Can I script myself something to stay awake during call?

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platon20

platon20

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OK heres the deal. I cant stand call. Half of my program is night float, and the other half is Q4 call and I cant handle it, I'm absolutely exhausted trying to cover 70 patients in the hospital while also admitting 7-10 on my own.

I need SOMETHING. Maybe methylphenidate. Whats a good drug I can script to a buddy so he can give it to me. No schedule II please, I dont have my own DEA number.
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Uh, well, methylphenidate is Schedule II.

This is a terrible idea. It's not a good idea to write prescriptions for other residents/have them write for you anyway, and something to alter your brain chemistry is worse. If you can't stay awake/alert for call, you should see a licensed physician to help determine if there's some serious reason (depression, sleep disorder, etc). Don't just write yourself an amphetamine.
 
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Agree with above - this is a terrible idea. It's a great way to get your licence yanked (or insure that you never get one).
 
Yikes. Crosscovering 70 (especially if they are old internal medicine patients) while admitting 7-10 patients is really sucky.
Sorry.
One thing I can tell you is that if you are an intern, this will get better. If you give this even 3-6 months, this will get better. You'll get faster and faster at doing the admissions, plus you'll figure out how to do everything faster. There's really no way to speed it up, though...it's part of the learning curve.
It's such a bad idea to write for an "upper". DON'T do it. You could get in SO much trouble. It is NOT worth it.

Some things I found helpful while on call were to always have some water and snacks (i.e granola bars, etc.) somewhere close I can get to them (i.e. resident work room or call room). Also have a separate bag packed for when you are on call, with all your stuff (i.e. toothbrush, extra socks, pens and blank notebooks, all your "help me" books that won't fit into your pockets, etc.). It helps if it's a separate bag that you keep so you don't have to remember to pack stuff every time you are on call.

If you are an intern, just remember that internship, like other forms of hell, will end eventually. You just need to survive with no major scars.

Also, you need to make sure you eat and sleep well on days you aren't on call. It won't make you untired, but it helps a little.

If you need a stimulant, I vote for just lots of caffeine...and drink plenty of water.
 
BAD idea.

VERY BAD idea. And any friend that would do this for you is an idiot.

Call is hard but thousands have made it through before you and so will you.

An amazing thing happens during internship - you get more efficient and call therefore gets better. There will always be sucky nights, but you will be able to get more done in less time and perhaps occasionally get some rest.

dragonfly's suggestions are good...I also found constantly moving (ie, not sitting down) and a clean pair of socks helpful. Caffeine, food (but not too much), and exercise will keep you alert-ish.
 
edmadison said:
Not to mention what the OP is proposing is a felony.

Ed
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Agreed. And a violation of the profession's ethical rules. This kind of action is probably the surest way to get one's license revoked, if caught, (if not jailed) so no way it's ever going to be worth it. On the risk - reward continuum, this is very far on the risk side. Foolish. Drink Red Bull or coffee like everyone else.
 
All right, so we've agreed he should NOT try to Rx some uppers for himself. BAD idea.
But just to play devil's advocate for a while - what about shift workers who take Provigil for "shift work sleep disorder"? That is a legal substance. What if this resident when to his primary care doc and asked for a Provigil Rx? There's no doubt that it sucks to work 30 or more hours without any sleep. I wonder if the use of such substances might become prevalent among house staff? I personally would be afraid to take something like that, and I don't think it was on the market yet when I was an intern, but almost anything seems better than that horrible feeling you get after being up 24 hours and the nurses are calling you @5:45 a.m. about renewing the restraint order that expired at midnight for some crosscover patient, or signing some piece of paper that patient's attending forgot to sign yesterday on rounds...
 
LMAO I love the suggestion that because I get sleepy after being up for 20 hours straight, that I have some kind of "sleeping disorder" :laugh: Uh guys I think we need to review normal physiology here, I'm pretty sure that its NORMAL to be sleepy after being up for 20 hours straight, especially after admitting a bunch of people and getting stressed out over BS crosscover pages all night.

