My First Solo Weekend on Call

March 8, 2011

This past weekend, for the first time ever, I was on call completely by myself. Since it was only me, I had to make some tough decisions.

This weekend was my first call weekend with my new group. For the first time ever, I was on call completely by myself.

Previously, as an intern, I was on with a senior resident. As a senior resident, I was on with an intern and supervised by an attending. Shortly after graduating residency, I was the attending who was supervising a resident and that’s pretty much the way it’s been ever since. Being on call by myself is both satisfying - I get to make all the decisions and I don’t even have to discuss them with anyone - and overwhelming, because I’m it for the whole weekend.

So, here’s a brief recap of my weekend. Friday night: pretty much nothing. I’ve found that’s pretty typical for a weekend. No one wants to waste their Friday night being sick in the ER. Saturday morning found me staffing the acute care clinic. I realized that patients only viewed the appointment time as a suggestion, leading to a leisurely 45 minutes first thing in the morning perusing e-mail and eating a chocolate chip scone followed by four hours running between four exam rooms.

I also felt incredibly guilty sending any patients to the ER or local urgent care center even when we were already fully booked, so squeezed them in wherever I could. Somehow, it all worked out and I got everyone taken care of and out the door at a decent time.

I had to make some tough decisions. Since it was only me, I didn’t have to make sure anyone else agreed with me, although I wondered how my partners might feel about the decisions I made when they looked through the Monday morning retrospectoscope. I went ahead and refilled 120 lorazepam for one patient who appeared to be on a stable dose and receiving regular follow up but only gave the next patient enough diazepam to get through the weekend when a quick chart review indicated that he may not have followed up like he was instructed.
 

I felt perfectly justified calling in penicillin for the household contact of a person with strep who had herself just developed a sore throat. I waffled on the patient who was certain she had sinusitis and wanted me to just call in an antibiotic rather than coming in to be seen, but finally did so with a strong admonition to schedule an appointment on Monday morning with her primary care doctor. I took a chance on a peritonsillar abscess that outpatient management would be successful. Unfortunately, he came back worse the next day and ended up being admitted anyway.

By Sunday evening, the ER physician was greeting my phone calls with a friendly, “Hi Jennifer.” We traded patients like players in high-stakes poker. I would send over a patient with hypertensive emergency and he would counter with a patient with chronic back pain who had no primary care doctor. I tried to decipher patients’ symptoms over the phone. Sometimes I was hampered by the fact that the patient did not want to actually talk to me, but preferred using a family member as an intermediary so that all my questions had to be relayed to the person with the actual symptoms. When in doubt, I overcalled it and sent them to the ER.
 

But it all went fine. It was a good weekend - I felt productive and confident that I really did provide the best care possible.
 

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