
Angela Smith, MD:Yeah, I would say a couple things. The first is when I had that moment of clarity, we'll call it regarding burnout. It was at that point that I stopped working weekends, I just, it was like cold turkey. I just said no more. It first it was an experiment because I thought, well, this is not going to work. I actually thought it would not work. But I said, Well, I haven't tried it. So let's see. And then and then I'll judge. Well, it was interesting, because after a couple months, because I told myself, I do it for two full months. And it did feel very awkward and uncomfortable. And I will say that I even had a mentor that was outside of my institution who was like, Don't do it. So I say that because you have to be careful where you're getting your, your advice from and suggestions. Mentors are great. And it's great to get outside advice. But it is really important to try out this advice yourself and don't just take someone's word for it. So in any case, I tried it for two months and wanted to see what happens. And I've said this to others before I probably have said this to you, Phil, I became more productive, no doubt about it. No doubt about it. I got more work done. When I was at work, I was more focused. It was actually surprising. I was just shocked. But I've never looked back. So I would say every weekend I take off, I don't really work on the weekends, I try to stay off email as much as I can. Although you always feel that pull to email, we probably will talk about that. And with vacations because I think it's a really good topic. But in general, I just you know, I hang out with the kids. I might hang out with some friends. But my weekends are mine. And they're not work related. So they're sort of mini vacations every weekend for me.
Phillip Pierorazio:Yeah, I think that's great. I've had a very similar experience. And I used to go in and round every weekend and see every patient and at some point I realized, you you need that disconnect, you need to recharge and it will make you better on Monday, if you've given yourself off Saturday and Sunday and connected with your with your Yeah,
Angela Smith, MD:you know, until I it made me think you said rounding. And because I was talking I was thinking a lot about my research. But I have I think you know, I'm gonna share how I kind of wrap my mind around it. Because a lot of how we view this is just the way we were thinking about it. And we could think about something one way at one part of our lives and then have completely different thinking later. And it just changes our experience of it. So I will say that I was the same type of person, I would round on the weekends and felt that my thoughts were I am a good doctor if I round on weekends. But that's just a thought. And is that really true? Maybe not, you know, we feel like we're the only people who can do the job we do. That's not true. Definitely not true. That's why we have a team. And so I had to really think about well, what what does my what is my as a patient, what would they want? And I realized that first of all they want to doctor, he's not burnout, everybody was we have enough evidence, right? That when you're not burnout, you're working at your, your optimal capacity and everyone benefits, including your including your patients. But what they really want, I think is some kind of connection to you. So I for me, and you have to figure out what it is for you some patients, some individuals are like, You know what, I'm good. I'm going to let my patients know, I'm not going to be there. And I feel good about that. And that's what matters. Others need to round and I'm okay with that too. Like that. You got to know what what works for you. I found for me, what works is I tell my patients I'm like, Listen, I'm not on call this weekend, I'm not going to be coming into the hospital. That being said, I have a great team, I'm going to communicate to them before I leave. I'm also going to talk to them every day over the phone. And also, I'm going to give you a call on Saturday and Sunday. And I'm just gonna check in if you have any specific questions for me, I'm happy to answer them. And I do that I do it before the kids wake up and or maybe when I'm driving to the grocery store. I just try to fit it into a part of the day where it's just me anyway. And it takes about five minutes. It helps my thinking and it's helped me disconnect on the weekends like in the way I want but yet still being vailable for my patients and showing up as a physician that I want to be at least the way I think of that so I think that it Good, and it's smart to kind of really dig into what what will work for you. And for a long term solution.
