“Call” is one of the most infamous aspects of medical training. However, it’s also a hugely significant part of the education of all ophthalmologists-in-training. From reading glasses to a call bag, here are 10 tips for providing the best care possible during late-night calls.
1. Don’t trust anyone else’s history or exam. ER docs and physician assistants are not trained in ophthalmology. Their input should be appreciated; however, always perform a complete and independent history and exam.
2. The Wills Eye Manual is a resident’s best friend. It may be worthwhile to read the manual before seeing the patient to help direct the physical exam and early differential. It’s an excellent resource to call upon before involving a senior resident or attending physician. Thoroughly explore it before climbing the ladder. In addition, download the Eye Handbook app for iOS or Android devices. It offers diagnostic pictures, treatment plans and tools, including a vision card and color plates.
3. Visit the local dollar store. Pick up a pair of +3.00 (as well as +1.50) glasses. This will make life easier when checking vision, especially in trauma patients requiring simultaneous lid retraction while holding the near card.
4. Bag it. Prepare everything in a call bag: vision card, fluorescein strips, eye patches, sutures for lid lacerations, Desmarres retractors ($20 for four on eBay), drops, etc. Be minimally reliant on the ER staff and stock.
5. Identify the tools available. Every program and hospital makes different instruments available. Know the most efficient ways to the indirect, portable slit lamp and other critical instruments. Know where to find an ultrasound (with an appropriate probe for B scans) that is available in the middle of the night, if needed.
6. Develop a routine. Vision, pressure, pupils, drops! Developing an efficient exam will save tons of time in the middle of the night. Be aware that dilating is not an option in every circumstance. In addition, streamline the process for preparing patients for the OR. Consider including a call bag to-do list (e.g., make patient NPO, update tetanus, place shield, etc.).
7. Know the coverage. This may seem simple, but no one wants to waste time at night determining backup, especially if different attending physicians cover different hospitals. Save the schedule and have it easily accessible.
8. Get their digits. Make sure to have a way to follow up with the patient. Certain diagnoses require close outpatient follow-up (e.g., preseptal cellulitis). Be able to contact the patient.
9. Provide clear instructions. This is very important when meeting people in distress at odd hours of the night! Make sure to write down all of the pertinent instructions and contact info so the patient can understand them and follow up accordingly. In addition, write the assessment and plan in plain English for the patient and ER staff!
10. Copy the note. Make a copy of the note for dictation and recording procedures as necessary.
Bonus. Get some sleep! It may be a long night!
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|About the author: James G. Chelnis, MD, is a resident at the University at Buffalo and has recently matched to the Vanderbilt/University of Tennessee ASOPRS fellowship. As a resident, he serves on the UB Residents’ Council, the Program Directors’ Advisory Council, and is a member of the UB Grievance Committee.