A bit confused about being "on call" means...

[KnuxNole]

Maybe I have to wait until I start to fully understand, but it seems the scheduling thing seems a bit off to understand. I've been told for the IM rotation for instance, that I have to go for 5 days a week, with Call. I'm assuming that I go to the rotation for 8-9 hours a day five days a week, and have weekends off. But, what exactly is call then? Is that a weekend thing, or an overnight thing? And do you have to stay at the hospital during call, or can you for example go about your day, but if your beeper rings, you gotta make it there in 30 mins or less?

These might seem like stupid questions, but I'm starting my rotations soon so I'm not sure how things work. I'm assuming for IM, I wont have much free time, and I guess I'm trying to get a feel for how things are gonna be.

Another "off-topic" question, but how many hours a day do 3rd years typically study for the shelf? I know a lot of people say you don't learn a lot in the rotation and have to depend heavily on books to teach you the bulk of the shelf, so it seems like a lot of studying. Some posts say how they bring books on the down-time, but how feasible is this? I feel like I'll get yelled at if they see me studying instead of doing something important for them like patient write up or faxing papers.

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[ANCAdoc]

Generally for inpatient medicine wards a student is expected to be present 6 days a week (so you are lucky if you only have 5). If it's ambulatory medicine, then M-F 8-5 is standard.

"On call" means that you are present with your medicine team overnight. Many programs have a team structure for medicine, with 1 attending, 1 resident, 2 interns, and 2-3 med students (possibly including a sub-I). Being on call can range from every 4 nights to every 6-7.

For a traditional 30hr call shift you would come in at 7AM the day of call. The latest you would leave the hospital would be 1PM the following day. You would go home, chill a bit, and then sleep. Most likely are you back in the hospital the next day, unless it's one of your 4 days off that month.

Some programs have abandoned traditional 30hr call since the ACGME has issued new work hour restrictions (16hrs for interns and 28hrs for residents). More programs are moving to night float which means that traditional daytime medicine teams will share being on "short call" (not staying overnight but with some overlap with the night float team).

 

[Perrotfish]

'Call' for most attendings: go home, stay sober, and carry this beeper. If we have a problem we'll call you. If it's bad enough you'll need to come in, but that should be a really rare thing.

'Call' for senior residents: Start the day at 8, stay till midnight, go home, sleep for 4-6 hours, come back in and get everything in order before the attending shows up.

'Call' for Interns: Start your day at 8, stay until noon the next day. Work non-stop.

'Call' for Surgery residents: Start the day at 4, work through the night until 8 p.m. the next day, lie about your work hours or you will be summarily fired.

'Call' for medical students: Start your day as usual, but stay a lot later. How much later depends on the rotation. Some variations I've had: stay as long as the resident stays, stay as long as the Intern stays, stay until your class starts at noon and then stay there until 5 (I challenge you to find the medical student who has learned something in a post-call class), and stay until you've done two complete work ups for two seperate admissions. The last system was easily the most annoying for the Interns, because whenever they were getting killed with a bunch of early admits all the medical students got painfully cheerful.

Keep in mind that new work hour rules are being implemented next year, so this may be completely different when you start.

 

[McGillGrad]

Most places I have seen have the students stay till 9-10pm for those days when they have call. Real overnight call is rare, i.e. every 4 days or so, just like the residents.

 

[Knicks]

......

'Call' for Interns: Start your day at 8, stay until noon the next day. Work non-stop.

......

Why aren't human rights activists doing something about that!?

 

[ShyRem]

I had call as a med student. It entailed being on for 30 hours pretty much working. On a lucky day I got 2 hours of sleep those nights. Call was Q4 for most inpatient months.

 

[Droopy Snoopy]

Why aren't human rights activists doing something about that!?

Don't worry, it's changing. My PD joked that next year at intern orientation they'll be handing out foam nap maps and assigning cubby holes.