Phillip Pierorazio:Yeah, I agree 190%. With everything you've just said, the only other stuff I would add is it's all about setting expectations, too. So I used to operate a lot on Fridays, and I loved operating on Fridays. And the reason is, if patients do well, they go home over the weekend, and they don't need you. Yeah, and if there's a problem, they're going to be there till Monday, you're going to see them first thing in the morning when you walk into the hospital. But along with that comes with setting the expectations. So I would tell every patient, listen, it's Friday, I typically don't come in on the weekends, because that's when I get to see my girls. And when I get to see my family, if there's an issue, I only live you know, X minutes away, and I will be in, you have my cell phone, you have my communication, there's someone in the hospital 24 hours a day, and 99% of patients are a okay with that. They love it, they actually say, Oh, they actually respect you for going to spend time with your family and doing that. So it is all about setting the expectations and recognizing that we like you said, we used to have this badge of courage, I'm in the hospital, you know, 27 hours a day, that's making me a better doctor, it doesn't, it really doesn't being a good doctor, to get to kind of mindfulness is being present with your patients and being present with the tasks at hand. And if you allow yourself to recharge, you can be fully present when you're when you're there. So really great take homes here. You brought up a great part about healthy communication. I think this is a great segue into where we're going with the next part of this discussion. But I'll just kind of share, as I've taken on this new role at the University of Pennsylvania, I've kind of set very clear ground rules for communication with my team. And basically, email is a non urgent form of communication. And we would love to not send emails at seven or 8pm or 10pm. But sometimes that's when we're getting work done. In an ideal world, you'd never send an email out after work hours, because you know, you don't want to put that burden on your team. But the way I've kind of established it is that after hours, that's not urgent communication, I don't expect you to be checking your emails, I will not be checking my emails on a consistent basis. That being said, I'm available 24 hours a day, seven days a week, call me text me, I'll pick up the phone at two o'clock in the morning. And we can have a conversation but don't expect an email to communicate and urgent communication. And I think setting boundaries with communication as we're going to work into vacation is a really important part. So how do you handle your communications on a, you know, non vacation basis, just kind of your weekly daily communications?
Angela Smith, MD:Yeah, I think it's just such a great topic, because email can completely overwhelm your life and if you let it. So that's where the boundaries come in. And communication, it's sort of like what you're saying, setting expectations is the beginning of it. I think, first you need to understand what it means for you. So be very clear about what you want, and you're going to stick with, and you have to commit to yourself. And then once you know what that's going to be you communicate it to your team. I will say I'm, I consider myself pretty responsive to email I'll generally within two to three days, I'm getting back to most individuals, I let them know, just like you do. I mean, email is not the best form of emergent communication, certainly. But I actually I think a lot of people do know that there may be a few who don't. Because they're in the same boat. I mean, just like a delusion email every every day. I try to to have patient care be in the electronic health record, and very minimally an email, I know they're secure email, and certainly that can be done. But I like to keep it separate from email, email being more professional development, you know, academic research type and administrative tasks. Whereas patient information is best I think, in the electronic health record, because you can have record of it. And that's usually quite important for communication over the whole team. So I think I don't have a lot of strict rules here. But I would say that is probably a big one for me. And then the last thing is I will say I have a colleague of mine, I haven't stolen it yet, but I might I love his his like tagline, or signature line and his email which is says exactly what you said. It basically sets his email expectations below and every single email that says I do not no matter when this email comes from me, I do not expect a response after hours while you're on vacation or on weekends. And I love that message. It's why I do my autoresponder for vacation, which I'm sure we'll talk about, but I think that's a really nice clear message that's sent out to people I haven't done it myself yet, but I might. Yeah, I'll credit him.
Phillip Pierorazio:That's great. That's I think that's a wonderful, healthy tip there. So let's start. Let's start talking about vacation. So how do you handle your practice and medicine? When you're when you're on vacation?
