I was on-call for my group last week. Call as an attending is much different than residency. Unlike many a call night adventure written about on this blog (or "blah-g" as my friend Rose says), I no longer work for 30 straight hours, wear scrubs and eat chicken tender wraps (a.k.a., heavy prozac) at 4 in the morning.
Call now is taken from the comfort of my bed with a pager near my left ear. The pager alarms, I get up, go to my computer, talk to patients and parents and try to make sense of health issues at 2:30 AM. Then I go back to bed. It's annoying. Fatiguing. But not exhausting. It's good not to be a resident any more. For the most part my goal is to keep patients home as much as possible. But the larger goal is to keep patients safe and healthy, whether it means a dose of acetaminophen or an ambulance ride to the emergency room. Whatever it takes, no one dies and the sun comes up in the morning. That's just how call works.
When my practice fills, I'll be the primary care provider for between 1800 and 3000 patients. For me, I'll be a bit on the lower end of that range because I care for a more complex population of patients with greater health issues and less resources. But when I'm on-call, I don't just take call for my patients -- if I did, I'd be on-call 24/7/365 which is not healthy. So I share call with 13 other partners, each of which has a panel consistent of between 1800 and 3000 patients. Doing the math, that's somewhere between a lot and a whole hell of a lot of patients. Makes for some potentially bad call nights with lots of pages. In reality, it's not so bad because my partners are thorough and dedicated physicians who do their best to tuck-in their patients before they leave the office.
But to be clear, I don't stratify the patients I care for when I'm on-call. Whether it's my patient or the patient of the partner with whom I'm constantly at loggerheads, they get the same care from me. I don't go the extra mile for my own patients but phone it in for everyone else's. If I did preferentially tend to my own patients, I wouldn't be in practice for very long. My partners would be pissed and much worse, something very bad could happen to someone's patient (you know, a human being, not some abstract straw man concept to be disparaged and ridiculed). Same rules apply. Whatever it takes, no one dies and the sun comes up in the morning.
So when I hear members of Congress talk about defunding the Affordable Care Act (an act STRONGLY supported by my two main professional societies, the American College of Physicians and the American Academy of Pediatrics), I am especially dyspeptic when trite one liners are dropped like 'I'm fighting for the people who sent me to Congress'. Fighting for some and jabbing a political spear in the eye of many others. I'm thinking to myself, rather than fighting for your people, how about you keep the needs of ALL your people (you know us human beings who call ourselves Americans and not some abstract straw man concept to be disparaged and ridiculed). And I'm not even getting greedy and asking these Congressional members to rethink their opinions on the ACA and support an already legislated sweeping health care reform bill. No, I'm a little more simplistic: "Douche, you may have been elected in state X, but you're on-call for all of us. Pass a fucking budget and stop furloughing a bunch of people (you know, human beings who call themselves Americans and not abstract straw men concepts to be disparaged and ridiculed)!"
Call now is taken from the comfort of my bed with a pager near my left ear. The pager alarms, I get up, go to my computer, talk to patients and parents and try to make sense of health issues at 2:30 AM. Then I go back to bed. It's annoying. Fatiguing. But not exhausting. It's good not to be a resident any more. For the most part my goal is to keep patients home as much as possible. But the larger goal is to keep patients safe and healthy, whether it means a dose of acetaminophen or an ambulance ride to the emergency room. Whatever it takes, no one dies and the sun comes up in the morning. That's just how call works.
When my practice fills, I'll be the primary care provider for between 1800 and 3000 patients. For me, I'll be a bit on the lower end of that range because I care for a more complex population of patients with greater health issues and less resources. But when I'm on-call, I don't just take call for my patients -- if I did, I'd be on-call 24/7/365 which is not healthy. So I share call with 13 other partners, each of which has a panel consistent of between 1800 and 3000 patients. Doing the math, that's somewhere between a lot and a whole hell of a lot of patients. Makes for some potentially bad call nights with lots of pages. In reality, it's not so bad because my partners are thorough and dedicated physicians who do their best to tuck-in their patients before they leave the office.
But to be clear, I don't stratify the patients I care for when I'm on-call. Whether it's my patient or the patient of the partner with whom I'm constantly at loggerheads, they get the same care from me. I don't go the extra mile for my own patients but phone it in for everyone else's. If I did preferentially tend to my own patients, I wouldn't be in practice for very long. My partners would be pissed and much worse, something very bad could happen to someone's patient (you know, a human being, not some abstract straw man concept to be disparaged and ridiculed). Same rules apply. Whatever it takes, no one dies and the sun comes up in the morning.
So when I hear members of Congress talk about defunding the Affordable Care Act (an act STRONGLY supported by my two main professional societies, the American College of Physicians and the American Academy of Pediatrics), I am especially dyspeptic when trite one liners are dropped like 'I'm fighting for the people who sent me to Congress'. Fighting for some and jabbing a political spear in the eye of many others. I'm thinking to myself, rather than fighting for your people, how about you keep the needs of ALL your people (you know us human beings who call ourselves Americans and not some abstract straw man concept to be disparaged and ridiculed). And I'm not even getting greedy and asking these Congressional members to rethink their opinions on the ACA and support an already legislated sweeping health care reform bill. No, I'm a little more simplistic: "Douche, you may have been elected in state X, but you're on-call for all of us. Pass a fucking budget and stop furloughing a bunch of people (you know, human beings who call themselves Americans and not abstract straw men concepts to be disparaged and ridiculed)!"