OP, your 3rd year IM rotation will probably shake out like this. Arrive at 6a, mix in a lecture or two during the day, leave between 3 and 10p (depending on whether your team is on-call, post-call, has afternoon clinic, how teachy your attending is, and how big of a douche your resident is). You'll work 6 days a week and be in-hospital on-call every 4th day. Your job as a med student is to learn, not fax papers. Sometimes your residents will get busy and need you to do stuff in order to provide good patient care, but in general you should be studying throughout the day in little chunks.

 

[werd]

Why aren't human rights activists doing something about that!?

it's actually much better than it used to be. intern shifts used to be up to 3 days straight on-duty.

in response to the op, i agree with most of the above. as a student your non-call days will generally be 6-7am until 4-6pm, call days probably 6-7am until late evening (8-11pm) but some schools have you do the full 30-ish hours. you'll have off the days your team has off, which averages 1 day/week.

the other thing you were describing above is "home call" where you get to go home, and come in to the hospital only if someone needs you. it's consult teams rather than inpatient services that do home call. in general it's a lighter/better type of call, but the twist is that ppl are usually on home call for a week or so at a time, so there's the possibility of being up all night multiple days straight.

hope this helps. if you were expecting 8 hours a day 5 days a week, your medicine rotation will be a rude awakening. it's usually ambulatory medicine, family, and psych rotations that have these hours.

 

[donkeyboy]

im a third year and i've heard of this short call vs. long call business but never have experienced it, all my calls have been overnight, but I havent been on IM yet where it seems like these short calls take place. my question is if you are "on call" and leave somewhere between 8 and 10PM, does the next day count as a post call day and do u have to come in and stay the whole day vs. come in and leave with intern vs. not come in at all

 

[Smurfette]

im a third year and i've heard of this short call vs. long call business but never have experienced it, all my calls have been overnight, but I havent been on IM yet where it seems like these short calls take place. my question is if you are "on call" and leave somewhere between 8 and 10PM, does the next day count as a post call day and do u have to come in and stay the whole day vs. come in and leave with intern vs. not come in at all

It depends. Rest assured, this will be explained to you at the start of the rotation as to whether it is 'short' or overnight 'long' call and how late you are expected to stay post call, etc.

When you start your IM clerkship, they should give you guidelines about how call for the MS3's works. My school did 'short call' until 11 pm, and yes, we were expected to stay all day the next day (although for us it would usually end slightly early by 3 or 4 pm since the interns would leave post call and there wouldn't be much left to do). Never heard of a school having the students who take short call giving the entire next day off; you are usually expected to be there to present your new patients from the previous day. Usually the schools that do overnight call will have the students leave around when the post call interns leave. But it does vary by school and rotation; on our surgery clerkship we took overnight call and had to be out of the hospital by 8 am but return for any mandatory afternoon lectures (failure to attend lowered our grades).

Regarding the OP: I highly doubt you have weekends entirely off. Inevitably you will be on 'in-house' call on some weekends, or expected to 'round' on patients on the weekend (and then leave early, usually by noon). I would avoid making any significant plans until you are officially told by either your clerkship director or your IM team that you are indeed 'off' for the weekend.

 

[Knicks]

it's actually much better than it used to be. intern shifts used to be up to 3 days straight on-duty.

It's still bad as it stands, though. Doesn't matter if it "was worse before".

 

[Jolie South]

With the current ACGME rules being what they are, I think a lot of places are switching to a night float system. On medicine at my school, that means we never even stayed overnight. We admitted 2.5 days during the week during "regular business hours" but we worked 6 full days/week. There were a couple of days when I would go home at 6 or 7 pm, but that's it.

For inpatient pedi, we took call until 10 pm one night a week and worked one weekend day. Other than that, it was 7-4.

On surgery, I worked 6-5 most days and came in once over the weekend to round. I did work at a private hospital with minimal trauma though. The residents took home call, so I was never expected to take call with them.

. . .So I guess it's pretty dependent on the rotation and the facility that you're at.

 

[mrmandrake]

'Call' for medical students: Start your day as usual, but stay a lot later.

Hey guys,

I have a related question. I'm an M2 and I usually sleep around 5 hours a night from 12-5am or 1-6am. I usually take a 20 minute nap around noon and a 15 minute nap around 5 or 6pm if needed. I can survive without the second nap but I need the first one to function.