Angela Smith, MD:Yeah, well, I will start by saying that every time I'm on vacation, it becomes a little different each time. What I found is that when I began vacation, I think I had this thought that vacation is like, like pure relaxation, in my belief of what that meant, was, I just do it, and it just happens. And it's like, the best vacation and then it's over. What I realize, though, is that just like, you know, if you're trying to become more efficient with your grant writing, or you become a better writer, for manual, you know, whatever task it is, in professional development, like you're actually like, trying to get better. I've attacked vacation that way. Which sounds a little silly, but, but oh my gosh, it's paid dividends. So I will say, my current way of approaching vacation is it's again, starting with expectation setting. So I on the Friday, before I take my vacation, I set things up in a way that I have half the day on Friday to clean it's called cleanup time. For my kids before bed is like for 15 minutes, we just y'all are like cleanup time. You know, click put all your toys away, get ready for the next day, get to book back downstairs winter shoes out, it's the same for vacation. You know, I have half the day to clean up my email inbox. I'm not going to get it all done. But maybe I can see what's there. I'm an organize it. I'm going to get all of my autoresponders through that means I need an autoresponder for my electronic health record, I need one for my email. And, and I'm going to touch base, I usually give a call to my nurse, my nurse navigator for the oncology clinic and I just say, Hey, I'm leaving in a few hours, anything you want to talk about before I go? And that way people know, okay, well, you know, is there anything out there, they may forget if I didn't bring it up. And so it gives that opportunity to stave off any emergencies that might come up or things that they had forgotten to discuss. So that's the first thing is just like the setup. The second is like figuring out what's on the other side of the vacation. So I like to take a half a day when I get back to it's sort of like clean up again. So I can start my next week with stress free, because I'm gonna get into the nitty gritty of what I do, and you'll see why I need to do that. But I think the the setup for the beginning and the end is really important, so that you can enter your vacation with your clear mind, and then re enter your work life with a clearer mind also, because if I don't have those half days, I am worrying I can be anxious sometimes. I just like probably any surgeon. I managed it pretty well but like the you know, sometimes I will get anxious if I have a delusion email where I feel like there's something that wasn't complete, then I'm going to be a little anxious and I might not enjoy my my vacation as well. Likewise, I may not I may be really tense my first week back because I'm something is undone. So So that's the first piece of it in the nitty gritty. I and you know this, we actually had a really nice debate. I love the debate on Twitter about what to do for email. And I think that the same debate can be what can what do you do for the electronic health record? I will, I will share what I do. And I'd love to hear your perspective film we can like have a nice little debate about this. I think what bottom line is you got to figure out what works for you. So the answer is going to be what you think it should be. But my my charge to anyone listening is challenge yourself. Okay? Remember challenge yourself. Okay, cuz I wasn't like this two years ago, but I am now and I love how I how I moved into this, this belief and that is for the electronic health record. As I mentioned, I talk to my nurse, my nurse navigator I talk to you whoever is on call the chief and I let them know I'm not available period. If they really feel they need me and sometimes that's true. They have my cell phone so they know they can call me sometimes I'm in a place you can't call me and I would let them know that but in general I really am not available and that's I'm okay with that. I think I do need that electronic health record. I have that in my autoresponder so that's what I do there. I do not check epic during that week, not once it is I actually turned it off on my phone, so I cannot even try to do it. It's just an not available. Second is his email during vacation, I likewise send an offset an autoresponder. And email is such a habit. And I would even call it an addiction that I have, much like many people probably listening, I like to check it, I like to have it on my phone and pull it up. It's an easy win when you like delete things off. So it's just, it's a habit, and it is an addiction just because of that. So I had to fool myself, trick myself. And there's an outlook rule where you can say, between this date and this date, all new emails get put into a different folder, and I buried deep, deep, deep in Outlook. So I could find it if I absolutely had to find it. But it's going to be pretty challenging, like in a folder of subfolders. You know, so it's gonna be really hard for me to get to it. And then I don't look. And that's what my email tells you. I do not look at this email guaranteed will not look at it until Monday during that half day. And then and if you need me, here's, you know, my nurse, here's my administrative assistant, you know, etc. And then if you don't hear me, for me, within a week of my return, resend your email, please. So that has served me very well. But I will say, and we can get into this a little bit, but I'll just stop, as you know by to saying that, that was very uncomfortable. It was very awkward to do at the beginning. And actually, I would just say hard. I really had that urge. It's an urge to check it. But now that I've done it for, oh gosh, probably one to two years, maybe even almost going to three years. It's very easy. No, it's just like anything you need more practice with it, it's just that we don't take enough vacation to have a ton of practice, we only do four to six a year. So give yourself some grace, it's going to take some time. Unlike surgery, where you're operating multiple times a week, we got a lot of practice there. And so your your your learning curves gonna have happen faster. Give yourself some grace on vacation, because you don't have as much practice, but use it as practice. And it's supposed to feel a little uncomfortable, so that you can get outside your comfort zone there.
