On-erous call

Being on call means different things to different people, but it is safe to say that on call is a state that most physicians would avoid if they could. On call obligations are almost always included in advertisements in search of primary care physicians because both recent graduates of training programs and older physicians with their eyes on a retirement horizon put less-taxing call rotations high on their priority lists.

What makes on call so onerous? There is the obvious fact of life that the on call person is working at times when everyone else would rather not work ... nights, weekends, holidays, etc. Being on call can mess with your mind. It smacks of martyrdom for those of us who weren’t cut out to be saints. In places like Maine where warm sunny days are a rarity, being on call can tempt even the most altruistic among us to silently harbor hopes for rain so that we won’t be missing out on as much fun.

Being on call means that you will be fielding questions and interacting with patients and families who haven’t chosen you to be their primary care physician and with whom you are unfamiliar. This mutual unfamiliarity can breed discontent. It certainly doesn’t foster confidence. As on call physicians, you may be forced to invest extra time and effort to establish a therapeutic relationship with patients to whom you are a stranger. The failure to accept this challenge makes you more vulnerable to lawsuit should there be an unexpected outcome.

The physician who has made an effort to educate his patients and families is usually rewarded with fewer calls from them after hours. But, he will be frustrated by calls from patients of physicians who haven’t been as diligent at providing anticipatory guidance.

And, of course, there is always the problem of "But, Doctor Otherguy always just calls in a prescription for eye drops." There isn’t a perfect solution to this problem because physicians don’t all pop out of the same mold. However, discussions at group or hospital meetings, even if just informal chats in front of a chafing dish of overcooked vegetables, can help create some semblance of uniformity and minimize on call friction.

In some ways, a busy on call day that involves scores of calls and patient encounters can be more tolerable than a quiet day sitting at home waiting for the occasional call or beep. When it’s busy, the time passes more quickly, and encounters may generate some income (but never enough to justify the inconvenience and discomfort of being on call). However, when it’s quiet, you can slip into denial that you are on call. You may be tempted to make plans and begin activities that if interrupted could tip you into a cauldron of anger and self-pity.

There is an art to crafting an on call lifestyle that is compatible with a quiet on call. Choosing activities that one enjoys, but can be easily interrupted is a skill that comes after years of painful trial and error. When I was carving birds, I could drop my knives and head out to the office or hospital without a whimper. However, if I was in the middle of painting a project, the process of cleaning up and preserving the mixed color was too frustrating. So I only painted when I was off call.

Choosing which social invitations to accept also can be a challenge. Backyard cookouts are usually easier to exit by disappearing into the foliage. However, a small dinner party is a bad choice when one is on call. Several years ago, I discussed the issue of drinking on call in this column, and clearly, this is a personal decision that we all must make after a period of honest introspection.

Finally, communicating to one’s family the reality of on call and the inevitability of interruptions is of critical importance. Spouses and children can learn that "it-is-what-it-is" as long as we don’t allow ourselves to dip into denial and communicate our frustrations to them. They can learn to build their own lives while we are in that onerous other world of being on call.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including "How to Say No to Your Toddler." E-mail him at [email protected].

Being on call means different things to different people, but it is safe to say that on call is a state that most physicians would avoid if they could. On call obligations are almost always included in advertisements in search of primary care physicians because both recent graduates of training programs and older physicians with their eyes on a retirement horizon put less-taxing call rotations high on their priority lists.

What makes on call so onerous? There is the obvious fact of life that the on call person is working at times when everyone else would rather not work ... nights, weekends, holidays, etc. Being on call can mess with your mind. It smacks of martyrdom for those of us who weren’t cut out to be saints. In places like Maine where warm sunny days are a rarity, being on call can tempt even the most altruistic among us to silently harbor hopes for rain so that we won’t be missing out on as much fun.

Being on call means that you will be fielding questions and interacting with patients and families who haven’t chosen you to be their primary care physician and with whom you are unfamiliar. This mutual unfamiliarity can breed discontent. It certainly doesn’t foster confidence. As on call physicians, you may be forced to invest extra time and effort to establish a therapeutic relationship with patients to whom you are a stranger. The failure to accept this challenge makes you more vulnerable to lawsuit should there be an unexpected outcome.

The physician who has made an effort to educate his patients and families is usually rewarded with fewer calls from them after hours. But, he will be frustrated by calls from patients of physicians who haven’t been as diligent at providing anticipatory guidance.

And, of course, there is always the problem of "But, Doctor Otherguy always just calls in a prescription for eye drops." There isn’t a perfect solution to this problem because physicians don’t all pop out of the same mold. However, discussions at group or hospital meetings, even if just informal chats in front of a chafing dish of overcooked vegetables, can help create some semblance of uniformity and minimize on call friction.

