Is intern only call ethical?

[Greenman]

Does anyone else feel uncomfortable with the idea of taking night call without a resident? Obviously it is intimidating but I cannot help but feel this is also somewhat unethical. I personally would not send my parents to a hospital in July if I knew they were being taken care of someone overnight who was a MD for 2 weeks.

Id be especially interested to hear from interns at some of these programs. Are there mistakes they made that would not have occured with an R2 as a back up in house?

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[TommyGunn04]

I was an intern in a program where I took "intern only call" for a few months out of the year, on subspecialty services like oncology and cardiology. Incidentally, this practice is ending in our program starting in July, but not because it was thought to be somehow dangerous or unethical, but rather to improve continuity of care and educational value.

Before I started internship I found the thought of "admitting alone" to be incredibly intimidating and frightening, but after a few weeks on the wards I realized it was not that big of a deal. I also quickly realized that I had plenty of backup if needed, in the form of a "night teaching resident" who would check in with the on call interns each night, and of course the MICU or CCU residents and fellows, and even moonlighting fellows at times. I also felt that it was incredibly valuable to work more independently like this, as it forced me to think critically about patient care issues instead of just reflexively asking a resident what to do.

Are there programs where interns take call alone without ANY sort of backup???

 

[CanIMakeIt]

I was an intern in a program where I took "intern only call" for a few months out of the year, on subspecialty services like oncology and cardiology. Incidentally, this practice is ending in our program starting in July, but not because it was thought to be somehow dangerous or unethical, but rather to improve continuity of care and educational value.

Before I started internship I found the thought of "admitting alone" to be incredibly intimidating and frightening, but after a few weeks on the wards I realized it was not that big of a deal. I also quickly realized that I had plenty of backup if needed, in the form of a "night teaching resident" who would check in with the on call interns each night, and of course the MICU or CCU residents and fellows, and even moonlighting fellows at times. I also felt that it was incredibly valuable to work more independently like this, as it forced me to think critically about patient care issues instead of just reflexively asking a resident what to do.

Are there programs where interns take call alone without ANY sort of backup???

I don't think I have heard of ANY program with just interns running the show without some sort of backup as you mentioned....there is always MICU/CCU/or some sort of night resident to call in case u r stuck ....and i personally like that because as TommyGunn said, it makes you think critically about the real issues regarding that patient....and if u r stuck, u can always call ..

 

[dragonfly99]

I don't think it's unethical if the intern has backup (should really be in house backup, either a resident and/or fellow). I took call alone as an intern on hem/onc, and I actually liked not having a resident telling me what to do, and I had people I could call if I needed to (only called the resident once during the month).

 

[Neurontin]

Honestly, I am not aware of any programs that have a strictly intern-only system to the point that there is no support available. The places I know where this happens are at MGH, Hopkins and Columbia. I can't speak for Columbia, but at MGH, interns have night teaching-residents who are available for help (and I am told that the number of teaching residents decrease as the intern year progresses), and at Hopkins, I can say with first hand experience, that at least for the first 5-6 months of intern year, there is an on-service night resident (PGY-3) available overnight to help the intern. At Hopkins, for example, the night resident disappears (takes home-call) around November-December of the intern year, but the MICU resident or fellow(s) becomes available for assistance on the floor if the intern needs help. So in reality, I don't believe that patientcare is ever compromised for the sake of "intern-only" call.

 

[drjitsu]

I'm not sure if it's unethical. And, as it's been pointed out, true intern only call does not really exist. That being said, I do wonder how open these upper level residents are to calls in the middle of the night at some of these more "notorious" institutions. I have heard a fair bit of hazing has been known to occur... but that's all hearsay.

Regardless of ethical implications, I think there are far greater implications on the value placed on and quality of education at these institutions. I think it's far to say this style of program is quickly becoming a thing of the past and will soon join 120 hour work weeks and paper charts in the land of "the good old days". In my opinion, Mayo really sets the standard for progressive program structure and balancing education and service. With programs such as Duke following suit in the upcoming year and the likes of Johns Hopkins suffering from work hour violations, I believe the future is clear. However clear the future is, resentment and resistance towards it will always be clearer. When visiting programs that still use paper charting/orders, the residents would universally oppose the transition, and I could not help but to shake my head in despair. Such is the way of the old dog... let us kindly put him out of his misery.

I think a question to ponder along with "is it ethical" should be "is it useful?".

 

[dragonfly99]

drjitsu
we only had one "intern only" rotation @my residency, which was the hem/onc rotation. I would say that YES it is a very good experience, at least in my opinion. It forced me to think much more and make a lot more and better decisions that a lot of other rotations. Of course it is necessary to have some in house backup person (resident, fellow) to provide advice and help PRN. My experience was I only had to call someone once or twice and he was pretty cool about it...I mean nobody likes waking up to a pager call at 2:30 a.m. but he didn't really bitch that much.

Much of the time I think the traditional system of 1 resident 2 interns in house all night "team call" is the thing that is the old dog that needs to be put out of its misery. This is particularly true in the last 6 months of the year. Who here honestly felt like she needed a resident breathing down her neck and hovering while she wrote orders and H and P's in April/May/June of intern year on a typical ward service? IMHO we had more house staff "in house" at night than we needed. I think to have some residents around in the hospital is necessary (for advice, to run codes, etc.) but having a 1:1 or 1:2 resident:intern ratio in many cases is way excessive.

 

[Monkeyguts]

Does anyone else feel uncomfortable with the idea of taking night call without a resident? Obviously it is intimidating but I cannot help but feel this is also somewhat unethical. I personally would not send my parents to a hospital in July if I knew they were being taken care of someone overnight who was a MD for 2 weeks.

Id be especially interested to hear from interns at some of these programs. Are there mistakes they made that would not have occured with an R2 as a back up in house?

Good, one less admission for me overnight. Tell your extended family and friends to stay away too. I wish more people would stay away from my hospital, I could finally get some sleep.