Phillip Pierorazio:I love that. I love the practical tips there. I love the philosophy of kind of addressing that, I think really important is the entering vacation with a clear mindset and re entering work with a clear mindset. That's the whole point of being on vacation. And I think that just verbalizing that is incredibly important and kind of putting down. I think one of the other things you brought up, it's really important is how you manage notifications. This is also a very personal thing. I get zero email notifications on my phone. I get zero email notifications on my smartwatch when I wear one I try not to wear one because I don't find them that helpful to be honest with you except for creating anxiety and angst. But that goes to my philosophy of emails, not an urgent communication. Right. And so I don't need to be notified. Every time an email comes through, I don't need to be notified every time a tweet comes through or somebody likes it. So I keep those things, I keep the notifications to a minimum on my phone so that I'm not getting that constant dinging in my ear. That's during the normal day, but especially when on vacation, there. As you said, No notifications unplug from the electronic health record. I'm pretty sure I've never looked at Epic when I'm on vacation. My vacation management and I struggle with this too. But I struggled, I have a slightly different problem than you is sometimes I just I need to unplug too much. And then all of a sudden, I get back to the real world. And I'm inundated with 2000 emails and I don't and it takes me forever to catch back up and during the week of vacation or days or whatever it is. I'm struggling with that anxiety of I know this stuff is building up. So I've gone through multiple iterations as well. I think one of the healthiest things for me, I tend to be a really early riser and the rest of my family isn't. So sometimes I will just sit there and for half an hour in the morning, just clear my inbox. And basically it's a triage, right? Not not urgent, not urgent, not important. Not important. Okay, answer this email. Not important, not important, not important. Answer that email, and then everything else can kind of wait at least then I've cataloged for the day and I've lowered my anxiety that I don't have anything urgent and pressing and life's not going to fall apart. I really like your idea about the vacation folder. I'm going to try that when I go to Turks and Caicos and see how that works out for me. But yeah, I struggle with this a lot. I don't know the right way to do it. I've completely unplugged I've struggled with that. I've done the 30 minutes. That helped me a little bit. There's lots of people out there on Twitter and social media who got involved in the conversation we're having who had other ideas on how to manage this. I think one of the important points is that you need to be thoughtful of it. You need to find what works for you and listen to what other people are doing because I learned a ton from listening to you and from others and I'm still working on the right way to manage it.
Angela Smith, MD:Yeah Yeah, I mean, I think that's exactly right. And I'll say that, you know, the, the, when I first started this method like trying it, that's what I had been doing. I had been, you know, maybe checking in the morning, I had read a book about, you know, attention residue, I think it was like Cal Newports book on. Oh, I'm trying to blank on the name, it'll come back to me. But oh, deep work. But in any case, the attention residue resonated with me with regard to emails, but I know myself, and even if I read those emails, they stick with me through the day, even if they're not urgent, or whatever. And maybe even I'm, like, irritated? Like, you know, I'll be honest with you. I mean, how many times have you read an email, you're like, oh, just This is annoying. And I realized I wanted to dry and see what happened if I didn't do it. And I think we're all scientists at heart if we're in medicine in some form. So I did it as an experiment. The first time I did the, you know, day off, and I will tell you, I actually counted, I'll give you my stats, okay. Because I actually really did this. I counted the number of emails I had in a week, and I thought it'd be 2000. And I get a lot of emails like I really do, you know, but I ended up getting, it was like about 650 emails that weren't junk mail. So 650 actual emails, and and I took Monday off actually took the whole day off, because I didn't know how long it would take. So I just added one extra vacation day, which, you know, what's the big deal there, it's just one extra day. So to use that day, went through it and actually set a timer, went through the entire email list. And I found in my rule, and I still actually use my rule to this day, I broke it once. And I actually regret it. I was like, This is why I have the rule is that I just go through it once I do not respond to anything. The first one is just delete, or read, leave, or read, delete. And what I realized is that about at least 50% of the