`On-Call' Doctors Become Medicine's Utility Players
BY DR. HERBERT KEATING | SPECIAL TO THE COURANT
Being “on call” nights and weekends is part of every physician’s life. Mandatory during the training stages of residency and fellowship, call responsibilities continue for the full-fledged doctor, some disciplines requiring more (e.g. cardiology) than others (e.g. pathology).
Predictable emotions are part of the “on call” experience.
For example, when approaching a weekend on call, a doctor invariably experiences a peculiar amorphous sense of pessimism. Especially true for younger trainees or physicians newly in practice, this pessimism can approach out-and-out dread, particularly if an unseasoned doc is placed in a situation that seems beyond his or her capabilities.
In my internship, I was on call every third night which means I spent every third night in the hospital. But because my butt was always covered by a more experienced resident, this call was not accompanied by the dread that occurred when I later became a second-year resident, responsible, for example, for all uninsured patients admitted to the hospital from the emergency department.
As the years pass, “on call” becomes easier as a physician acquires more experience. However, as time goes on, there is a natural tendency – what I call a cumulative toxicity – that results in an unbecoming, smoldering but perfectly understandable resentment of taking calls. This seems especially true for physicians in private practice, most of whom are pressed to meet the expenses of running an office and meeting a payroll.
“Why should I be forced to field phone calls from strangers who might sue me, and give out hundreds of dollars in free advice?” some doctors ask aloud.
And for many of them a second sentiment follows, as night follows day:
“Couldn’t get a lawyer to give out free advice.”
But, really, in the era of increasing co-pays and frantically busy lives, who could blame a patient for calling to get his bronchitis treated over the phone rather than cough up the $30 co-pay for an office visit?
And then call day arrives. The weekdays of dread lead to the Friday of the call weekend itself. And the calls start coming in around 5 p.m.
The first calls are routine. One patient wants to know what to do with his stool sample now that the lab is closed for the weekend. Two pharmacies call for medication clarification.
But then a disturbing call comes from a young man. He wants something to help calm down. Twenty-three, his girlfriend has just broken up with him, and he feels upset.
“Just give me something, you know, doc, like Xanax or something.”
“Are you depressed?” I ask him.
“No,” he says.
“Do you have any thoughts of hurting yourself?”
“No,” he says.
“Do you have any thoughts of hurting anyone else?”
“No,” he says.
“So, let me understand,” I continue. “You want me to give you a drug to make you feel less pained from breaking up with your girlfriend?”
“Yeah,” he answers.
“I don’t feel comfortable doing that,” I say, and he says, “Oh, OK.”
“But if you get worse, like have any of those thoughts I mentioned, don’t hesitate to call back. Or you could go to the ER.”
He says “Oh, OK” again.
(When I tell my wife about this call, she says to me that I should have told him to go for a long walk. “As in, take I hike?” I ask her, and she says, “Precisely.”)
But then things improve. I get to be a real doctor. I get useful.
A pleasant woman in her late 50s calls. She is worried that symptoms of numbness and tingling around her mouth and in her fingers and toes mean that she has multiple sclerosis. She has gone online and is convinced. But her symptoms sound like the hyperventilation syndrome, brought on by a stressful life and over-breathing. This has changed the acid-base balance in her body. My advice makes her symptoms go away, and she feels relieved.
A worried mom calls about her beloved 16-year-old daughter who is having cramping abdominal pain. After a few minutes of questioning, I figure out that the teenager has “irritable bowel” which has been worsened by an antibiotic (erythromycin) prescribed the previous Thursday for sore throat. And I set in motion ways to make her feel better.
I feel like a fencer or a chess player or a preacher. On the playing field of the patient’s body, demon disease’s thrusts or sorties are deftly met and I deliver decisive counter-blows. Nausea is knocked out and people can rest. I can hear airways plugged by asthma and I help people breathe again. Incipient heart attacks – disguised as acid-indigestion – are detected and an ambulance is summoned; heart muscle may be saved.
And then the predictable happens. Call – as everything else must – passes.
As every survivor does, I feel privileged.
Dr. Herbert Keating practices and teaches internal and geriatric medicine at Prohealth Physicians in Bloomfield and is clinical professor of medicine at the University of Connecticut. His columns include real stories, but names are changed to protect patient confidentiality. His website is FearLessAging.net.