Just something I was curious about (med student). Radonc seems to have relatively few emergencies, how does call work? How frequently does an emergency actually arise that requires you to answer your pager? To go into the hospital?
How does call for residents work in radonc?
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It depends a bit on your residency program but I can comment on my experience.
1. Residents were on-call for one week at a time
2. On-call responsibilities occurred outside of business hours on weekdays, weekends and holidays
3. If patients on treatment have urgent questions/concerns then their calls come to you
4. If a hospital service needs an urgent radiation consult the call comes to you:
a. You must first determine if the need indeed is urgent
b. If so, you see the patient in the hospital and report your findings to the attending on call
c. If attending wants to treat the you must arrange it
5. If patients need to be treated on weekends/holidays/after hours then you must be physically present
Call weeks can range from no work to absolute hell depending on luck. Usually more senior residents are more efficient on call and only come in if clinically indicated. Junior residents may work harder mainly due to their inexperience.
1. Residents were on-call for one week at a time
2. On-call responsibilities occurred outside of business hours on weekdays, weekends and holidays
3. If patients on treatment have urgent questions/concerns then their calls come to you
4. If a hospital service needs an urgent radiation consult the call comes to you:
a. You must first determine if the need indeed is urgent
b. If so, you see the patient in the hospital and report your findings to the attending on call
c. If attending wants to treat the you must arrange it
5. If patients need to be treated on weekends/holidays/after hours then you must be physically present
Call weeks can range from no work to absolute hell depending on luck. Usually more senior residents are more efficient on call and only come in if clinically indicated. Junior residents may work harder mainly due to their inexperience.
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I would echo GFunk's comments above and add just a couple things:
1. At our program (like most programs, I presume), the call schedule is hierarchical in that the junior residents take more call. For example, we have 12 weeks of call as a first year, 8 weeks of call as a second year, 6 weeks of call as a third year and no call as chief resident.
2. Generally speaking, it is preferable to be on call with a more senior attending b/c on the borderline cases of "Do we need to go in to see this consult now?", they are more likely to say, "Nah...we'll see them in the morning."
Conversely, the more junior attendings are understandably more vigilant and more apt to have you go in after hours to see the non-emergent consult.
1. At our program (like most programs, I presume), the call schedule is hierarchical in that the junior residents take more call. For example, we have 12 weeks of call as a first year, 8 weeks of call as a second year, 6 weeks of call as a third year and no call as chief resident.
2. Generally speaking, it is preferable to be on call with a more senior attending b/c on the borderline cases of "Do we need to go in to see this consult now?", they are more likely to say, "Nah...we'll see them in the morning."
Conversely, the more junior attendings are understandably more vigilant and more apt to have you go in after hours to see the non-emergent consult.- Joined
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Some programs split it evenly, but senior residents having dibs on scheduling first. (AKA incoming residents almost always got stuck covering xmas/thanksgiving or new years their first year)
2. Generally speaking, it is preferable to be on call with a more senior attending b/c on the borderline cases of "Do we need to go in to see this consult now?", they are more likely to say, "Nah...we'll see them in the morning."
haha probably true
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For those not in the know and want this deciphered:
Steroids -- often a good temporizing measure for reducing cerebral and spinal cord edema in patients with brain/spine mets causing neurologic Sx, which brings us to the next word
Neurosurgeons -- the data suggests that a single-lesion cord compression causing neurologic Sx should be operated on first, rather than just radiated, as the overall survival and ambulation outcomes are much better
Chemo --- a small-cell lung CA presenting with SVC syndrome will melt away with chemo
Cava stents -- good temporizing measure for SVC from non-small cell lung CA that may not respond as quickly to chemo.
Other call emergencies can often revolve around bleeding from malignancy (cevix CA presenting with heaving vaginal bleeding, H&N/Lung CA present with hemoptysis or bloody secretions etc.). Often we try to get these patients expediently treated after a proper staging workup and multi-disciplinary evaluation. I recently had to start a patient before they got chemo for a large tonsil/BOT CA causing bleeding to the point that their had a 2 point drop in their Hgb requiring a transfusion. Within a week, the bleeding was resolving.
Steroids, chemo, cava stents and the always-present neurosurgeons are all our friends.
Steroids -- often a good temporizing measure for reducing cerebral and spinal cord edema in patients with brain/spine mets causing neurologic Sx, which brings us to the next word
Neurosurgeons -- the data suggests that a single-lesion cord compression causing neurologic Sx should be operated on first, rather than just radiated, as the overall survival and ambulation outcomes are much better
Chemo --- a small-cell lung CA presenting with SVC syndrome will melt away with chemo
Cava stents -- good temporizing measure for SVC from non-small cell lung CA that may not respond as quickly to chemo.
Other call emergencies can often revolve around bleeding from malignancy (cevix CA presenting with heaving vaginal bleeding, H&N/Lung CA present with hemoptysis or bloody secretions etc.). Often we try to get these patients expediently treated after a proper staging workup and multi-disciplinary evaluation. I recently had to start a patient before they got chemo for a large tonsil/BOT CA causing bleeding to the point that their had a 2 point drop in their Hgb requiring a transfusion. Within a week, the bleeding was resolving.
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In my personal opinion, there is very little in the world of radiation oncology, that needs to be treated in the weekend.
Steroids, chemo, cava stents and the always-present neurosurgeons are all our friends.
Because as we all know, cancer doesn't grow outside of business hours, on weekends, or on holidays.
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