OK so I wont go the script route, although I think you guys are overstating the danger here. BTW I know its unethical, but are you sure its really a felony? I've heard of doctors scripting themselves stuff before and they never went to jail or anything unless it was narcs.
 
If you are an intern, you may not legally write a prescription for yourself or a fellow intern, or anyone you are not caring for under the supervision of an attending at your institution.

Taking a controlled substance prescribed for someone else is a felony. Illegally obtaining a prescription of a controlled substance for yourself or someone else (e.g. self-prescribing as an intern) is a felony. Purchasing a controlled substance pursuant to an invalid prescription is a felony. Don't put your license in jeopardy like that.

Not to be preachy or anything, but I really find your lack of moral compass disturbing, and I just had to say it. Flame away if you like.
 
platon20 said:
LMAO I love the suggestion that because I get sleepy after being up for 20 hours straight, that I have some kind of "sleeping disorder" :laugh: Uh guys I think we need to review normal physiology here, I'm pretty sure that its NORMAL to be sleepy after being up for 20 hours straight, especially after admitting a bunch of people and getting stressed out over BS crosscover pages all night.

OK so I wont go the script route, although I think you guys are overstating the danger here. BTW I know its unethical, but are you sure its really a felony? I've heard of doctors scripting themselves stuff before and they never went to jail or anything unless it was narcs.
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But you didn't say that you "get sleepy." You said you "can't handle call." We've all handled call, and yeah it sucks and yeah we're tired - but we haven't begged for advice on how to obtain stimulants. I stand by my suggestion - if you truly find it difficult to even keep your eyes open while working, to the point that you feel you need medication to survive the periodic sleep deprivation that is a part of residency, you should consider seeking the advice of your physician.
 
platon20 said:
OK heres the deal. I cant stand call. Half of my program is night float, and the other half is Q4 call and I cant handle it, I'm absolutely exhausted trying to cover 70 patients in the hospital while also admitting 7-10 on my own.

I need SOMETHING. Maybe methylphenidate. Whats a good drug I can script to a buddy so he can give it to me. No schedule II please, I dont have my own DEA number.
Click to expand...

Hold on......

(pulling out Intern Exaggeration Translating Calculator 2000)

Beep-boop-boop, beep-boop-boop.......

Translation:

--> Call q5

--> Cross-covering 45-50 patients

--> 4-8 admits per night.


ps If you're still wanting to know which script I recommend getting from your co-intern, it's Depo-Provera.
 
Sorry for my blunt opinion, but you are so not fit for this profession!!!!
 
sandraf said:
Sorry for my blunt opinion, but you are so not fit for this profession!!!!
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The ***** who made metylphenidate class II is not fit to classify drugs.

If you're a doctor you should be allowed to prescribe any drugs you wish to anyone you wish. Anything else is just moral panic.
 
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MSHell:
:D Good one!

Tired:
I've been a "Non-student" for the last 16 years, I'm glad to say. Although I did study like craaaazy to pass the USMLE steps and will keep doing it for the rest of my life, because I do like it, a lot.

plainfacts:
This has nothing to do with moral panic. A doctor "should be allowed to prescribe any drugs he wishes to anyone he wishes" but be responsible and weight the risks and benefits of it. A doctor who's not physically/mentally fit to work long hours and has not enough common sense to decide what's good for his own health is probably in the wrong profession. Again, no offense intended. Maybe it was only a silly idea platon20 had, and he would not end up taking the drug(s).
 
platon20:
I just read your other ranting about the type of work you've been putting up with, and now I understand better why you thought about taking the medicine. It's still a bad idea, though. I hope everything will be better in time.
:)
 
sandraf said:
I've been a "Non-student" for the last 16 years, I'm glad to say. Although I did study like craaaazy to pass the USMLE steps and will keep doing it for the rest of my life, because I do like it, a lot.
Click to expand...

You're going to keep studying for the Step the rest of your life?
 
start a caffeine drip
 
Tic: :D
I meant "I'll keep studying for the rest of my life", silly...
 
