email at night

When email becomes the monster on your back

Laura Rose Lambert business systems, email, practice management 0 Comments

I have always struggled with email. When I get overwhelmed or just plain busy, it is the first essential routine that gets dropped. To my shame many, many e-mails addressed personally to me have gone ignored because I. simply. cannot. deal.

This is why I’m changing my approach to email. Because if the system you have isn’t working (aka you’re not actually processing email) then you need to come up with something different.

During my research into new strategies, I came across the concept of inbox zero. In many circles, inbox zero is simply processing all your email everyday down to 0 in your inbox. Not necessarily responding to every e-mail but processing and prioritizing responses to messages.

Unfortunately, this does not slay the email monster.

Inbox zero methods felt like trying to control some creature I work with everyday. I thought of email as something that controlled me. An obligation I had very little say in. I could see the benefits of using email, but honestly I felt resentment every time I fell behind in maintaining my inbox.

E-mail is a huge problem even for us techie types. Why?

We get a TON of e-mail everyday AND we spend too much time on it.

Many practitioners have a least two e-mail addresses; one for their business and one for personal use. In a survey from the McKinsey Global Institute we spend 28% of the average work week checking, reading and writing emails. A few years later, in a U.S. survey from Reuters participants estimated they spent 3.2 hours a day on work e-mail and 3.1 hours a day on personal email.

By having notifications on our devices and chronically checking email we’re losing time and increasing our stress. A study by the Dagwood Group found that it takes an average of 64 seconds to recover from an email interruption and return to the previous task.

Misaligned expectations

Some expect an email response within 24-48 hours while others completely understand upwards of two weeks in turn around. Of course it depends on the circumstances, but no one is explicitly talking about expectations. We’re all just making up our own rules and assuming everyone is operating the same way.

Many, if not most, put great pressure on themselves to respond within 24 to 48 hours regardless of the expectations of the sender. We build up so much anxiety as we slowly fall behind on e-mail. But the reality is, we don’t actively talk about email expectations or have a strong idea of what is cultural expected. This is why we need to take the time to reflect on what is realistic for ourselves.

The reframe

Anytime I start to feel powerless about an obligation, especially with technology, it is time for me to rethink my relationship with it. The reality is none of us talk about expectations around email. Do not let some cultural obligation or the expectations of the sender dictate your work flow with email. Set your own boundaries.

Clear your mind of what you think others want or need. Focus on what is realistic for your circumstances. Then be vocal and clear about what you can and cannot do for patients, clients and colleagues through email. When you do this you feel respected and in return are capable of consistently keeping up with your relationships through email.

Email is a powerful business tool. The top two ways patients initially contact me is through email and a phone call. This is the direction we are going. Opening up your inbox to potential and existing patients is a good idea. But like most technology integrations, you must form an intentional relationship with your email. Thoughtfully designing a system for how you process and respond to email is key to having a consistent, reliable relationship with potential patients, current patients and colleagues.



I’ve outlined below what I did to change my relationship with email. This is built to my specific circumstances but from it you’ll get an idea of what you could change in your own system.

Laura’s new approach to email

1) Consolidate all your email accounts into one place.

I’m a Mac user and used the native Mail app. Through this app I managed five email addresses. But I decided to move everything over to Gmail.

Why Gmail?

I already paid monthly for the Google business service, G Suite. Through G Suite I have a Business Associate agreement, which makes many aspects of my Google use HIPAA compliant (of course my behavior must be HIPAA compliant as well). I also felt Google has a better algorithm for filtering spam out of my inbox and I simply prefer the design and functionality of Gmail’s interface.

There are also several add-ons to Gmail that I used regularly. As a result I was using my web browser over Mac mail or my phone.

  • Virtru – Provides an extra layer of encryption on an e-mail if required or requested by a patient.
  • Boomerang for Gmail – I primarily use this service to schedule my emails. My clinic days are over the weekend. Often I need to email my landlord or a colleague but don’t want it to land in their inbox until the new week. I schedule the email to arrive Monday morning at 9am. I also use the read receipt feature. If someone doesn’t open an email I sent by a date I set, Boomerang will email me to let me know I need to follow up.
  • Inbox When Ready – I only look at my inbox twice a day. Inbox When Ready hides the inbox during certain hours or you can simply click a button on or off to see your inbox. I work out of my Action folders, not my inbox.
  • Wisestamp – A service that makes a dynamic signature with images and social media links.

2) Turn off notifications and badges on all mobile devices.

