Call without flak jacket


For call, the way to prepare

Is to grit your teeth if you dare.

But this busy season

The load’s come within reason

And doesn’t hold much of a scare.

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 a position with a Community Health Center which dropped from 54 hours a week to part-time on December 1.  I’ve also done a working vacation in Petersburg, Alaska, Continuing Medical Education (CME) in San Diego and Denver, and a trip to Mexico for our daughter’s wedding.

It’s Sunday evening and I have weekend call but the meaning of that phrase has changed substantially. Joyously and radically.

Our practice gave our adult inpatient work to both hospitalist groups.  But internists only staff those, and neither will care for patients under the age of 18.  Thus we still attend pediatric and newborn patients.

I rounded on and discharged a young teenager at one hospital and two newborns at the other yesterday.  Today I sent those two babies home and admitted another newborn.

During medical school, standard practice demanded keeping newborns in the hospital for 5 days following normal delivery and a week following Caesarean section; by the end of residency the stays had dropped to 3 and  5 days, respectively.  Down to 2 and 3 days currently, we don’t see nearly as many septic babies as we used to when we kept the children longer in the germ-laden hospital.

When I go to the hospital and I print out the census for my group, I see names of patients admitted from our practice but on whom I don’t have to round.  One hospital had 5 names and the other had 4 yesterday and today the total came to 12, when a month ago our minimum total came to 20 and frequently ran over 30.

I have to ask myself if our respectful, expert care had anything to do with the fact that he patients kept getting so sick.  Certainly I find it believable that the drinkers would fail to learn if our well-oiled alcohol withdrawal machinery did such a great job of keeping them comfortable while they sobered up.  After all, people will jump more if you keep setting up the safety net.

But I also have to ask if our sicker patients have switched to doctors offering better continuity of care.

I slept well last night; I received no calls in the critical hours between midnight and 6:00AM.  I still got up early, had a good breakfast and went to work.  But afterwards I could go to the gym, go to brunch, take a nap, do some reading, and take in a movie.

And I could do it all without vigilance ruining the experience.

 

We used to talk about the emotional preparation for taking weekend call as “getting your flak jacket on.”  That 72 hours could be physically and emotionally exhausting, but we figured if we could make it to Sunday at noon we could handle any evil that would last less than 18 hours.I look forward to getting back to the office tomorrow.

I’m really enjoying my job now; easier without a flak jacket.

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