questions that were posed to me, usually there's someone else on it, they got answered either by that person, or by someone on the chain. And I actually could just delete them. Had I responded to them, I would have looked like an idiot because they're like, Oh, we already solved this. Yeah, and you're wrong. This is how we did it. Okay. So I laughed, I broke my roll. Recently, I was like, I did what happened. Um, but in any case, I now I do it. And I and I timed it. I said, I timed it. It took me about two and a half hours to do it. It's not actually that long. And I think the cumulative attention residue I would have had during that week, and responding to things I probably wouldn't have needed to respond to, eventually, would also save me time. So in any case, I say that be open minded. Was that uncomfortable? Yes. And I'm sharing my experience when I did it. My first day, I kept going, I don't have notifications, like you. But I do have my email app on my phone. And I kept like, I mean, it was like, it was like I was a zombie, I would just go to the app and open it and it would be empty, because I made this like trick. So like, say they have nothing in it. But I'm like, Oh my gosh, why am I my email, I might have to turn it off. Okay, turn it off. But I had to do that. It's almost like an itch. And I felt that itch for at least two or three days, into my seven days, but then it went away. And then I felt like a different feeling I'd never felt before, which is like complete relaxation. And then every time I've done vacation, that itch is still there the first day, but it's just faster and faster. It goes away within like maybe half a day. So my my suggestion is just be open minded. My I'll give you an example of someone giving a suggestion that I'm thinking about trying, which is I know of a urologist who doesn't even have any email on his phone, like that's his rule, he doesn't have any email on his phone. And I haven't been brave enough to try it. But I know I need to. I know I need to because it's, it makes me uncomfortable. Usually, we talked about this, if it makes you uncomfortable, you probably should try it. And I'll get there some time. But, you know, eventually I will try it.
Phillip Pierorazio:I'd say I did try that. And it didn't work for me. And the reason it didn't is because we spent so much time in meetings where you're not, you're not necessary. You don't need to necessarily be 100% invested in and you can you can get some work done in found time. And you're not on your computer. So right or you're standing in line or you're waiting in between cases and you're you want to let the resident put their orders in so you can just work on your phone. So that's why it didn't work for me. But then again, the flip side of that is I've also learned that if there are meetings that you're on your phone, answering emails in because you're not paying attention, you probably don't need to be in that meeting. And that's probably better life management than then, you know, working on the email infilled time.
Angela Smith, MD:Yeah, I use a screentime password. Now, I may have told you this, but my husband has it. It's like a it's like for a kid except the kid here. And after a certain hour, like, you know, 5pm for email and 8pm for Twitter. I, it turns off, and I can turn it on if I have the screen time password, but I don't my husband has it. And it's, you know, I will not ask him for it. Okay, I'm too proud. So it means that if I really want to do something, I actually have to sit down at my desk, open My Computer to much activation energy, usually, unless I really need to do something. And then, you know, maybe I should be doing it anyway. So anyway, that's been my middle ground. And I'm, I've been continuing to try it, it works fairly well. But again, always open to suggestions and new ideas. Yeah, that's,
Phillip Pierorazio:that's another great idea. I, I'm fairly disciplined. So I'm, and I love to just shut my phone off. Or not totally, you know what I mean, just kind of put it away. So I can hear it ring, but but kind of do other things. But these are, I think, really helpful tips. And once again, getting to the point, we each need to find individually, what what works for us. And to bring a little bit of mindfulness into this, too. It's, as you said before, it's really all about being present, and what, whatever helps you be present in the moment, whether it's at work or vacation, or at night with your family. That's what you need to work towards. And being thoughtful about how to get to those processes, I think helps you out the most, I think one of the worst things that is when we get in a rut, and when we end up in these burnout episodes, is when we just let life take advantage of us. Instead of recognizing that we're the captain of the ship, we can control which direction we're going. And we can set boundaries, not to keep people away from us, but just to guide our lives and make sure we're being productive and efficient. And, you know, meeting our priorities and the things that we want to do.