Is there time on rotations to take a 15-20 minute nap? I mean, I'd rather scarf down a clif bar in 30 seconds and take a nap during lunch if possible. Anyone see how I can fit in a nap? I'd really hate to change my sleeping schedule since I know even if I get 6 hours of sleep at night, my body still looks forward to that nap. Thanks.

 

[werd]

for the most part you won't be able to nap. i'd see how you can arrange your sleeping schedule so as to not count on it.

 

[Winged Scapula]

Hey guys,

I have a related question. I'm an M2 and I usually sleep around 5 hours a night from 12-5am or 1-6am. I usually take a 20 minute nap around noon and a 15 minute nap around 5 or 6pm if needed. I can survive without the second nap but I need the first one to function.

Is there time on rotations to take a 15-20 minute nap? I mean, I'd rather scarf down a clif bar in 30 seconds and take a nap during lunch if possible. Anyone see how I can fit in a nap? I'd really hate to change my sleeping schedule since I know even if I get 6 hours of sleep at night, my body still looks forward to that nap. Thanks.

I think it will range from very unlikely to impossible during clinical rotations and residency to be able to count on a nap, especially at a certain time.

As noted above, I think you might need to reevaluate the need or your sleep hygiene for the time being as clinical rotations and residency are anything but predictable. Not a sleep expert but if your body needs two naps a day, even short ones, you might not be sleeping enough at night.

 

[2012mdc]

Most places I have seen have the students stay till 9-10pm for those days when they have call. Real overnight call is rare, i.e. every 4 days or so, just like the residents.

Yeah, that's how my schools works for IM. We take call until 9pm and do not get early days post-call. The post-call day length just depends on whether it's the weekend or not.

On Surgery call was 24 hrs and thus overnight. Post call days were shortened dramatically and we were sent home by 12 whether it was the weekend or a weekday

 

[mrmandrake]

Thanks for the insight guys. I used to work full time while doing my undergrad so my sleep has been weird for a long time. I guess I'll need to fix it before my third year. Good bye nappy time ....

 

[ZagDoc]

My call responsibilities as an MS3 varied by rotation. Some of the systems I rotated through:

Peds - True all-night in-house call. Day started at 6am on Day 1, normal work day through sign-out at 5pm, hitch onto on call team, hopefully squeeze in GI rounds, then help the night team juggle admits all night. Maybe grab an hour or 2 of sleep depending on if the hospital lands on divert. On Day 2, we pre-rounded and rounded on patients with our usual day team, and were required to stay through afternoon didactics. So some days we were going 6am Day 1 to 3 or 4pm Day 2. (36 hours)

Gen Surg - Took trauma call. Got to hospital at 4am, pre-rounded, rounded, operated, evening rounded. After evening rounds, we would swing by the trauma workroom and pick up a trauma pager. Our responsibility was to then show up in the appropriate ED bay whenever it started screeching and help with triage. If a trauma got taken back, we were expected to scrub the case. Depending on how busy the night (aka if it wasn't a Friday or Saturday), you could generally grab an hour or two of sleep but it was intermittent, never consolidated. At 4am you start the whole pre-round/round dance again, and after rounds we would generally help the 'tern with some floor work and get out by 11am. (31 hours)

Psych - ED call with the on-call psych resident. If you were still in the hospital by 9 or 10pm, they'd look at you like you were as crazy as their patients and send you home. Of course, no post-call as a result. So really, it was like a really long work day (yes, 12 hours of psych can feel really long) every 5th night or so. (12 hours)

OB - No call, but we had a week on nights. Grocery shopping at 8am after a night shift is truly bizarre.

