Do I know what on-call docs go through?
Let me know your thoughts after reading this post – one of my first posts ever more than 4 years ago.
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OK, while I’m at it, I have to add one of the terms I created. No offense to the Chinese on this one. Even Wikipedia isn’t sure how the Chinese got implicated with this term. According to Wikipedia, Chinese water torture occurs when “water is slowly dripped onto a person’s forehead, driving the victim insane.”
Chinese Pager Torture occurs when a doctor slowly keeps getting pages all through the night until the doctor goes insane. Here’s an example as described to me by a colleague (I embellished just a little):
9:00 PM – Put kids to sleep.
10:00 PM – Go to bed.
10:30 PM – Get a page just as entering REM sleep. Patient is having a colonoscopy in morning and wants to know what type of laxative to take. Have patient read instructions to you. Explain what citrate of magnesia is. Call in prescription to pharmacy because patient wants to make sure he is getting the right laxative.
11:00 PM – Go back to bed.
11:15 PM – Get another page just as entering REM sleep. Patient’s girlfriend was just diagnosed in the ER with gonorrhea and wants to know if he should get checked. Refer patient to office. Patient does not want to go to office because he has been intimate with office nurse in past. You just want to go to sleep. Refer patient to ER.
11:35 PM – Call from answering service. Patient has called several times and threatened to sue them if they don’t put her through to physician on call. States she ran out of her blood pressure medications three days ago and now feels that her blood pressure is high. Wants physician to call in prescription so she can pick it up at pharmacy tonight. Call patient back. Ask patient why she feels her blood pressure is high. She states that her husband saw the blood vessel in her temple pulsating and that always happens when her blood pressure is high. Tell her she will have to wait until the morning and see her physician in the office. She threatens to sue you if she has a stroke. Pull phone away from ear and make face at phone receiver miming the words “Blah Blah Blah.” Look up the ER call schedule. You don’t particularly like the ER doc working tonight. Send patient to the ER, too. Get temporary bit of satisfaction for payback to ER doc from previous bogus chest pain admit. You’re officially getting slaphappy.
12:10 AM – Page from patient who is having chest pain and sweating. Beeper wakes baby up. Patient wants to know if it is OK to go to the ER. Tell patient he needs to call ambulance immediately. Patient asks if you can call 911 for him. Tell him “No . . . hang up the phone and dial 9-1-1.” Patient’s wife, who was apparently listening in on extension, suddenly yells at you for having a bad attitude. Get ticked off, hang up the phone, and go to the internet to look up laws on eavesdropping in your state.
12:40 AM – You’re officially wide awake. You have rocked the baby back to sleep and put her in bed. Now you can’t go back to sleep and are sitting upright in bed staring out the window because you know the pager is going to go off in the next 10 minutes. You just know it.
12:55 AM – Page from the hospital. Begin to wonder if you are psychic because you can predict pages within 5 minutes. Start to think that the nurse was probably paging the wrong number and you would actually have gotten the page within 10 minutes if she paged the right number the first time around. Nevermind that now. Nurse tells you that one of your partner’s patients has been having palpitations for the past 30 minutes. Ask nurse what patient’s pulse is. Nurse tells you “hold on.” You hear her put hand over phone receiver and hear a muffled yell down the hall “CAN SOMEONE TAKE THE PULSE OF THE PATIENT IN 443B?!?” Three minutes later she takes hand off the phone receiver and says “88.” You order an EKG. The nurse says that the EKG machine is broken and that they will have to go borrow one from another floor. You ask them to call you with the machine reading.
1:35 AM – Paged from hospital again. Baby wakes up crying again. Nurse states that this EKG machine does not give interpretations. Ask nurse to go to ER doc to see if he will read it for you. Hope that the patients you sent there have not actually gone to the ER. Begin thinking about it . . . he’s really not such a bad guy and a reasonable doctor may have admitted that last chest pain that turned out to be bogus. Rock baby back to sleep and put pager under pillow so it won’t wake baby any more.
2:10 AM – Spouse elbows you in the side to wake up and answer your pager. You jump up, pick up the clock, stare at the time, and dial hospital extension “210.” Spouse holds up your pager and tells you 210 is the time, not the extension number. Shoot spouse a glance that “I’ll deal with YOU later.” ER doc tells you that the EKG is normal and wants to know if you actually see patients in your office since three patients came in telling him that you sent them to the ER in the middle of the night for such medical “emergencies” as medication refills and STD checks. Thank him for his help and secretly hope that a couple of your chronic back pain patients show up in the ER, too.
2:15 AM – Call the nursing station. No one answers. Call back twice more. No one answers. Call hospital operator and ask to have nursing supervisor paged. Ask nursing supervisor whether there is a problem on floor because no one is answering phone. She goes to floor and all the staff states that the phone never rang. Asks you what extension you dialed. Suddenly slap your forehead and state that there must have been a connection problem. You do NOT tell her that you have been dialing extension 210 for the past 5 minutes. Finally speak to a nurse and ask for update on patient with palpitations. Nurses state that patient’s symptoms resolved. Order patient a sleeping pill.
