There was a recent article in the New York Times written by a woman to explain why she wasn’t returning an email.  I would have replied to your email after a few hundred more words, I am certain, except that my 11-year-old daughter came in, clutching some pieces of paper… was the style of the article.  She wrote well, and most of the comments were favorable, that these issues with which she was spending time were indeed important.

A few commented that she was fortunate to be able to work at home, have good, healthy children, but that ignoring work-related emails for many is a good way to get fired. I decided to comment, although I am at a disadvantage in that I need more time to process information than most, in order to optimize what I say.  When I used Facebook, most of my comments were “Edited,” meaning I had posted and later changed something.  Many would do well to edit what they write, since first impressions and first words usually are not what most of us truly want to convey.  But if I wait 24 hours, the comments section is closed, and if I want people to read my thoughts I need to write quickly, not after hundreds of others.  I wrote that many of my good faith emails were never replied to even though it took all of 24 seconds to write, “We regret that we have no use for your services.”

My comment got a reply that interruptions slow down a person’s ability to re-focus on what they had been doing for up to a half hour.  I agreed, but added that there is a difference between “Not Now” and “Not Ever.”

That’s really what I wanted to say to the author in the first place.  It’s acceptable not to reply to an email now.  Very few things in life are urgent, and emails can usually wait.  But Not Ever?  You mean to say you are so busy that you can’t find any time in your day or week to reply to a good faith email from someone?

I continued that interruptions in my medical practice, which were seldom truly urgent (life threatening that if I didn’t act someone would significantly deteriorate), did affect my ability to concentrate afterwards on the my care of the patient before being interrupted.  More than once, after two or three interruptions seeing the same patient, I had to explicitly ask my secretary to stop all interruptions so I could get some work done.  I didn’t know back then how badly interruptions interfered with my work, because much research hadn’t been done, except in aviation, where there is the “Sterile Cockpit Rule” below 10,000 feet, where all cockpit conversation relates to only flying the aircraft.  Nevertheless, my colleagues were quick to tell me medicine and flying airplanes were different in regards to errors.  I retorted that they were both quite similar.

[Ten years later, CVR, “Cockpit Voice Recorder,” was a big hit at medical meetings, where two people sat on a stage and read what transpired in an aviation disaster, so perhaps my thoughts earlier were on track.]

I continued, writing that hurry and fatigue were two other reasons I left medicine, both of which again were confirmed by research in part using aviation experience (The Canary Islands disaster in 1977, and the 1999 crash in Little Rock in part respectively.)

I come from a bygone era. When I practiced, we had to return phone calls from patients.  THAT was time consuming.  We had to call, wait for the individual to answer or to be summoned, often repeat ourselves, answer things we had answered in the office, try to explain something to someone without seeing their expression, and not have any sort of written summary of what we said.  I returned calls as soon as I could during the day; many others waited until the evening or didn’t return them at all. I returned my calls if I had a few minutes to do so.  They weren’t interruptions.  Most of us have a lot of time available during the day; back then, we couldn’t use social media as a time dump, but we all have a few minutes here and there that we squander on things that may not be earth shattering.  Want to have time to reply to emails?  Stay away from social media. 

Before there was email, I couldn’t make a phone call between seeing patients, unless I knew it would be very brief.  Today, many questions could be answered in that same time period. I would have loved emails back when I was practicing.  My calls could take several minutes; an email take a matter of seconds.  This is a matter of prioritizing time.  

I used to have a pile of pink slips from calls, answered by an actual human being, that I needed to make, low tech but useful, because human beings could write notes, using a pen, and convey that the patient sounded angry, sad, depressed, busy, strange.  From here, we went to voicemail, which was listened to by a human being, until people used it as a way to avoid work by ignoring them.  That’s going from Not Now to Not Ever.  I consider myself fortunate if my voicemail gets a reply.

From voicemail, we went to email, faster and easier, but I contend that my computer is strange in that it appears to send emails but doesn’t seem to receive them.  Two decades later, I still read complaints that emails are interruptions.  Like most technology, when email is used properly, it is a wonderful tool.  How can it be an interruption unless one lets it be one?  A ringing phone is an annoyance, and those in my generation learned to pick it up, because it was polite and it usually was from someone whom one knew, not Marriott or some other big chain trying to sell me something I didn’t want and my punching 2 to not get any more of these calls made no difference, nor did a national registry of Do Not Call remove these calls.

An email is quiet, unless one chooses to activate the sound letting one know there is an email, which again admittedly used to be important, not someone trying to sell military surplus or Viagra because I was foolish enough to click on a link to read some article seen on the Internet, and didn’t delete the cookie fast enough.  

We have spam filters, and while I’m not in at least the paid work force these days, it seems obvious one can have a work email address for work and a personal one.  Twenty years ago, when I was in graduate school, I had two email addresses, and that was a good screen.

Returning calls, returning emails, communicating with people who ask good faith questions either as friends, clients, or family, is a matter of prioritizing one’s time.  It’s as simple as that.  It’s as complicated as that.  

What is clear is that email, Messenger, Whatsapp, Telegram, and Twitter have not brought us together, but rather pushed us apart, allowing formerly taboo religion and politics into the public sphere, allowing thoughts from those living in caves to see the light of day, and forgetting the best communication is what it always has been, watching body language, listening to tone of voice, repeating back instructions, and seeking first to understand before being understood.

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