Samoa you are 100% wrong:
"If you are an intern, you may not legally write a prescription for yourself or a fellow intern, or anyone you are not caring for under the supervision of an attending at your institution."
 
Uh, no. Interns have only a training license (limited license, whatever your state calls it), which does not allow them to treat anyone other than the patients they treat as part of their training program. No matter how uninvolved the attending may be in moment to moment decision making, they are still the responsible party.

If another intern sees you in the course of a clinic visit with an attending at that program, they can write you a script. Otherwise no. And you can't write for yourself, unless you are the patient of an attending at that program, and the attending is Ok with you doing so.

Anything else is practicing medicine without a license. Which is a felony in most states.
 
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He wasn't wrong about it being a felony to fraudulently obtain and use an Rx for a controlled substance, which is what it would be if you wrote an Rx for your buddy and then used the substance yourself.

If someone has a full medical license, he/she can prescribe whatever he/she wants, but writing controlled substances for yourself will generally cause a pharmacist to take notice and they probably wouldn't fill the Rx. As discussed above, it's not kosher to write an Rx for someone else and then use it yourself...particularly if it is a controlled substance. Don't do it!!!

sandraf,
When was the last time you took call for 30 hours without sleeping? And crosscovered 50 patient that weren't yours? If you've done that recently then I could take seriously your assessment that this intern, "Isn't fit to practice medicine" ...perhaps. Otherwise I do not.
 
dragonfly99: it's been a long time, but I did it, and so did thousands of doctors. You know, every generation thinks things are getting easier for the younger ones, and that's not necessarily true. At least now there is the 80 hours rule, in "my time" and in my country, there wasn't.
I don't need you to take me seriously. I think I went overboard saying that he isn't fit for Medicine and I felt bad after reading the description of his call in his other post. But yes, the possibility that somebody can't handle it because he can't handle it always exist. Hopefully not in this case.
 
dragonfly99 said:
What if this resident when to his primary care doc and asked for a Provigil Rx? There's no doubt that it sucks to work 30 or more hours without any sleep. quote]
:thumbup:

I have several patients with shift work sleep disorder who are doing well on provigil. I have several dozen patients with narcolepsy, osa, or idiopathic hypersomnia on provigil. Not quite as effective as the traditional stimulants, but much safer.
Click to expand...
 
plainfacts said:
The ***** who made metylphenidate class II is not fit to classify drugs.

If you're a doctor you should be allowed to prescribe any drugs you wish to anyone you wish. Anything else is just moral panic.
Click to expand...

Says the pre-med student....
 
I think what may be confusing people is that we're not making explicit the distinction between using Provigil obtained with a legitimate prescription from one's actual primary care doctor, for an accepted medical condition, and self-prescribing a stimulant to treat a normal and expected occurrence on overnight call, which is important to learn how to handle as a part of this career.

The former is indisputably legal, although perhaps not desirable. The latter is neither legal nor professionally accepted.
 
sandraf said:
dragonfly99: it's been a long time, but I did it, and so did thousands of doctors. You know, every generation thinks things are getting easier for the younger ones, and that's not necessarily true.
PHP: 
At least now there is the 80 hours rule, in "my time" and in my country, there wasn't.
I don't need you to take me seriously. I think I went overboard saying that he isn't fit for Medicine and I felt bad after reading the description of his call in his other post. But yes, the possibility that somebody can't handle it because he can't handle it always exist. Hopefully not in this case.
Click to expand...


"80 hours rule"........HAHAHAHAHAH....ROTFL...man, that's a good one!
 
I agree, the 80 hr rule is kind of a "ha ha" thing, esp. for internal medicine and surgery. I think it did curb the surgeons' work hours some, though (i.e. only 90 or 100 instead of 120!).
 
My on-call personal perscription is a large Rockstar, sugar-free, over ice sipped slowly through the night. The downside is if it ends up being quite I usually can't sleep much more after that.
 
NorCaltoSoCal said:
My on-call personal perscription is a large Rockstar, sugar-free, over ice sipped slowly through the night. The downside is if it ends up being quite I usually can't sleep much more after that.
Click to expand...