IM - We rotated "short call" and "long call" days every 3rd day or so. On short call, your team took all admits that came through the day through 3 or 4pm. We had didactics until 3pm most days so you'd generally start your work-up around that time, then scamper home by 7pm to go spend the next 6 hours working on a long ass write up due at rounds the next AM. On long call, your team took admits starting at 3 or 4pm until 7am the next day. If you were lucky, you picked up your patient early, got home by 9 or 10pm, then spent the next 6 hours working on said long ass write up. Rounds as usual the next day, then peace out after noon didactics if long call. Business as usual if short all. (31 hours - ~25 of which spent in the hospital... though if your short call patient came in late in the afternoon and you didn't sleep the night before days could stretch to 35 or 36 hours)

Neuro - Stroke call. Nice residents would send you home around 10pm. If you were getting hammered it could be a long night. No post-call day, so neuro clinic the next day listening to patient after patient talk about back pain could be brutal.

The point is... there's a ton of different systems out there. Like everything in third year, prepare to be flexible, adapt quickly, and never, ever, ever make any plans the evening you're on call. The medicine gods will punish you.

 

[45408]

Maybe I have to wait until I start to fully understand, but it seems the scheduling thing seems a bit off to understand. I've been told for the IM rotation for instance, that I have to go for 5 days a week, with Call. I'm assuming that I go to the rotation for 8-9 hours a day five days a week, and have weekends off.

On medicine, I got there around 7:15am and left at 5-6pm, except for every fourth night, when I stayed until 10pm. I was there six days a week, with 4 days off for the month. That's pretty typical. Peds was the same. 40 hours/week would be a pretty light month for inpatient medicine.

Trauma surgery was Q4 in-house call, just like the residents, for 5 weeks. Very little sleep. OB/gyn was a 25 hour call, where you were done at 7am after being there all night (and being up almost all night). It was Q5 for six weeks. Pysch, neuro, family med, and peds outpatient had no call. ER was strictly shift work.

 

[coldweatherblue]

typical inpatient medicine call schedule:

0600 - pre-round (collect 24hr vitals on your patients, talk with nursing about any overnight events, do a focused H&P, etc.. doesn't sound too bad but if you have 5 patients it can take some time).
0800 - rounds
1200 - finish rounds, head to the ED to work new admits. this is where patients who present to the ED with criteria for admission are admitted to your service. Basically as a med student you go see the "straight-forward" cases, then chief it with your intern/resident and the senior resident finalizes the care-plan the with the attending. This continues until the next day when your team passes off the call-pager..

0600 (the next day) pre-round
0800 - round
1200 - done with rounds. finish up floor work and go home.

my inpatient medicine months were Q4 and Q5 call.. which is nowhere near as bad as Q3 but can still get pretty tiresome, especially when you don't get weekends off.

So your basic Q4 call schedule is:

monday: work 0600 - 1600
tuesday: work 0600 - 1600
wednesday (call day) work 0600 - about 1400 thursday.
friday: work 0600 - 1600
saturday: hopefully this is a day off.
sunday (call day) work 0600 - 1400 monday.. repeat.

so just notice that after you do this for a while it really starts to feel like weeks are only 5-6 days long, since you skip an entire day somewhere in between being at work 30+ hours. really what sucks about being on call on medicine is that you have to work for 24 hours straight, usually without much sleep, then work an entire full day afterwards. The 24 hours aren't really that bad; working up patients in the ED has by far been my favorite part of third-year, it's just that after working for 24 hours straight, you still have to deal with all the craziness for another full work day.

Neuro call, and psych call call for us were all just a single day of being on call from 1200-2200 or so.. and usually we only got paged once to come in, not bad at all.

Bottom line: imo call is a great opportunity to learn medicine as an MS3. When your team is slammed with new admits and your senior resident tells you, "go work up Mrs. A in the ED for chest pain" you really feel "on your own" and can take time to gather data, interpret it, and present your assessment to the team. That whole process is very educational. Most of the time your plan will be wrong, but you still learn a lot. it can really suck too though, no doubt.

 

[KnuxNole]

This is probably a dumb question, but how is the eating situation? It seems like you have to starve yourself on call(assuming cafeterias close) and when you're done, you basically go back home and too tired to heat anything so you crash :O

 

[McGillGrad]

This is probably a dumb question, but how is the eating situation? It seems like you have to starve yourself on call(assuming cafeterias close) and when you're done, you basically go back home and too tired to heat anything so you crash :O

bring a protein bar or have a sandwich set aside somewhere to eat when you have 5 minutes. The days of sitting down for one hour to eat are pretty much gone, but you can certainly eat something every few hours. This isn't a Nike shoe factory, it's medicine.

