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Dear Patient: An Open Letter on Why I've Been Working Part-time During the Pandemic

Jennifer L. Lycette, MD

Disclosures

November 16, 2021

Dear Patient,

I heard you were asking my staff about what I do all day when I'm not in the clinic and why I work part-time. This is an important question and one I'd like to answer.

When I'm not in the clinic, I see my vaccinated teens off to school each weekday morning. Then, my unvaccinated 11-year-old and I sit side by side with our laptop computers. He logs in to do his remote schoolwork, and I log in to our electronic health record (EHR).

In the EHR, I respond to questions the same as if I were in my office. I reply to patient emails, including yours. I review lab and imaging results and contact my patients to explain the results. I feel even more pressure to do this at least four times per day since the 21st Century Cures Act went into effect in April 2021, since all medical results are now released immediately to the patient portal. I never want my patients to see a test result in their chart and not know what it means or suffer any distress from an unexpected adverse result.

I also, throughout the day, answer clinical questions from the nursing team and from colleagues. I respond to "e-consults," which are requests from colleagues in primary care and other specialties. I review the charts on their patients for questions related to hematology and oncology and determine if they need to be seen by me for a formal consultation or, if not, offer my expertise on suggesting appropriate tests.

I review chemotherapy orders for accuracy and safety. I enter chemotherapy orders, which, for new patients or a customized change in plan on a current patient, can take up to 20 minutes per plan. I'm not given this time during the patient visit (or typically any other time during a clinic day). These orders can include modifying doses, schedules, or supportive medications, such as a custom anti-nausea plan. The EHR is a very safe system but is not exactly flexible, so any changes to the default plan require meticulous adjustments by the oncologist. I then double- and triple-check my work and send it to the oncology pharmacist for another review and safety check.

In between my remote clinic work, I answer questions from my 11-year-old on his schoolwork. Sometimes his assignments might include a hands-on science project or require me to take a break from my work to help him in other ways, such as assisting him with reading through something he doesn't understand or helping to motivate him when he loses steam. (Basically, I'm his home teacher. My undergraduate degree in chemistry has come in handy).

I also have to remind him to keep quiet when my spouse, who works remotely and has set up his home office space in our basement, has his work Zoom meetings.

(I'm not going to include all the other household duties here, but suffice it to say they are the same as for any other parent).

This has been my life, and the life of many women physicians, since the pandemic. I hope you will grant me the grace of acceptance and flexibility. I may not be physically in the office every day, but I am still working just as hard for you, if not harder. (Ironically, I'm getting paid less — because my in-office hours are the only hours I'm paid for). But regardless, I am still just as accessible to you, always only a MyChart message away.

Sincerely,

Your dedicated oncologist

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About Dr Jennifer Lycette
Jennifer L. Lycette, MD, is a rural community hematologist-oncologist, mom of three, and recovering perfectionist who's writing her way back from physician burnout, one word at a time. Her essays have been published in The Intima, The New England Journal of Medicine, JAMA, JAMA Oncology, Journal of Clinical Oncology, The ASCO Post, and more. Connect with her on Twitter @JL_Lycette or her website.

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