WILTIMS #340: "On-call"

Yesterday was my first of four on-call shifts for this clerkship. It seems that these shifts are only called "on-call" to make us feel like like we are important enough to call about anything. Really, they're just extra shifts at odd hours to get us used to long miserable hours. This one was 10 hours in the ER. I've worked 10, 12, and more hours before but when you're as useless as we are, the time sure flies like a brick.

I had one other classmate who was on-call yesterday, only this was his first day in the ER and this was my last. We had a good laugh as he made the same mistakes I did last Tuesday by treating the ER like an inpatient ward. When a patient is admitted for an inpatient stay, we need to know everything about them. We need to ask about this illness, all other illnesses, their family's illnesses, their living conditions, school, social life, habits, etc, etc. But in the ER, all we really need to know is how long the fever/rash/vomiting has been going on and what body part needs to be x-rayed.

Our most anxiety inducing task in the ER is presenting the patient's case to the attending physician (the head honcho who oversees all care in the department). In the ER, the attending really only has the time and need for a very bare bones assessment and plan. So when my colleague jumped into the most thorough presentation I have ever heard, we all listened wide-eyed and I was reminded of this:

YesterdayIL: If a patient asks you if you've done a simple procedure before, the answer is yes. It might more accurately be, "Yes I've done something not entirely dissimilar to that procedure once, two years ago and it only went so-so," but for the sake of your education and the patient's mental well-being, just say "yes."

It seems dishonest, but especially if you're inexperienced, you will be guided through every step by an extremely qualified overseeing physician. The whole point of teaching medical students for years before putting them in clinical situations is so that we know exactly what the instructing physician means as s/he guides us through each step. We know all the whats (body parts, medications, tools) and most of the whys, we just haven't had an opportunity to master the hows. With proper instruction we are essentially a new pair of hands acting out an old physicians wishes.

Of course, if a patient asks point blank how many times we have done this exact procedure, none of us are going to lie. Hopefully if the routine nature of the procedure is adequately explained, the patient (or parent) would be willing to let us continue even knowing our inexperience. But when possible, it can be useful to use confidence to garner some mutually beneficial trust, even at the expense of full-disclosure.