I made this decision based on the many psychological studies out there on the general anxiety notifications cause. My goal is to only look at my email twice a day. With notifications on, I’d look at my email immediately but often do nothing with it. It was just a distraction from focusing on other tasks and spending time with my family.

3) Clear out the newsletters, coupons and other email you never look at.

I love to sign up for educational newsletters. My intentions are innocent enough, but the reality is 90% of these emails I will never read. So I went through and unsubscribed from everything I hadn’t read and ignored the internal voice that said, “THIS time I would totally make the time to read them.” Because I won’t and it really clutters my inbox.

4) Start a bank of common email responses.

There are many emails I write that I’ve written before. Often I get general messages through my websites that ask the same question over and over again. A lot of the time answers turn into blog posts. But I still like to respond and point these people to relevant resources and posts on my site and elsewhere.

Going through your sent folder will help you realize if you’re responding to the same questions frequently. There’s a lab in Gmail called ‘Canned Responses’ that allows you to store text and drop it into an email. Often I write a personalized beginning and ending to an email but the middle is drawn from a pre-made template. Saves me a ton of time.

5) Outline daily and weekly goals for your email.

Inbox zero kinda stressed me out. Everyday I failed to reach inbox zero felt like a let down. Focusing on the number was not a motivating factor for me.

I’m what Gretchen Rubin in her book Better Than Before calls an obliger. When it comes to forming habits I have a heck of a time doing something for myself. Most of my successful habits involve obligations to others. Ugh annoying when it comes to change. My goals for email needed to revolve around others with the happy coincidence that it helped me as well. But in order to avoid the burnout many obligers experience, I had to put strong limitations around the time I spent on email.

Daily Goals

  1. Check and process inbox twice a day for a maximum of 20 minutes.
  2. Put task oriented emails into Trello (my productivity app) and/or calendar.
  3. Spend 10 to 40 minutes responding to email in the @Action (respond within 7 business days) & @Immediate Action (respond in 24-48 hours) folders.

Weekly Goals

  1. Responded to all the email personally addressed to me in the last 7 business days.
  2. Let those I didn’t get to know I’m thinking about them. Would they like to arrange a phone call?

6) Create a process for going through your inbox.

I actually keep a sheet in my computer case that I pull out every time I process my inbox. I ask myself these questions every time I look at an email.

  • Can I delete it?
  • Can I do it in 2 minutes or less?
  • Can I delegate it?
  • Do I defer it?

These are the 4 D’s of productivity. A concept talked about by many business leaders and often applied to email.

The flow sheet I use, which goes into much more detail, is at the end of this post.

7) Don’t work out of your inbox.

Working in your inbox can be very distracting. Every a time a new email arrives I feel I have to deal with it. Instead of getting distracted, I work out of two ‘action’ folders that I move emails that need a response.

8) Talk with your patients

During the process of signing forms and going over policies I say something like this:


“I cannot guarantee the security or privacy of email. However I know there are many times that email will make sense for us to talk through. If you need an immediate response (24 to 48 hours) please give me a call or text me. If you send me an email, it can take up to 7 business days for me to respond. My timing is usually much faster, especially if we are actively making arrangements at that time.

If I know it will take me awhile to write a lengthy and complete response, then I will email you and let you know my timeline for getting back to you. When I send you an email I do not expect an immediate response, but will place a follow up call 2 business days after the email was sent.

If you’d prefer one type of communication over another please let me know and I’ll make a note of it.”

9) Add your policy to your email signature & create responders about your email policy.

Here’s my current email signature:

I also created canned responses to let people know it may take some time for me to get back to them. The main difference between my pre-written responses are that some include my phone number while others do not.

I know my new system will change over time. Systems don’t last when they are rigid. They need flexibility to stretch when things get tough and return to proper shape when the rough patch is past.

Do you need to change the way you handle email?

Do you feel like your email is a distraction?

Do you feel anxious about responding to email on time?

Are you constantly falling behind?

Do you spend too much time on email?

Are you missing emails from potential patients?

Anxiety, stress and irritation around using technology and maintaining online communication is related to feeling like our needs are not heard or respected. If you answered yes to any of the questions above, it is time to draw a line and really think about the place email has in your professional and personal life.

Creating boundaries around email and messaging will help you relax and then responsiveness becomes easy. Relationships build practices. Email is another way to nurture relationships with your colleagues and patients.

Click Here to download Laura's flow sheet for processing email

How do you feel about your email? What does your inbox look like? Comment below.

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