Taking call as an addictive process

Let me talk about my predilection,

Which looks a lot like addiction

I keep taking call

After I’ve hit the wall

But improvement is my prediction.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went to have adventures and work in out-of-the-way locations.  After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took up a part-time, 54 hour a week position with a Community Health Center.  Since August I’ve done a working vacation in Petersburg, Alaska, Continuing Medical Education (CME) in San Diego and Denver, and 4 days In Mexico for our daughter’s wedding.

In 2001 a government Task Force declared pain the 5th Vital Sign that needed to be assessed at every visit along with temperature, pulse, blood pressure, and respiratory rate.  In the aftermath, pain management did not improve.   But the unintended consequences marched forward, with non-suicidal lethal overdoses of prescription opiates quadrupling in the course of ten years, until last year those drugs killed more than traffic accidents did.

Since September I’ve logged more than 70 hours of CME; about one-fourth of those hours have concerned addictions, pain management, and narcotics.

All addiction processes share certain characteristics.  The behavior continues despite adverse consequences, and occupies time to the detriment of other important activities.  Loss of control strongly indicates a pathologic behavior, where, for example, a person might say at the beginning of the night, “I’ll only have two drinks,” but loses count.  Or the runner who, intending to just do a quick 5 miles, ends up doing 14.  Loss of control counts even if it happens rarely.

The part about the addictive behavior robbing time from family hit home when I thought about my years taking call.  When I have call, my family knows they can’t depend on me.  I need increasing amounts of time to recover afterwards, both because I am aging and because the call burden has grown.

I have had adverse consequences.   About a year ago I started having palpitations corresponding to runs of atrial tachycardia from the stress of staying up too many nights in a row.

And I have lost control.  In residency, one can understand the naïve young doctor volunteering to help another resident out, but I failed to learn.  Recently I found myself working at 2:00PM though my call had ended at noon.

Yes, my employment depends on my taking call.  But I also have a friend in the wine and spirits business, who drinks for a living.  That he does it professionally does not negate his alcoholism.

To the best of my knowledge no one has examined taking call as an addictive process, but it sure looks that way to me.

I have only two bad nights of call until my clinic hands over our hospital business (with the exception of patients under the age of 18) to the hospitalists.

I wonder if I’ll backslide when I can’t find (or start) a Calloholics Anonymous meeting.


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