Wednesday, July 16, 2008

What is Call?

Some clarifications, based on a question I received in comments. Call is defined differently depending on what program you're in, what rotation you're on, and possibly by what country you're in.

Currently, when I say "call" I mean "long call" or "overnight call". I get to my regular weekday shift between 6 and 7 am (right now, usually around 7--we round kinda late). If I'm on call that night, I start carrying the call pager at 4 pm, and I take in all calls for patients in the ER to admit, or consults on medicine patients who have neuro problems, until 7 am. During the week, responsibility for admissions and consults goes to the consult resident; we admit every day on this rotation. On weekends, call starts at 7 am and goes to 7 am the next day.

After I quit taking new consults or admissions at 7 am, I finish any H&P's that aren't complete, write notes for the day, and get ready for morning rounds. We only round on newly admitted or consulted patients, but rounds still take awhile, as both attendings like to lecture--so where's the lesion? What tract of the white matter? What piece of the trigeminal ganglia is affected?

After rounds, I try to finish my notes, put in orders, and be out by noon. The latest I've stayed this month is 12:45 post-call; we didn't finish rounding/lecturing till 11:30 and I still had notes to finish and residents to page about their patients.

The rule is 30 hours straight: 24 hours of taking new patients, and 6 hours to finish up with those patients, but not take on any new patient duties. In actuality, this turns into "the 30 hour rule." If I get to work by 7 am, I should be gone by 1 pm the next day. Thus far, I've been "in compliance" with this rule. (I've also worked 79 hours, which keeps me "in compliance" with the 80 hour rule. No one has asked me to misreport hours, and thus far it hasn't been a problem.)

What different kinds of call are there? I know there are night float situations, long call/short call situations, even a "rolling call" deal on medicine at my program, which I will experience in November, but I have no idea how that works. Any thoughts on different kinds of call? How long are people working? My colleagues in general surgery, who are taking q3 call, have to be working at least 90 hours per week.


The MSILF said...

Holy crap - we don't round post-call. We have morning handoff where whoever was on call presents the new patients we admitted overnight in a meeting first thing, anyone who will be there can ask whatever they want, but we don't stay for the rounds. I'm pissed if it's 11:00 and I'm not out (which happened today).

If I had to round after some of these calls, I think I'd jump from the roof.

Basia said...

We have a rotating call schedule. Short call (admit till noon), post short, Medium call (admit noon to 5), post short, Long call (admit overnight), post long, and start over again. The awesome thing is that for long call, only one intern stays overnight. One admits till 9 and goes home, the other stays overnight. So technically, I have Q12 overnight call. Admitting every other day can suck at times, but the hours are sweeeeeeet!

Tiny Shrink said...

Man, I sure wish I didn't have to round post-call. I turn into a giggly, hysterical pile of mush who can't even find her patients' rooms post-call.

Anonymous said...

I wish... on our internal medicine service here in Canada we have no 80 hour rule... I worked 105 last week - and we always round post-call on our own patients. I left the hospital at 1:30pm today, hour 29.5 :)

Tiny Shrink said...

Holy crap, 105 hours???? That's awful! I'm barely functioning at 79 hours! I hope you are doing okay and that this doesn't last too long!