 

[KnuxNole]

bring a protein bar or have a sandwich set aside somewhere to eat when you have 5 minutes. The days of sitting down for one hour to eat are pretty much gone, but you can certainly eat something every few hours. This isn't a Nike shoe factory, it's medicine.

I lol'd

That's cool though, I usually make sandwiches a lot as of now so it will be familiar territory!

 

[Cruzinman]

No sympathy here. Vandy resident, IM, 1974-1977. On call q other night. Same for Hopkins residents. 36 on, 12 off. Bags under my eyes have required blepharoplasty, but as a result of my intensive training I can spot a case of Acute Intermittent Porphyria at 50 paces.

 

[45408]

No sympathy here. Vandy resident, IM, 1974-1977. On call q other night. Same for Hopkins residents. 36 on, 12 off. Bags under my eyes have required blepharoplasty, but as a result of my intensive training I can spot a case of Acute Intermittent Porphyria at 50 paces.

I bet the ladies love that.

 

[McGillGrad]

I bet the ladies love that.

Dude, he was a doctor in the 1980s! The biggest swinging-time in doctor history where GPs made 250k in today's dollars.

Of course ladies loved that!!

 

[ZagDoc]

This is probably a dumb question, but how is the eating situation? It seems like you have to starve yourself on call(assuming cafeterias close) and when you're done, you basically go back home and too tired to heat anything so you crash :O

Lived off Clif bars at various points during my third year. Eating definitely stops being a luxury at times and starts being a required evil. I lost 10 lbs during third year, probably because my diet sucked during the preclinical years and as a third year my diet still sucked I was just too busy to eat as much. Others in my class gained weight from all the caf food. It depends.

 

[donkeyboy]

note: med students, residents, and attendings greatly exaggerate how much they work.

for example, med student who works a 36 hour on ONE call during his entire rotation, says to his friends that he takes a 36 hour call every time, and when he stays til 9PM on a normal day he'll claim it was 11:30, though normally he gets out at 4:30 he'll just say its 6:30

resident: worked 90 hrs average for two weeks with the rest of the weeks averaging 80 hrs, tells the med students he averages 95-100 hr/ week during intern year, and NEVER sleeps on call though he really gets 2-3 hours

and my favorite, attendings..."back when we were residents we worked 160 hr weeks, worked 48 hrs straight on no sleep, didn't eat or drink for 72 hours, and then took a 6 hour nap and were back at it... blah blah blah, bunch of bull

take everything with a grain of salt

 

[45408]

note: med students, residents, and attendings greatly exaggerate how much they work.

Note: this is not specific to medicine. In fact, it's probably not as bad in medicine as in other fields, because we do occasionally work 30 hours straight. Studies show that people often overestimate their work hours by 20-40% on a routine basis.

 

[KnuxNole]

Lived off Clif bars at various points during my third year. Eating definitely stops being a luxury at times and starts being a required evil. I lost 10 lbs during third year, probably because my diet sucked during the preclinical years and as a third year my diet still sucked I was just too busy to eat as much. Others in my class gained weight from all the caf food. It depends.

oh dang.

I'm already a slim jim as it is, if I lose 10 pounds I might enter skeleton status.

Time to charm those cafeteria ladies and get extra grub poured on my plate

 

[Cruzinman]

Wish I were exaggerating. It still pisses me of when I recall the Chief Resident giving us that old saw, "When you're on call every other night you still miss 50% of the pathology".

 

[McGillGrad]

Wish I were exaggerating. It still pisses me of when I recall the Chief Resident giving us that old saw, "When you're on call every other night you still miss 50% of the pathology".

It's all relative. Now with deceasing compensation and increased medico-legal costs, you cannot justify 120 hours a week for half the money your generation made 30 years ago.

People work 60-80 and make 60-80% of what you made.

