First call as a resident

[agranulocytosis]

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I'll be taking my first real call as a general surgery resident this weekend. I'll be covering all the surgical services including the CT ICU, except neuro, ortho and uro. There is a separate Trauma service, and I will have an intern on NF covering floor pages. I've covered nights on weekends as an intern, so I'm fairly confident on what to expect on call as far as consults go.

Any tips/suggestions/advice on how to tackle my first call?

 

[ESU_MD]

To quote one of my heroes... " be sure you are right, then go ahead"

 

[maxheadroom]

1. Go see the patient
2. Call a senior/attending if you're not absolutely sure about what you're doing
3. Don't ever believe anything that the intern tells you -- in the words of Reagan, "Trust, but verify."
4. Document all encounters. If you go see a patient, put a time-stamped note in the chart, even if it's just one line.

 

[Buzz Me]

Always see the patient when called by a nurse. Call your backup when you have problems.

 

[tussy]

Wow, i remember my first day of surgery call like it was yesterday (it was 11 years ago).

My advice: Know who your backups are. Call when you need help, but need help when you call! Unless someone is actively coding in front of you, you usually have some time to think about the problem, look a few things and formulate your plan.

Make sure when you're calling your senior/staff/other service that you have the patients chart and all the useful info in front of you. I HATE it when my residents call me with "Mrs. Smith looks really sick". then i ask "who's patient is she" "what surgery did she have" "when" "what are her vitals" "what is her past medical history" and they have no idea of the answers.

 

[Winged Scapula]

Make sure when you're calling your senior/staff/other service that you have the patients chart and all the useful info in front of you. I HATE it when my residents call me with "Mrs. Smith looks really sick". then i ask "who's patient is she" "what surgery did she have" "when" "what are her vitals" "what is her past medical history" and they have no idea of the answers.

Yep. Don't call your senior about a sick patient from the call room.

Please answer your pages. Nothing makes a senior madder than having to come in because the nurses can't reach you only to find you asleep in the call room, drooling, with the pager attached to your chest beeping away. (true story)

Know what your territory is. If you are cross covering you are there to keep the patients alive until the primary service is back in. You are not there to have a "what is the long term plan" with a second cousin once removed or with the nursing staff with nothing else to do at 0300. That does not mean being rude to the allied staff but setting the expectations up front if called on such things will make the next 4+ years much easier.

 

[igap]

Agree with the excellent advice so far. I would add that if you are calling a senior resident, do the following:

1. Always see the patient, do your own physical examination, and for God's sake, take a fresh set of vitals. Nothing is more irritating to hear on the phone than, "Well it looks like the blood pressure 6 hours ago was..." You are the guy/girl on the seen, and there is no excuse for not doing your own examination, and taking a fresh set of vitals.

2. Before you call, have a plan, and a diagnosis. You might be wrong, but at least think about what you are looking at, make a presumptive diagnosis, and formulate a treatment plan. The sooner you start to do this, the better you will get at being a doctor. Do not call unless you have thought these doctorly things first, so that you can have an informed discussion with your senior. The conversation on the phone will go a lot better, you will learn a lot more from the exchange, and you will solidify your reputation as a good resident.

3. Cannot agree more with the advice to document every patient encounter with a time-stamped note in the chart. Even if you miss something, you will be forgiven if you saw the patient and documented your findings. If the patient codes 30 minutes after you saw her and did not document your normal exam during your visit, you will be in a tough spot.

 

[agranulocytosis]

Thanks all! Call went pretty well, pretty busy and picked up a case post call that I get to log as surgeon junior. I can definitely appreciate formulating a plan prior to calling, it definitely makes the phone calls to seniors/attendings much more educational.

I think it would help the rest of the junior level residents out if we keep this going.