Hey, don't you know to never use the "Q" word when you're on-call?

:)
 
I made the mistake of downing a can of Bawls about an hour before an exam during my second year in medical school (relatively caffeine-naiive prior to that). It was bad - I was so wound up during the exam that I was sure I would have a seizure. It was work just to keep from filling in those stupid little circles outside the lines, lol!
 
crazylegs said:
I made the mistake of downing a can of Bawls about an hour before an exam during my second year in medical school (relatively caffeine-naiive prior to that). It was bad - I was so wound up during the exam that I was sure I would have a seizure. It was work just to keep from filling in those stupid little circles outside the lines, lol!
Click to expand...

Did you get blue Bawls before your exam?


LAWLZ!!!111
 
There's a lot of outrage in this thread...it's obvious the OP feels tired and overwhelmed, and is thinking "screw it, i'll try meds". I would be hesitant to judge anyone unfit for their profession based on that sentiment.

I say give it some time. You may adjust without medications or caffeine toxicity. If not you can take up your troubles with a physician. I'm sure there are many people who would benefit from a mild stimulant at times but it's a slippery slope.
 
coffee...caffeinated sodas...tea...and repeat.

I've just finished a hellish q4 calls rotation admitting and cross-covering the ICU in a community hospital where we have to rotate once a year (the rest of the year, we are rotating in our university campus with night float and ICU shift-work system...sweet!). My poor intern was cross-covering the whole hospital, who frequently/always calls me with questions/concerns.

When I was a stud studying for steps 1 and 2, I was sipping cans of red bull, coffee, colas, and chewing some apples/other snacks...I remember my HR was running in the 150's in the good old days.:laugh:
 
Although a well-rested, alert substance-free physician is the ideal state, I think that a physician dealing with sleep deprivation with provigil (prescribed by another physician, a non-resident) is a safer and more fit-to-practice physician than one coping by the use of excess doses of caffeine
 
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OK. Now this discusision is starting to interest me. So Dr Rack, do you think that we should start routinely prescribing Provigil to medicine and surgery interns who have to do 30 hour in house call where they are up all night admitting patients and crosscovering a whole bunch of patients? I am totally seriously asking this, because thinking back on things I'm not sure I wouldn't have been better off on some sort of mild stimulant. It seems that it's a slippery slope, though...I've heard in the bad old days that some hospitals kept bowls of "uppers" in the doctor's lounge for the residents to take when they were up all night on call. Clearly, this would now be considered unethical and criminal. But then I think - what really is the difference between Provigil and large caffeine boluses? I guess personally I'd be too afraid of addiction. Otherwise I might consider trying to get some Provigil from my PCP for my call nights next year (starting clinical years of my fellowship), should they turn out to approach the heinousness of my medicine intern year.
 
michaelrack said:
Although a well-rested, alert substance-free physician is the ideal state, I think that a physician dealing with sleep deprivation with provigil (prescribed by another physician, a non-resident) is a safer and more fit-to-practice physician than one coping by the use of excess doses of caffeine
Click to expand...

That's an interesting thought. It certainly seems acceptable for a resident's PCP to prescribe them a sleep aid if they need it during the day on a night float rotation. But that's for use at home, not while taking care of patients.

Obviously, in a surgeon, the tremor that caffeine overdose tends to cause is detrimental to the fine motor skills required in certain surgical tasks. And the feeling of alertness is unpleasant at best, since it really doesn't make you feel any less tired, it just creates so much akathisia that you're less likely to succumb to the tiredness. And reportedly, provigil actually reduces the tired feeling, without causing the tremor and jitteriness that caffeine does. (I have no idea if this is true, having no experience with it myself.)

So I would tend to agree. This is something that merits sane and rational discussion, and also some objective study, rather than knee-jerk moral outrage.

But until and unless an ethical and evidence-based consensus develops, I would hold off actually using it, or asking my doctor for a prescription.
 