It is a fair trade.

 

[Perrotfish]

It's all relative. Now with deceasing compensation and increased medico-legal costs, you cannot justify 120 hours a week for half the money your generation made 30 years ago.

People work 60-80 and make 60-80% of what you made.

It is a fair trade.

No, f- that. Don't justify this. Don't get me wrong, you're right with any justification you may throw out. The poor quality of care patients recieve from sleepless residents. The fact that decreasing compensation makes the endless hours less reasonable. The increasing length of residency that makes sweatshop hours less reasonable. The detrimental effect of sleeplessness on your ability to learn and retain the pathology that you're seeing. The fact that the saintly physicians who decided that we should not sleep to avoid a debateable marginal statistical risk to our patients have no problem punting any chronically ill patient who can't pay the full price that they're charging for our almost unpaid services. They're all right, but in trying to justify sleeping at night you are none the less wrong.

You have a right to go to sleep at night. Any other American employee knows this. Third world factory workers know this. Prisoners of War know this. Depriving a human being of sleep is inhumane and internationally recognized as a war crime and you don't need any other reason to insist on being allowed to go to bed at night. If someone else had it worse then your only responsibility is to make sure that no one has it worse ever again.

And that old resident with that old saw? F- him too.

 

[Cruzinman]

If you're in this profession to punch a clock I hope that I don't get admitted to your hospital during your "shift change". No, my teachers were not saints. Residents were called residents because they had to live at the hospital. Personally I would rather take call from my bed in a nice on call room after being awake for 24 hours because it is unlikely I will hurt myself, as opposed to getting in my car and driving back to the hospital.

As for those "studies" on medical errors made with long work hours, who came up with 80 hours as a magic number? Trust me, it was all lawyer driven. Trust me as well, in OB-GYN and Gen Surg., in the prestiguous programs if you strive for an 80 hour max. you will soon find yourself looking for a new program. What does NOT get published are the observations (ridiculed as "anecdotal") by seasoned physicians that people coming out of residency these days are less prepared than previously because of the reduced work hours. Also ask any "night float" hospitalist to tell you about your patient when you arrive for rounds at 6AM and they will be lost. Even a sleep deprived resident can give me a better presentation than a well rested hospitalist. It's called "continuity of care".

Finally if your philsophy is to work less because the pay is less, then you're in the wrong profession in the first place.

 

[45408]

If you're in this profession to punch a clock I hope that I don't get admitted to your hospital during your "shift change".

Ah, Burnett's Law. You don't want a physician who is well-rested?

No, my teachers were not saints. Residents were called residents because they had to live at the hospital. Personally I would rather take call from my bed in a nice on call room after being awake for 24 hours because it is unlikely I will hurt myself, as opposed to getting in my car and driving back to the hospital.

If you're concerned that you're going to hurt yourself while driving, aren't you also concerned that you're going to hurt patients?

As for those "studies" on medical errors made with long work hours, who came up with 80 hours as a magic number? Trust me, it was all lawyer driven. Trust me as well, in OB-GYN and Gen Surg., in the prestiguous programs if you strive for an 80 hour max. you will soon find yourself looking for a new program.

Honestly, for me, it's not about the studies quoting error rates. Working 120 hours in a week for anything other than a fluke of being on call 3-4 times in a week is simply inhumane. There's simply no need for that. The only situation in which this would be called for is in a mass casualty situation or similar emergency.

What does NOT get published are the observations (ridiculed as "anecdotal") by seasoned physicians that people coming out of residency these days are less prepared than previously because of the reduced work hours.

Is there any data to support this? I certainly haven't seen any. Even if what you're saying is true, this should simply put the onus on programs to actually make good use of their teaching time. If you can't teach a resident to practice medicine in 80 hours a week, then how are you going to do it with 100 hours a week? How about hiring midlevels or secretaries to do the meaningless paperwork and tedium that we often do that has nothing to do with our education? Hell, if they just knew how to utilize computers in systems integration in medicine, I could shave about 10 hours off my week every week if it would just put all my patients vitals and labs on a sheet for me and write all of the basics of my progress notes (e.g., date, time, patient name and vitals) so that I could just review them rather than write them every time.

