I Hate Email

I hate email! No, I love email. No, I hate email! Sound familiar? Love it or hate it, physicians today no longer have the option of ignoring email.

On an average day, I receive between 100 and 150 non-spam emails. How to deal with the onslaught? First, read the email tech manual. The book Send:

The Essential Guide to Email for Office and Home by David Shipley and Will Schwalbe is probably the best description of how to effectively use email and avoid its many pitfalls. I have given it to every member of my staff and every physician in SDCMS leadership — that’s how good it is.

Email is divided into two broad categories: reading and sending. Here’s my routine for an email reading session:

• First, I go through every email in my queue and read every subject line, ruthlessly deleting — without opening or reading the text — every email that looks like junk or appears irrelevant, based only on the sender, the subject line, or both.
• Then, I triage every incoming email into one of four categories: requests for action, information for me, requests for information from me, or scheduling. If it does not fit into one of those categories, it’s most likely junk, and I will delete it.
• Now I go back to the top and open each email (most recently received first) and ruthlessly apply the 4Ds: Do, Delegate, Delay, or, my favorite, Delete.
• If, when I open the email, it turns out to be junk, that’s easy: I delete it.
• If it’s information for me, I read it, assimilate it, then either delete it or move it to a folder (see below on folders). I’m ruthless — I don’t leave it in my inbox.
• If it’s a request for action (sometimes embedded in information emails), I then do it, delegate it, or delay it. Once I do it, I delete it from my inbox. If I delegate it, then I move it to a folder for the individual for whom I’ve delegated it. If I delay it, then I either assign it as a task or as an event, at which point I move it to a folder labeled “Pending.”
• If it’s a request for information, see item above.
• If it’s scheduling, then I respond and move it directly to my calendar — I do not leave it in my inbox.

I have a simple metric for my inbox: If it’s empty, that’s fabulous. If it has between three and five extremely high priority current items, that’s OK. If it has more than 10 items, then I need to go back to the triage cycle.

I’m a big fan of this simple rule: Touch every email exactly once. Hard to do in practice — and there will be exceptions — but, in general, if you follow the rule, you’ll stop wasting time.

Develop a useful hierarchy of folders, including in each several broad categories: actions you’ve delegated to others, actions you’ve delegated to yourself (pending items), event-driven folders (e.g., CMA’s next House of Delegates), and broad categories of information.

Here are some suggestions for sending emails:

• Prior to sending an email, ask yourself before anything else, “Is this email really necessary?” Then ask the same question again.
• Keep it simple.
• Keep emails totally — and I mean absolutely totally — free of negative emotions. If you’re using adjectives or adverbs that are pejorative, that’s a great indicator that you should not be sending the email.
• Check your tone: Is this what you would say and how you would say it if you were face-to-face with the recipient?
• Check your recipient list: Got everyone? Got too many?
• With one exception, never blind carbon copy (BCC). It’s a recipe for disaster.
• The exception to not BCC’ing is if you want to ensure privacy for the email addresses for a large group of recipients.
• If there’s action requested, say so in the subject line, e.g., “Action Requested.”
• Make sure the subject line is clear and compelling.
• Use dates, not “tomorrow” or “today” or “yesterday.”
• Spell check.
• Syntax check.
• Read the email from beginning to end at least twice before sending.
• Make sure the attachments, if there are any, are attached.
• Before you hit the Send key, ask yourself what would happen if this email were published verbatim in The San Diego Union-Tribune. If there is any doubt in your mind, then listen to the voice in the back of your head and reconsider the email.

A short note on PDAs and the habit we’ve gotten into of sending emails from PDAs. Many busy professionals now have a PDA that allows them to download their emails continuously while they are away from their desks. I use my PDA to keep me informed and to ruthlessly delete anything that is junk so that when I get back to my computer, I am able to rapidly take action as above.

Feel free to contact me at any time at Gehring@SDCMS.org or on my cell at (619) 206-8282.