Samoa said:
That's an interesting thought. It certainly seems acceptable for a resident's PCP to prescribe them a sleep aid if they need it during the day on a night float rotation. But that's for use at home, not while taking care of patients.

Obviously, in a surgeon, the tremor that caffeine overdose tends to cause is detrimental to the fine motor skills required in certain surgical tasks. And the feeling of alertness is unpleasant at best, since it really doesn't make you feel any less tired, it just creates so much akathisia that you're less likely to succumb to the tiredness. And reportedly, provigil actually reduces the tired feeling, without causing the tremor and jitteriness that caffeine does. (I have no idea if this is true, having no experience with it myself.)

So I would tend to agree. This is something that merits sane and rational discussion, and also some objective study, rather than knee-jerk moral outrage.

But until and unless an ethical and evidence-based consensus develops, I would hold off actually using it, or asking my doctor for a prescription.
Click to expand...

Modafinil (provigil) has an indication for shift-work disorder syndrome and is not really a sleep aid. If you review the package insert prescribing information the citation is to a 2006 NEJM article here: Czeisler CA, Walsh JK, Roth T, et al. Modafinil for excessive sleepiness associated with shift-work sleep disorder. N Engl J Med 2005;353:476-486 The free-text link is here.

The suggested administration for SWDS is one hour prior to the anticipated activity. Note that the overall benefits aren't that stunning but were sufficient for FDA approval.

In the overall context, a comprehensive sleep medicine evaluation may be better to assess for other factors such as unrecognized sleep-disordered breathing, hypersomnia/narcolepsy (without cataplexy) or more-commonly insufficient total sleep time preceeding work.

If possible, sleeping a full 8 hours prior to a shift may help you deal with staying up all night better. It's also cheaper and more effective.
 
You totally missed my point.

And I do know that modafinil is for keeping people awake, not helping them sleep. But thanks for the lesson in pharmacotherapy. :rolleyes:

Likewise it would probably be insulting to your intelligence and training to remind you that drugs are often used for indications other than what the FDA approved. And modafinil has been used to enhance alertness in technically complicated activities under conditions of sleep deprivation. Which is analogous to what we're discussing here.

Obviously the point of going to your regular doctor rather than a colleague is so that these other problems can be considered.
 
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bobblehead, good post, but I think you are missing our point....and hopefully most of us on here know what Modafinil is and what the prescribing indication is supposed to be.

The problem with working these 30 hour overnight shifts with no sleep is that even if one sleeps 7-8 hours the night before, it's still hard to be continuously on duty with no sleep for 30 hours, and with your pager going off very frequently and no adequate time to sleep, urinate and rest. If one is in the hospital 30 hours continuously, then one has been awake/up longer than that...the situation we're talking about is something like being at the hospital continuously, and awake continuously, from perhaps 5 or 6am one day all through the next day until 11am or 1pm or so. So I'd say giving Provigil in this situation would be considered off-label since you're not just giving them to survive "shiftwork" (i.e. being awake at night while sleeping during the day) ...you're really giving it to them to help them stay awake longer than a normal human would/should usually stay awake ... not just for the night but for a day + night together.
 
To the OP, no, it is not legal to write prescriptions for yourself for something to "stay awake" while on call.

To the person who sips iced Rockstar: ugh, that stuff tastes like cough syrup.

To all those sleepy interns: You adjust to the work and to the schedule. It is normal to be sleepy on call. You don't want to be sleepy and jittery or sleepy and wired at the same time.

A breath of fresh air (cold is good), a shower, a change of clothes (socks), walking some stairs or brushing your teeth can help. Stay hydrated and optimally fed - no food coma please. Hunger and thirst probably contribute more to your fatigue than lack of sleep. Try to keep moving as you at least perfuse your brain when you walk. When the sun comes up, you always get a second wind - unless you are in the OR without windows.

Don't do stupid stuff that will kill your career. You can't hide DEA violations in 2008 (computer knows all) and you don't want to waste your career because you made a stupid mistake to try to "stay awake". In the long run, you will get in less trouble for being sleepy than for DEA violations.
 
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