In some ways, a busy on call day that involves scores of calls and patient encounters can be more tolerable than a quiet day sitting at home waiting for the occasional call or beep. When it’s busy, the time passes more quickly, and encounters may generate some income (but never enough to justify the inconvenience and discomfort of being on call). However, when it’s quiet, you can slip into denial that you are on call. You may be tempted to make plans and begin activities that if interrupted could tip you into a cauldron of anger and self-pity.

There is an art to crafting an on call lifestyle that is compatible with a quiet on call. Choosing activities that one enjoys, but can be easily interrupted is a skill that comes after years of painful trial and error. When I was carving birds, I could drop my knives and head out to the office or hospital without a whimper. However, if I was in the middle of painting a project, the process of cleaning up and preserving the mixed color was too frustrating. So I only painted when I was off call.

Choosing which social invitations to accept also can be a challenge. Backyard cookouts are usually easier to exit by disappearing into the foliage. However, a small dinner party is a bad choice when one is on call. Several years ago, I discussed the issue of drinking on call in this column, and clearly, this is a personal decision that we all must make after a period of honest introspection.

Finally, communicating to one’s family the reality of on call and the inevitability of interruptions is of critical importance. Spouses and children can learn that "it-is-what-it-is" as long as we don’t allow ourselves to dip into denial and communicate our frustrations to them. They can learn to build their own lives while we are in that onerous other world of being on call.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including "How to Say No to Your Toddler." E-mail him at [email protected].

Being on call means different things to different people, but it is safe to say that on call is a state that most physicians would avoid if they could. On call obligations are almost always included in advertisements in search of primary care physicians because both recent graduates of training programs and older physicians with their eyes on a retirement horizon put less-taxing call rotations high on their priority lists.

What makes on call so onerous? There is the obvious fact of life that the on call person is working at times when everyone else would rather not work ... nights, weekends, holidays, etc. Being on call can mess with your mind. It smacks of martyrdom for those of us who weren’t cut out to be saints. In places like Maine where warm sunny days are a rarity, being on call can tempt even the most altruistic among us to silently harbor hopes for rain so that we won’t be missing out on as much fun.

Being on call means that you will be fielding questions and interacting with patients and families who haven’t chosen you to be their primary care physician and with whom you are unfamiliar. This mutual unfamiliarity can breed discontent. It certainly doesn’t foster confidence. As on call physicians, you may be forced to invest extra time and effort to establish a therapeutic relationship with patients to whom you are a stranger. The failure to accept this challenge makes you more vulnerable to lawsuit should there be an unexpected outcome.

The physician who has made an effort to educate his patients and families is usually rewarded with fewer calls from them after hours. But, he will be frustrated by calls from patients of physicians who haven’t been as diligent at providing anticipatory guidance.

And, of course, there is always the problem of "But, Doctor Otherguy always just calls in a prescription for eye drops." There isn’t a perfect solution to this problem because physicians don’t all pop out of the same mold. However, discussions at group or hospital meetings, even if just informal chats in front of a chafing dish of overcooked vegetables, can help create some semblance of uniformity and minimize on call friction.

In some ways, a busy on call day that involves scores of calls and patient encounters can be more tolerable than a quiet day sitting at home waiting for the occasional call or beep. When it’s busy, the time passes more quickly, and encounters may generate some income (but never enough to justify the inconvenience and discomfort of being on call). However, when it’s quiet, you can slip into denial that you are on call. You may be tempted to make plans and begin activities that if interrupted could tip you into a cauldron of anger and self-pity.

There is an art to crafting an on call lifestyle that is compatible with a quiet on call. Choosing activities that one enjoys, but can be easily interrupted is a skill that comes after years of painful trial and error. When I was carving birds, I could drop my knives and head out to the office or hospital without a whimper. However, if I was in the middle of painting a project, the process of cleaning up and preserving the mixed color was too frustrating. So I only painted when I was off call.

Choosing which social invitations to accept also can be a challenge. Backyard cookouts are usually easier to exit by disappearing into the foliage. However, a small dinner party is a bad choice when one is on call. Several years ago, I discussed the issue of drinking on call in this column, and clearly, this is a personal decision that we all must make after a period of honest introspection.

Finally, communicating to one’s family the reality of on call and the inevitability of interruptions is of critical importance. Spouses and children can learn that "it-is-what-it-is" as long as we don’t allow ourselves to dip into denial and communicate our frustrations to them. They can learn to build their own lives while we are in that onerous other world of being on call.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including "How to Say No to Your Toddler." E-mail him at [email protected].