Angela Smith, MD:You're exactly right. And, you know, it makes me think of maybe one other last thing that I wanted to talk about vacation that, you know, I had mentioned, vacation is a iterative process, and I'll share what I'm currently working on. Because I have a big I told you have a vacation coming up in two weeks. I'm actually after vacation. I know this sounds super nerdy. But I actually journal what didn't work for me on that vacation. And I look at it for my next vacation. Because again, we don't have a lot of time to practice this. We don't have a lot of vacation time. So I recently did this, and I just looked back because my vacation is coming up. And I can tell you what I learned from my last vacation is and I mean, put your hands up if you're like me, when I go on vacation, I love to eat. And I love flour and sugar. of maybe a little too much. And I just like let it go. Maybe I'll have like a cocktail every day. Or maybe I'll have Yeah, are exactly. Those putting his fingers up. I won't I won't divulge what you just said. But, but yeah, I mean, it's, it's it's true. I mean, I, you kind of like you, you believe like letting go of all these things in all the habits are helpful to you. And I realized on my last vacation, I had a really challenging week back. Why? Because I didn't exercise during that entire week, I usually exercise every day. And it because why? Because it makes me feel good. Honestly, I just, I start my day like with more energy. So I like to do it and make just three minutes or so. But I didn't do it on vacation. Likewise, I was maybe having like a cocktail every day. And I was, you know, eating whatever I wanted to eat. And not to say that I need to deprive myself, but what I realized was I just like completely throw away all of my really good habits. And yes, I had good habits prior and I got them back. But it took me like a good maybe two or three weeks to get them back in I did not like that process. I'd rather just keep those habits. So this coming vacation, what I plan is I'll pepper in those things like I'm going to have some desserts and I'm gonna have maybe, but I'm not going to eat every day. Maybe moderation. And I'm definitely keeping some of my good habits like, you know, exercising at least a few times that we just to keep that going and not have to have the activation energy when I get back to resume it. So that's my current, you know, model you can check in with me and see how it went. But I know that's what I want to do better on my next vacation. So that coming back, I am fully recharged and I don't have to, you know, come back to more work and more effort in reestablishing my good habits.
Phillip Pierorazio:That's a really important point. And I forget which of the habits book this is it's in maybe atomic habits. But yeah, it's the idea of kind of a compounding interest. Right and as long as you do something it may not be your normal routine. You may not put in your hour of hardcore workout that you do normally. But at least if you do something you're not going backwards you're continuing to maintain and move forward in the last few minutes here, and you want to go back to something we talked about in the beginning, and you talked about one of the important reasons to take vacation take time away is to reflect. And I've shared this story before, but you know, Dr. Wall shoes, you know, the prostate cancer guru at Hopkins for decades, and is still there, and actually is on this on the podcast this season. Every August, he would take a full month off. And this is the time where he would review his cases, he would review his videos, and he would make his incremental improvements to his surgical, you know, approach to radical prostatectomy. And that was his purpose, that was his goal, we may have individual differences, we you may not be looking for the cure for cancer, you may be looking to improve your practice, or improve your family life or improve your physical well being whatever it is, but reflection time is really important. So So tell us about reflection, you mentioned a little bit about journaling. What are some of the other ways you can reflect and kind of improve on that?