2:30 AM – Call from hospital. Nurse states that patient with palpitations is now sleeping and wants to know if you want to wake up the patient to give her a sleeping pill. You yell “WHAT?” loud enough that you wake your spouse. Spouse rolls over in bed and puts head in between two pillows. Great. Now you can’t shoot your spouse any more of those looks.
3:55 AM – Pager beeping again. Drool is rolling down the side of your mouth like you had a stroke. Spot of drool is on shoulder. Patient complains of not being able to sleep. That little blood vessel in your temple gets pulsating when you think of the bitter irony. Return page and find out that patient has had URI symptoms for two weeks. Tonight, the patient’s nose is so stuffy that she can’t sleep. Wants you to call in a prescription. Ask her if she has taken any medications in the past 2 weeks. No, she’d rather have a prescription since they tend to work better. Take phone away from ear, hold in front of you and squeeze with both hands as if you are choking it. Wonder if you called in a prescription for arsenic whether any pharmacy would actually fill it. Begin to wonder how to dose arsenic. Tell the patient you will call in a prescription for her. Let evil giggle slip out of your mouth as you are hanging up phone. Spouse now rolls over and looks at you as if you have lost it. Smile at spouse. Make a mental note of patient’s phone number so that next time you are up at night on call you can call her back at 4:00 AM and ask her how she’s feeling.
4:45 AM – Pager goes off. One of your partner’s patients with chronic back pain ran out of his Vicodin prescription last week and now his pain is unbearable. Holy crap! You really are a psychic. Wonder what your spouse is dreaming about. Command that the pager not go off until 7AM when your call ends. Shake your head again to wake up. OK, professional dilemma. Do you send patient to ER and hope that there are no more patients with palpitations or do you call in narcotic prescription and reinforce future phone calls at 5AM? Tell the patient you will call in two Vicodin tablets until patient sees his physician in the morning. Patient argues with you over whether they will be regular strength or ES. Tell him they will be Vicodin ES. Call in regular strength Vicodin to pharmacy.
5:30 AM – Pharmacy calls. Patient stated that he was supposed to get Vicodin ES and prescription was for regular Vicodin. Hit yourself in the head with phone receiver. Your little scheme backfired. By the way, were you aware that the patient has had 180 Vicodin pills prescribed in the past 3 weeks by 4 different physicians? Tell pharmacist not to fill prescription. Text message partner that this patient is a drug-seeker and you busted him.
6:00 AM – Pager goes off. Back pain patient is calling back and wants to know why you canceled the prescription. You tell the patient to wait because the office opens in two hours and he can just come in to be evaluated. He yells at you that his pain is “10 out of 10, dammit!” Fine. Go to the ER, then. Who cares what the ER doc thinks, anyway? He gets to go home after his shift and doesn’t get woken up by a pager. Hang up pager and put phone under pillow.
6:45 AM – Spouse wakes you up and wants to know what you did with the phone. Kids ask you why you look so tired. Smile and hum along to the circus music playing in your head.
Just think, you’re on call again tomorrow night.
How are these two people related? Actually, they are pictures of the same person taken 5 years apart. The woman started itching after having a “bad reaction to seafood.” Afterwards, she aged 50 years “in a matter of days” and she keeps getting worse. Doctors can’t figure out what is causing the problem.
Time To Join The Debate Team?
Sunday, October 9th, 2011This past Friday, I saw six patients who had assorted injuries from football games. Six.
Two of them had concussions, which goes along with a recent study published by the CDC showing that concussions are on the rise. See articles here, here, and here. CDC report is here.
There is a lot of debate on how to manage sports-related concussions.
The American Academy of Neurology essentially recommends discontinuing participation in the sport until symptoms resolve and appropriate evaluation … by a neurologist (or other physician with “proper training”) … prior to being cleared for participation.
The Consensus statement on concussion in sport (2008) recommends physical and cognitive rest until symptoms resolve and then a graded return to activity prior to medical clearance.
There is also an excellent but dated (1999) article in American Family Physician containing a summary of the then-current treatment recommendations for concussion. Several recommendations included discontinuing participation in the sport if several concussions occurred.
Anyone symptomatic when I see them gets taken out of sports and gym until cleared by their physician.
I also had another “oops” from Dragon Naturally Speaking related to the football injuries which was almost finalized in the medical record …
I dictated “… followed by hitting head on another player’s football helmet.”
Dragon spat out ” … swallowed getting hand in another player’s foot vomit.”
Haven’t seen foot vomit in a while, but I know I wouldn’t want to be getting my hand in it.
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