 

[Cruzinman]

Prowler, I agree 100% with your last point. Many of my peers are computer illiterate. However, my personal belief is that because of HIPPA restraints fully electronic medical records will never be a reality. One small example: I was out of town two weeks ago and lost my prescription sunglasses. I went to a national optical chain that was fully online with all of the other stores in the country. After my eye exam I asked the OD to e-mail the results to my local OD in the same chain. I was told that this was impossible because of HIPPA. Instead they would have to fax the paper chart. Of course this is a complete fallacy because the same "wrong eyes" that might view the computer screen may also be picking up the fax.

This is just one tiny example, and why I believe that EMR's are DOA. Another reason that office EMR's are lagging is that there is no single cost-efficient program that can be justified for the solo practioner. The cheapest I've been quoted is $10,000 just to set up the system, with a $5000 annual service contract. With a net profit of $17/patient after expenses it would take nearly 600 extra patients in Year One alone to not lose money from the EMR system. Now if Obamacare would pay for my system that would be another story, but i'm not holding my breath.

 

[JenB]

Now if Obamacare would pay for my system that would be another story, but i'm not holding my breath.

Ummm...it will (in many cases): http://www.cms.gov/EHRIncentivePrograms/

(apologizes to the OP for continuing the off-topic part of this thread).

 

[Cruzinman]

Here's a good use of EMR's, IMHO: If you don't feel like working 80-100 hours/week like physicians from my generation, then please when I pre-round on my patients at 5:30 AM pre-surgery please just enter your observations into your tablet computer before going "off shift" the night before so that I can read something when I get in in the morning rather then trying to get a detailed presentation from someone who has one foot already out the door, striving for your "work/life balance", or whatever it's called these days.

 

[mrmandrake]

Hell, if they just knew how to utilize computers in systems integration in medicine, I could shave about 10 hours off my week every week if it would just put all my patients vitals and labs on a sheet for me and write all of the basics of my progress notes (e.g., date, time, patient name and vitals) so that I could just review them rather than write them every time.

Hi Prowler,

Could you clarify what you meant here? I'm an M2 but I do have an computer engineering degree and I've been meaning to look into EHR's and how they could improve. We use EPIC here and the doctors I've worked with like it. From what I understand, most EHR's do have a "summary" page with old patient visits and their vitals and labs from those visits. Is there something I am missing?

What exactly is the problem you are seeing with your system and what system do you use exactly? Thanks!

 

[Jolie South]

Hi Prowler,

Could you clarify what you meant here? I'm an M2 but I do have an computer engineering degree and I've been meaning to look into EHR's and how they could improve. We use EPIC here and the doctors I've worked with like it. From what I understand, most EHR's do have a "summary" page with old patient visits and their vitals and labs from those visits. Is there something I am missing?

What exactly is the problem you are seeing with your system and what system do you use exactly? Thanks!

I think what he's saying is that all that stuff is in the computer, but you have to copy it down by hand into a note every single day. If an EMR could put all the vitals, daily labs, and meds into a note format that could just be reviewed and annotated with an updated A&P everyday, that would save a lot of time.

 

[Llenroc]

Call is what separates being a doctor from all those other professional jobs out there like being a lawyer or a banker. It's no small thing.

If you didn't know that medicine involved a fair bit of call during the early training years, and perhaps lifelong call, then you could be in for a rude surprise.

 

[45408]

Here's a good use of EMR's, IMHO: If you don't feel like working 80-100 hours/week like physicians from my generation, then please when I pre-round on my patients at 5:30 AM pre-surgery please just enter your observations into your tablet computer before going "off shift" the night before so that I can read something when I get in in the morning rather then trying to get a detailed presentation from someone who has one foot already out the door, striving for your "work/life balance", or whatever it's called these days.

I'm usually there until 11:30am on a post-call day. It's not hard to get a post-call presentation on a patient. It's not really a work/life balance as much as actually sleeping periodically.

