How does "on call" work?

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JakeSill

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Does that mean you have to be in close proximity to the hospital? How often is one on call. Not sure if I'm using the term right.
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JakeSill said:
Does that mean you have to be in close proximity to the hospital? How often is one on call. Not sure if I'm using the term right.
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Residency: Being on call just means working a really long shift. You work a day shift where you cover your patients, then a night shift where you cover your patients and a lot of other patients, and then maybe part of another day shift where you cover your patients again. You are given a bed in the hospital and are allowed to sleep during the night, but you are given an amount of work to do that makes it highly unlikely that you will sleep for more than 30 minutes. They call it 'call' because '28 hour shift' sounds more overtly like they're taking advantage of you. Q4 call means you work a 28 hour shift every fourth day, Q3 call means every third day, Q5 call means every 5th day, etc. Most residencies will have several months of Q4 call.

BTW I found that overnight nursing seemed to do a lot better with the concept of call when I stopped calling it 'call'. For some reason even experienced nurses seem to struggle with what being 'on call' means, but when I said "I'm 12 hours into a 28' it clicked immediately and I got far fewer pages. So I just removed the word call from my vocabulary.

Attending: Call means what it sounds like. You're at home, and if there's a problem they call you. You need to be sober and within a certain distance of the hospital as specified by your contract. The frequency that you are on call, the frequency you are called, and the frequency you come in for those calls can all vary wildly from one job to another. An on call dermatologist for a hospital might be 'on call' every other week, or even for months at a time, but might expect get called no more than once or twice a month and come in no more than once a year. Meanwhile an on call surgeon might have a contract where he only covers one night of call every two weeks, but he might expect to come in multiple times on each and every call night.
 
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But for a medical student? It's an awkward position. I mean that for overnight. You have to glue yourself to the resident and never lose track of them.
You might enjoy it
You might hate it.
I got to experience both. My first was awesome with the most hilarious inguinal hernia repair (basically, the resident jinxed the staff by saying it was just a hernia repair which ended up taking hours because the patient had so many revisions. Ending with the fellow saying "hey, remember when you said hernia repairs were easy? ")
And then the next call was boring. Beyond boring.

I'm only saying this if you're asking what it's like for a student. Because it does suck. Or it can.
 
Why would you not have time to sleep no more than 3o minutes? After you round, what's keeping the pager going off every 30 minutes?
 
Slack3r said:
Don't forget "home call", which is really just a nice way to get around duty hours while maintaining hospital coverage.
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How often are you paged on home call and how often do you actually need to go into the hospital? I would suspect some specialties like psych, call would be pretty easy. And night float would be great.
 
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olivarynucleus said:
Why would you not have time to sleep no more than 3o minutes? After you round, what's keeping the pager going off every 30 minutes?
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So, never mind that patients are in the hospital because they are sick, and can go south on you unexpectedly. Or that, since hospitals are 24/7 establishments, new patients may arrive at any hour of day or night, and often do.

There are also crappy rules written by administrators that compel nurses to page you, even when they would rather not do so. Or someone on your team has written orders that require the same. "Page physician immediately with results" is one of my least favorite things to see in a chart or a policy. It actually is necessary to do often enough that you can't just blow it off and tell them in the morning. Sometimes, that barely abnormal sodium level is relevant, and there really is someone eagerly waiting for that information. More often, though, nurses know they are waking you up for B.S. that could wait. Most of them really regret that, especially if you keep your composure and handle the minutia you've been awakened to deal with gracefully.
 
olivarynucleus said:
How often are you paged on home call and how often do you actually need to go into the hospital? I would suspect some specialties like psych, call would be pretty easy. And night float would be great.
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Yeah, its not like Psych residents work in inpatient mental health facilities or anything. Psych is not a home call field in residency. Oh and about night float :laugh:.

I'm guessing third year will be quite a change for you.
 
olivarynucleus said:
I would suspect some specialties like psych, call would be pretty easy.
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Wait until you meet your first borderline personality making their weak suicide attempts to "show" somebody so that someone will be "sorry". Wait until you meet that same person every other month because of the same basic thing. Between the seriously depressed/suicidal and the psychotic you have a lot of personality disorders gumming up the works and causing problems. A few of them, relatively speaking, can cause a whole mess of work for lots and lots of people, and they never really get "better". Psych call is busy in residency and usually covers more than one hospital/ED plus the in-patient.
 
Im on call right now for IM rotation. Just sitting in the closet they call the "med studnet on call room" in front of a fan and doing nothing bc the hospitalists here mostly hate teaching or have no idea what a med student is. One of them called the room and asked me to go upstairs and "pronounce a guy." I said I cant because im a student not a resident. He just got aggrevated that i wasnt an md and told me to call the next shift if i wanted to do anything. The MD who came on at 8am hasnt returned page. Had to be here at 6am and wont leave till midnight.
 
cbrons said:
Im on call right now for IM rotation. Just sitting in the closet they call the "med studnet on call room" in front of a fan and doing nothing bc the hospitalists here mostly hate teaching or have no idea what a med student is. One of them called the room and asked me to go upstairs and "pronounce a guy." I said I cant because im a student not a resident. He just got aggrevated that i wasnt an md and told me to call the next shift if i wanted to do anything. The MD who came on at 8am hasnt returned page. Had to be here at 6am and wont leave till midnight.
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You don't have a resident or intern to follow? The residents and intern I work with all have my number and want me there with at least one of them. Sorry they don't enjoy teaching man, but in those cases I would bring something to study. I put all the books on my iPad and whenever we have down time in between admitting people I just whip it out and read something. Sitting in front of a fan twiddling your thumbs isn't going to help your morale, just sayin'.
 
Mr. Mojo Risin said:
You don't have a resident or intern to follow? The residents and intern I work with all have my number and want me there with at least one of them. Sorry they don't enjoy teaching man, but in those cases I would bring something to study. I put all the books on my iPad and whenever we have down time in between admitting people I just whip it out and read something. Sitting in front of a fan twiddling your thumbs isn't going to help your morale, just sayin'.
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There arent any residents here.
 
cbrons said:
There arent any residents here.
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Ah ok that explains it. How are you liking it? Seems like that would be really tough if your attending isn't really interested in teaching you. Hope all goes well. Only 1.5 more hours!
 
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