Taking call is one of the more stressful experiences during residency, but certain things can make your call duty simpler. Here are some tips to help.
1. Take your own history and perform your own exam.
Ophthalmology is a “black box” to most physicians and other practitioners. You can trust, but make sure to verify!
2. Make The Wills Eye Manual your best friend.
This book will keep you out of trouble and help you shine. Especially early on, consider reading before your exam to help direct your patient interview. Definitely review it before contacting someone senior. By the end of your residency, this book will have helped you develop sound plans and differentials for common presentations.
3. Maintain a running list.
Keep running lists for everyone you see that include primary diagnoses, contact info and planned follow-up. If you’re old school, buy a notebook or use your favorite app (e.g., Evernote). Confirm the patient’s phone number! Certain diagnoses require close observation (e.g., preseptal cellulitis, hyphema, etc.). These steps will save you tons of headaches and make it easy to follow up.
4. Develop a routine.
Vision, pressure, pupils, drops! An efficient exam will save tons of time in the middle of the night — and developing good habits will help you ensure a complete exam, even when you’re tired. Be aware that dilating is not an option in every circumstance. For the OR, streamline the process for preparing ruptured globes. Lastly, include a to-do list in your call bag (e.g., make patient NPO, update tetanus, place shield, etc.).
5. Bag it!
Prepare everything in a call bag: vision card, fluorescein strips, eye patches, suture for lid lacs, Desmarres retractors ($20 on eBay for four), eyedrops, etc. Be minimally reliant on the ER and staff who don’t always know where to find all the “eye stuff.” Make sure to periodically restock necessary items.
6. Identify the tools available.
Every program and hospital makes different instruments available. Know the most efficient routes to the indirect, portable slit lamp and other critical instruments. Also, learn where to find an ultrasound with an appropriate probe for B scans that you can use in the middle of the night.
7. Know the coverage.
This may seem simple, but no one wants to waste time at night determining backup, especially if different attendings cover different hospitals. Save the schedule, and keep it easily accessible.
8. Visit the dollar store.
Pick up a pair of +3.00 and +1.50 glasses. This is especially useful for trauma patients who require lid retraction while simultaneously holding the near card. You’ll never have to hear, “I forgot them,” again!
9. Give clear instructions — in writing and without acronyms.
This is very important when meeting people in distress at odd hours of the night! Write down all instructions and contact info so the patient can follow them and follow up accordingly. Use words, not acronyms. Ophthalmology has a library of unique abbreviations and terms the ER physician may not know, so write the assessment and plan in plain English!
10. Copy the note.
Make a copy of the note for dictation and recording procedures as necessary.
Bonus.
Get to bed! It may be a long night.
* * *
About the author: James G. Chelnis, MD, is a newly appointed assistant professor in oculoplastics at the New York Eye and Ear Infirmary of Mount Sinai and has been on YO Info’s editorial board since 2012.