Being on call as a first-year ophthalmology resident is a trial. Junior residents are exposed to a flood of patient scenarios and information. Here is a primer to make your time on call just a bit simpler.
1. Develop a routine early on. Learning any complicated task requires repetition. Developing good habits early on will leave you bulletproof from fatigue and save you time in the middle of the night. You can start with vision, pressure, pupils and drops. Have a protocol for patients you are dilating, those you are taking to the operating room and any particularly high-stake cases, such as ruptured globes. Just like a jet fighter pilot, have a printed checklist in your call bag.
2. Understand the risks. Ophthalmologists are in contact with infected mucosa and patients’ airways daily. So be sure to use proper personal protective equipment, especially if you are facing a patient with “red eye” or a possibly infectious case. There is no reason to expose your patients or yourself to unidentified pathogens. N95 or similar respirator masks and face shields are the standard for protection from droplet-borne pathogens.
3. Be a good communicator. We know you’re tired, but remember that so is everyone else. Make sure you confirm all instructions and write down your notes and instructions without acronyms for both the patient and the consulting team.
4. Perform your own exam and take your own history. Even if everyone has good intentions, you are responsible for this patient and their care. Take your own history and perform your own complete exam. Patients often change their story inadvertently, and physicians perform every exam a bit differently. Be sure to reduce medical errors by being thorough.
5. Bring your own supplies. When possible, have a call bag that is fully stocked. You know what happens when you assume. Don’t assume that things are stocked and left in the place you like them to be. If you bring your own readers, drops and fluorescein strips, for instance, you will save yourself a lot of trouble on call.
6. Know the resources available to you. Every program and hospital has different resources available — and sometimes different ones during the day and at night. So get to know the ED personnel and resources there as well as the physical space, the availability of lasers and, perhaps most importantly, who runs what and how. This will make you more efficient at examining the patient and communicating with the urgent care team.
7. Record everything. Write your notes and dictate right away. Not only is it fresh in your mind as soon as it’s done, but other providers will be waiting for your note to complete the patient’s visit. On the flip side, record the patients name, date of birth, medical record number and their phone number. This way fewer patients will be lost to follow-up for their vision-threatening issues.
8. Familiarize yourself with the Wills Eye Manual — your new best friend. This resource will help you keep a thorough differential and make you shine in the eyes of your seniors. Consider reading before your physical exam to direct your experience with the patient. Once done, leave the room and make sure you have explored all pertinent findings before calling your senior residents.
9. Support your local dollar store and pick up a pair of +1.50 and +3.00 readers. Patients often don’t bring their glasses during emergencies, and this way you can get a legitimate near vision for your exam. Often the visual acuity will drive your decision-making. Make sure to have a real metric to rely on.
Now get your sleep and know that you can wake up for a call confident that you are prepared!
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James G. Chelnis, MD,
is chair of the YO Info
editorial board. He is an oculoplastics surgeon in private practice in New York, Ny.