I've got 99 problems but working on the weekend ain't one

[The 805]

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Gfunk's musical posting got me thinking about starting my own (thus the title). I was in the middle of an awesome nap today (a Sunday) when the on-call pager went off regarding a non-urgent issue for a patient who is already scheduled in clinic next week. I was not enthusiastic about answering that page. Yesterday (a Saturday), I got two pages from a med onc fellow (who clearly doesn't know how radiation works) regarding non-urgent issues in "VERY unfortunate" patients. The first of these pages interrupted a great walk with my dog, and the second interrupted a nice dinner with friends.

Despite these champaign problems, I have seen zero consults, treated zero patients, and had a lovely weekend despite being on call. Anyone else have any good "not really on call" stories?

 

[medgator]

It's amazing how much your mentality will change if/when you end up in private practice after residency.... you'll be a little more motivated to see those after hours/weekend "consults"

 

[Gfunk6]

I agree with both the above posters. While a resident, I tried to minimize my time in hospitals over the weekend and holidays. Unless it was clear that a patient needed treatment ASAP (e.g. cord compression), I generally punted the consult to Monday.

In an independent private practice, it is completely different. I love to get calls from referring MDs over the weekend/holidays, thank them, and haul my ass to the hospital for a consult. It is amazing how incentivization can improve one's motivation!

 

[The 805]

Well said. I can totally see how that would be the case.... I presume you guys are treating bone mets with protons, right?

 

[Gfunk6]

Well said. I can totally see how that would be the case.... I presume you guys are treating bone mets with protons, right?

No, of course not! That would not be standard of care!

We treat bone mets with protons AND daily cone beam CT AND at 1.2 Gy per fraction AND to a total dose of 50 Gy.

Proving that the above regimen is superior to 8 Gy x 1 via a clinical trial would be unethical since protons are dosimetrically superior.

 

[The 805]

I like where your head is at. Could we add Calypso to that regimen??? I am confident that daily CBCT plus Calypso improves both targeting and disease control.

 

[medgator]

In an independent private practice, it is completely different. I love to get calls from referring MDs over the weekend/holidays, thank them, and haul my ass to the hospital for a consult.

Yup. Allows you to get into the inpatient "trenches" and demonstrate to other primary/specialist MD's that we aren't outpatient "button pushers" that don't see consults on weekends/evenings. It's amazing how many MD's you'll run into on the floors and in the doctors' lounge.

 

[Palex80]

I like where your head is at. Could we add Calypso to that regimen??? I am confident that daily CBCT plus Calypso improves both targeting and disease control.

After all unstable metastatic vertebrae are a moving target. Thus you probably need 4D-planning too.

 

[The 805]

Exquisit. We seem to have established our protocol: Weekend treatment of sub-centimeter, non-painful bone metastases with hyper-fractionated protons planned by a 4D technique and delivered under the guidance of Calypso plus daily CBCT.

Tentative company name: Bonemetorads

 

[RadOncDoc21]

I guess you could claim you're sparing the spine... In that case I would add a cone down plan with repeat Sim halfway and towards the end of treatment.

 

[thesauce]

Exquisit. We seem to have established our protocol: Weekend treatment of sub-centimeter, non-painful bone metastases with hyper-fractionated protons planned by a 4D technique and delivered under the guidance of Calypso plus daily CBCT.

This is what we've been doing for skin with excellent results