What they didn’t teach in medical school: Part 6 Being On Call

In the last fortnight the new registrars started and they have been thrown into being ‘On Call’. This means fielding calls from doctors in the emergency department about patients who might need admission to hospital.

This is something I do all the time and it is interesting to reflect that nobody actually taught me what to do – one day I was on a roster. I guess the expectation was that I’d been on the other side of the phone making calls to consultants so of course I knew what to do. But actually taking the calls is different from making the calls. For starters you might be asleep when the call comes in.

@cancersolutions (Matthew Links) & I have been pondering the question of what needs to be taught in medical school about being on call.

Some of the key competencies for oncology on call that we’ve identified include:

1. Assessing the reliability of the information obtained over the phone and the competence of the person making the call.
2. Prioritizing problems and anticipating other problems that the caller may not have thought of
3. Determining the appropriate location of care for a patient – does the patient need to go to a high dependency unit or even transfer to a different institution?
4. Appropriately involving or referring to other medical teams
5. Addressing supportive care and symptom management needs
6. Actively considering end-of-life issues and advanced directives
7. Communicating with other teams
8. Using the call as a teachable moment
9. Using the call as an opportunity for reflection – what would I have done differently next time?
10. Managing the caller – sometimes one gets a long-winded story that totally misses the problem….it can help to recalibrate the call e.g by returning to ask what was the reason the patient came to the ED?

Being on call can be stressful especially if there are a lot of calls. Learning how to do it properly can certainly make life easier.

If you’re interested in the topic of being on call my next post will be on how remote presence technology could be a disruptive innovation for the on call doctor.

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