Angela Smith, MD:Yeah, I think that's such a great, first I was a great topic. And I love that he takes off an entire month to think about it. I would have would I so I do have reflection time. And I build it in as an appointment that is unbreakable. Actually, I have it tomorrow. It's tomorrow. And I do it usually, or typically on Fridays, because that's just the day I have open from an academic perspective, I try to at least book three hours of time, once a month, either the first or the last Friday. And when I do it, I actually, again, this is the nerdiness in me, but I have an agenda. But I think it's good to have an agenda because you want to cover you want to cover things that are important to you. So in that agenda, I have professional life, like career goals, you know, just just, you know, it could be anything like developing leadership skills, or whatever that case might be research, clinical, so that's my work three, and then my and then I have a fourth, which is my personal so work, you know, my things outside of work. So that would be my kids and my family, my friends. And vacation would of course, move into that realm. But I spend a certain amount of time I divide up the time into those four categories. And I asked myself questions about it, I use, you know, I write it down, I actually type it out because I use that for the next month. And I might even put some goals down and just say here's are some goals. And and I actually take the reflective time is really good to identify like, what tangible can you actually do to achieve the goal because we can all say, Okay, I have a goal to, you know, write in Arlen. But you do need to go through the steps to actually develop the proposal, assemble your research team, write the grant, submit it, right, you need to have component parts, and they need to be objective. Usually, if you have those, you're much more likely to accomplish the goal if you know exactly what the steps are, and what better time than your reflective time. So I do that once a month. And I always look I start that I start the morning, I like the morning because I'm like more clear then. And I started by reviewing last month, and then I and then I get kind of get going. And I and I do that twice a year, I do an entire day. And one day is sort of around June. And then the other day is that the very beginning of the year. Why? Because I do it on my birthday. I like to put it on my birthday because it's the day for me. In on that day, I do everything I enjoy doing. I and so it's sort of like a vacation. But it's a vacation just for myself. And so I take off work, always I go to lunch at my favorite restaurant by myself. I go through just what I didn't like, like sort of like it's like it My kids always say joys and concerns I think about like successes, I think about things where I do want to get better. And, and I kind of do sort of a deep dive on where I want to be in six months. And I just do that for an entire day. And those are again, non negotiable. It's like me going to a conference or I'm you know, I'm out of town. Like it's just non negotiable. And you do have to have discipline to make sure that happens. Because you know, it's tough, but I always say like most of us really are good at committing to others, but we're not good at committing to ourselves in the same way like we would not treat others the way we treat ourselves. And I'm definitely guilty of that. I break a lot of promises to myself if I'm gonna like give myself a time. So, you know, it's important to have that discipline. But having that reflective time is really important. It's sort of like again, these like micro vacations and to rest and recharge and know where you're going in your professional life and your personal life. Yeah.
Phillip Pierorazio:Well, I know we're coming up on an hour and I'm sure you have something scheduled whether it's with yourself or with someone else, but it's always great talking with you, Angie, I think, you know, I just wanna make a couple of comments before we wrap up. You know, I don't know, if you practice, if you are a, if you practice meditation at all, but you are an incred, you have an incredibly mindful approach to your life and to your processes. So I give you a lot of credit for that. And I think it's a shining example of how you could potentially be mindful without having to do meditation, all these other things that we see in kind of pop culture with with mindfulness. We've definitely identified some topics for your next podcast, whether we want to talk about journaling, or exercise. The self reflection piece has been really enlightening. For me, I think it's something we could potentially talk about. But just to kind of highlight some of the themes. From the vacation talk today. I talked about micro versus macro breaks, and how it's so important to reflect and recharge during those time periods. You made the important point that one of the most important things is action, you actually have to schedule your vacations and go, your nothing's going to happen if you just think about it. Although there is some data that says the act of physically planning a vacation, looking through the hotels, booking the flights, actually can bring you almost as much emotional relief as going on vacation. So there is something to be said about the action planning, too. We talked a lot about setting expectations for yourself, for your practice for your patients, whether that's on your weekends or on your vacations. I really loved your concept of entering vacation with a clear mind, and reentering work with a clear mind and finding the ways to do that. I think. However, we find the specifics for ourselves. I think that is a concept that is universal. And all of us should strive for that. So leave it if Is there anything else you want to talk about any questions you have before we sign off?
Angela Smith, MD:No, Phil, I think that was a great summary of a lot of really great conversation we had today. I always enjoy speaking with you. I would love to talk more about journaling too. It's probably deserves its own entire topic. I do it every single day without exception. And yes, I don't meditate regularly although i i have. I have meditated before, but I think you can be mindful in many different ways I agree with that could be its own topic. But again, always very good to talk to you. And I really applaud you for bringing this topic to the podcast because it's so important, and we don't get to talk about it as much as we should.
Phillip Pierorazio:Thank you Angie, I want to thank you for spending time sharing your experiences with everyone. I want to thank everybody for listening and look forward to talking to you again soon.