Home call during my first rotation

[Anath]

SOOO! My very first rotation as a PGY-1 is in peds at a mostly unopposed hospital. Peds here is home call. I've never taken calls at home -- from what I understand, the parent calls the hospital, and over the phone the nurses will assess the patient and if it is of concern or they don't know what to do, then they will page me to call the parent back and talk with them on the phone.

I suppose this is very cush as far as "call" is concerned as I'm told that most time, most kids do not have to be admitted so you rarely have to come in - once a call night if even that. Despite the silly CS exam, I've never really had to assess a patient over the phone and I haven't the foggiest idea of what to do. I'm at home -- who do I ask questions to -- it seems silly to go back and forth between calling a senior resident and calling the patient. Do I do 3-way? What if I believe the kids okay from what the mom says but the kids really sick as hell? Aw shucks, I ALMOST half wish I had in-house call for peds. Just feels akward that my very first rotation is home call in a field I'm not the most comfortable with (my peds rotation SUCKED in med school).

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[jerhaymore]

I am currently a resident in a program that does 80% plus call as home call.

It certainly represents an opportunity to learn skills that you usually don't get in medical school, but often need in practice after residency. Phone histories can be really tough to get the complete story.
In my program, you are required to staff all phone calls, even the silly ones, for the first few calls with your upper level. After that staffing is not required, but still encouraged especially when you have questions. It can be amazing how much you don't know your first few months of internship and how helpful someone with a little more experience can be to you.
I would suggest discussing most of your phone calls with your upper level until you feel pretty comfortable. I would just tell parents that I had another call or page, or just that I would call them back in a couple of minutes after getting a history from them. Then I'd call my upper level, staff the case and call the parents back. Sometimes just hearing some simple suggestions and a different perspective from my upper levels made a really big difference. None of the patients seem to mind having me call back in a few minutes.

 

[deleted87716]

You might find this book helpful:

http://www.fadavis.com/online_store/catalog/catalog_detail.cfm?publication_id=1503

Also, if you're taking calls from patients in your clinic, I think it's a good idea to document your phone calls, and include your notes in the patients' charts.

 

[Anath]

Thanks for the book recommendation! Just read a couple sample chapters they had online -- looks great!

 

[McDoctor]

You might find this book helpful:

http://www.fadavis.com/online_store/catalog/catalog_detail.cfm?publication_id=1503

Also, if you're taking calls from patients in your clinic, I think it's a good idea to document your phone calls, and include your notes in the patients' charts.

Thanks for the link. In our FP program, the majority of call is done this way. I think I'll look into getting the PD to provide this for all of us residents. I think it would help at least standardize our approach to commonly encountered problems/questions. As it stands now, I think there is too much variability in our recommendations for some of the same complaints/problems.