One hundred forty-nine messages.

This is what I return to on my first day back from vacation.

Many of them were marked with a little red arrow, indicating a high-priority phone message.

Recharging with a little time off is a darn good thing, something we all need, and something which has been shown to help all of us be better at what we do. All of us, no matter what our jobs are. Getting away makes us more present when we are here.

However, coming back from a 10-day vacation and finding that you are 10 days behind on your work takes a little bit of the joy out of it, brings quickly back the tightness in the stomach, the hunching of the shoulders, the furrowing of the brow.

Now it’s not that most of this work hasn’t already been attended to. While I was away I had excellent coverage. The rest of my team held down the fort, checked my messages, triaged urgent matters, and forwarded on things that could be safely left for me to take care of on my return.

The nurse practitioner on our team told me that many patients were shocked, and some were downright angry, that I was away, unavailable. “But Dr. Pelzman never goes on vacation! Can you reach him?”

Understandably, a lot of things were left to wait till I returned. Much of the triage was “Nothing looks too bad on your labs; Dr. Pelzman will go over them with you when he returns on Monday.”

This is really how we want it to work; none of us wants to burden the rest of the team with all of our routine tasks. This system of coverage encompasses several of the components of the patient-centered medical home: access to care, continuity of care, quality of care, all wrapped up into one.

As I have said before, I don’t want to be on call 24 hours a day, 7 days a week. My wife won’t speak to me any more if I try that again. But care continues, even on vacaton.

Figuring out the right balance of access and continuity, and ensuring quality, are the keys to building an effective out-of-practice solution that lets us keep our sanity without just passing on the craziness to our colleagues.

The electronic health record and the patient portal provide tools that can help the team take over the care of our patients while we are away. Covering providers can review last notes, find out what we were thinking, access accurate medication lists and recent labs.

Refills are a snap with a few clicks of the mouse. Patients can message the practice with clinical queries and possibly avoid unnecessary visits, allowing the bare-bones coverage team to handle minor issues without overwhelming the schedules.

No system can be perfect — we have long known that both patient and provider satisfaction are lower with interim care, but making sure that it is the best it can be is better than no care at all.

Now it’s time to get to the 483 lab and radiology results in my in-basket.

Fred N. Pelzman is an associate professor of medicine, New York Presbyterian Hospital and associate director, Weill Cornell Internal Medicine Associates, New York City, NY. He blogs at Building the Patient-Centered Medical Home.