• JAN 01, 2014

    Top 10 Pearls on How to Survive Being on Call

    “Call” is one of the most infamous aspects of medical training. And, of course, it’s also a hugely significant part of the education of all ophthalmologists-in-training. From reference materials to a call bag, here are 10 tips for providing the best care possible during late-night calls.

    1. Pre-pack call-bag essentials. Put your common tools in one easy-to-access location. And make sure to include:

    • A near card;
    • Inexpensive (e.g., dollar-store) reading glasses for presbyopic patients;
    • Dilating drops;
    • Topical anesthetic;
    • Fluorescein strips; and
    • Tools (retractors and jeweler forceps).

    2. Know who’s got your back? Don’t lose precious time searching for a backup. Upper-level residents, fellows and faculty complete a rotating call hierarchy, but their schedules differ. If you need help tracking down this information, hospital operators can be useful.

    3. Be a good consultant. Don’t trust the referring source’s exam — they do their best but simply don’t have the same expertise and equipment that you do. Also, don’t forget that a non-ophthalmologist is going to rely on your note, so make it intelligible.

    4. Keep track of the patient. Call duties often require that you cover a diverse set of services — multiple emergency rooms, faculty practice patients, etc. Always get the patient’s phone number and make a copy of your note.

    5. Try to get a home-field advantage. The ideal ophthalmic examination requires specialized equipment that is sometimes not available in a call setting. If possible, arrange for exams in an ophthalmic exam lane (but keep security in mind, especially after hours). If the exam is at bedside, know where your equipment is stored — especially your portable slit lamp, Tono-Pen, indirect ophthalmoscope, B scan, etc.

    6. Take your time. Call is an educational opportunity, both in terms of diagnosing pathology and improving exam skills. The time pressure on call is often less than in the clinic, so take a moment to work on finer exam techniques such as scleral depression.

    7. Develop an efficient routine. Because you are doing the exam from workup to finish when on call, develop a routine that optimizes efficiency — your sleep is at stake! Applying dilating drops as quickly as appropriately possible and using dilation time for writing the note will help get you home (or on to the next consult) faster.

    8. Keep reference materials handy. Having a reference such as the Wills Eye Manual is critical, but it doesn’t cover everything. You may find that the management preferences at your institution are different, so make your own notes too.

    9. Stay logged in. As health records continue their electronic migration, remember that passwords expire. This can easily happen if you rotate off a service, so keeping current will save you from having to call IT in the middle of the night.

    10. Take care of yourself. Sleep when you can, eat well and maintain a semblance of normalcy with your routine and relationships. After residency, call duties don’t go away, so it’s important to learn good management skills early.

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    About the author: Brian Chan-Kai, MD, is a vitreoretinal specialist at EyeHealth Northwest in Portland, Ore. Dr. Chan-Kai completed his residency at the Cullen Eye Institute, Baylor College of Medicine, where he also served as chief resident. He then trained in vitreoretinal surgery and diseases at the Casey Eye Institute/Oregon Health and Science University.