E-Maternity Leave

To the Editor: E-maternity leave may be a useful option for some psychiatrist mothers. I covered my patients during my recent maternity leave primarily by means of e-mail and telephone. My small, relatively healthy caseload of patients under medication management were encouraged to contact me during my leave as needed. I gave all patients my home e-mail address and home telephone number. I offered traditional cross-coverage as an option, but no patients took it. I also made each patient aware of my limited availability and the necessity of going to the emergency room if they could not reach me and needed emergency attention. The therapists working with my patients were aware of this plan.

I received approximately one e-mail message a day and one telephone call a week from my patients and their therapists. There was no billing for these contacts. One patient was hospitalized during this time, and I arranged for this admission after extensive telephone contacts.

There were some pluses to e-maternity leave for my patients. First, there was less loss of continuity in treatment. The psychiatrist who knew them best continued to manage their medications during leave. Second, when I returned from leave, I was well informed of their progress. Third, there seemed to be fewer clinical worsenings during my absence than during my first, traditional maternity leave. The patients seemed touched that I would care enough to continue to be available. Fourth, I got to know a couple of patients better because these anxious patients seemed to communicate better by means of computer than in person.

Online maternity leave also worked well for me. First, patients seemed to respect my leave and contacted me only in an appropriate manner—and when they needed help. I did not receive one trivial e-mail message or telephone call throughout this time. Second, the medium of e-mail allowed the contacts I received to enter my home without a telephone ring, so my newborn’s sleep went uninterrupted. And unlike with the telephone, I was able to answer e-mails at times convenient to me and my baby. Third, it was nice not to impose cross-coverage on a colleague.

Certainly there were downsides to this approach. There were a couple of patients who did not remain in close contact. My oldest patient, who was perhaps the least familiar with the computer, did not contact me throughout this time. And, of course, there must have been aspects of my patients’ status that eluded me since a mental status examination is impossible online.

Generalizing my experience with e-maternity leave is of limited use. I carry few patients regularly, and these are relatively well functioning. I have no patients with psychosis or bipolar disorder, who perhaps would be most difficult to evaluate online. Nonetheless, I continue to be impressed by the possibilities the computer offers our patients and ourselves and believe we should cautiously explore new uses of this powerful medium.