 

[45408]

Hi Prowler,

Could you clarify what you meant here? I'm an M2 but I do have an computer engineering degree and I've been meaning to look into EHR's and how they could improve. We use EPIC here and the doctors I've worked with like it. From what I understand, most EHR's do have a "summary" page with old patient visits and their vitals and labs from those visits. Is there something I am missing?

What exactly is the problem you are seeing with your system and what system do you use exactly? Thanks!

I think what he's saying is that all that stuff is in the computer, but you have to copy it down by hand into a note every single day. If an EMR could put all the vitals, daily labs, and meds into a note format that could just be reviewed and annotated with an updated A&P everyday, that would save a lot of time.

Jolie is right. I copy it into the patient's chart as well as onto my patient list that I carry with me so when the attending asks what someone's urine output and WBC count are, I can give them a reliable answer. I can't memorize that info on 25 patients.

 

[Cruzinman]

I'm sure that you guys have a pretty good idea on inpatient charting, but hopefully you will unlearn some of the lessons they teach you in med school, which will save everyone mountains of time and get everyone home earlier. Believe it or not, not every problem of every one of your patients has to be "SOAPED". It's not just med students but everyone down to the social worker student feels that every problem has to be SOAPED. If only the patient's current medical problems that actually affect decision making on that day were SOAPED, that might be reasonable. For example, if the patient is being treated for lobar pneumonia, then SOAP the notes for the pneumonia. If the patient also happens to have a small, 3 cm benign lipoma that hasn't changed in size in 25 years, trust me, that doesn't need to be SOAPed until it needs to be addressed, which carries a 100% chance of it being excised in the outpatient clinic.

 

[tigress]

So explain how residents in many other countries work fewer hours (35-60/week! depending on country), and yet their health care systems have better outcomes when looking at almost all statistics? It's complete BS that we can't train residents in this country on as few as 60 (or fewer) hours a week. The older generations just want us to suffer through the same hazing they did.

You can easily look up worldwide health statistics.
And this site has an overview of residencies in various countries
http://residency-database.helmsic.gr/

 

[45408]

So explain how residents in many other countries work fewer hours (35-60/week! depending on country), and yet their health care systems have better outcomes when looking at almost all statistics?

Better access to care, better utilization of comparative-effectiveness research, more treating the patient and less covering your ass, lower case loads, fewer obese alcoholics with a 2 pack/day habit, etc.

 

[tigress]

Better access to care, better utilization of comparative-effectiveness research, more treating the patient and less covering your ass, lower case loads, fewer obese alcoholics with a 2 pack/day habit, etc.

This may all be true, but you still have to have physicians functioning at a certain level of competency (a fairly high level, I would think) to achieve the outcomes reported by the high statistics in these countries. So my point still stands.

 

[McGillGrad]

So explain how residents in many other countries work fewer hours (35-60/week! depending on country), and yet their health care systems have better outcomes when looking at almost all statistics? It's complete BS that we can't train residents in this country on as few as 60 (or fewer) hours a week. The older generations just want us to suffer through the same hazing they did.

You can easily look up worldwide health statistics.
And this site has an overview of residencies in various countries
http://residency-database.helmsic.gr/

In the UK, the answer is 8-10 years of residency after medical school.

 

[tigress]

Well I might be in the minority but I'd be happy to do 4-5 years of residency if I could work fewer than 60 hours a week, compared to 3 years at 80+ hours a week.

Anyway as far as the original post, I think it depends so much on the school that you can't generalize. I've had friends who have never had overnight call through med school and usually had 5 day weeks, whereas at my school the standard is overnight call in most rotations and 6 day weeks almost without exception.

 

[Winged Scapula]

Well I might be in the minority but I'd be happy to do 4-5 years of residency if I could work fewer than 60 hours a week, compared to 3 years at 80+ hours a week.

You are in the minority then; on SDN and elsewhere (ie, ACS surveys) residents have consistently said they would rather work more hours for less years.

And you have to be careful interpreting world-wide health statistics; there are many factors, including the US's tendency to treat at the extremes of life (and have unsuccessful outcomes) which in other countries would not be done.