13 May 2010

Many kinds of "call"

I didn't realise until now that there are many kinds of call. It turns out, the overnight kind we all think of when we hear "on call" is more precisely long call. If you are on long call, it means your service is admitting patients. On my current service, the interns cap out at 4 patients each and the senior resident doesn't stay all night.

While on long call you also cross-cover the patients on other services. If something happens to a patient admitted to another service over the night, you will get the page instead of them. Of course, this also means that your patient's problems will be handled by others when you are not on call.

The day after overnight call you are post call. Interns usually leave by noon because they were working all night. The senior resident will finish any remaining management on the patients for that day. Unlucky for the medical students: afternoon conferences are still required even if you're post-call.

The second day after long call you are on short call. You admit one patient early in the day.

The day before your long call, you are pre-call. Your service doesn't admit any new patients in anticipation of the new load during long call.

Another good question: what does it actually mean - "admitting" a patient? Well, it means the ED or another hospital has determined a patient needs care in your hospital. When your service accepts the patient you get a one-liner about their major symptom (chief complaint). Then you go and examine the patient, ask lots of questions and come up with several possible reasons for their illness (differential diagnosis). You also come up with a plan of how to manage each of the patient's problems. Usually the intern will see the patient first, then the senior resident, then the attending. The intern writes up an admission note and the attending co-signs it.

Each day in the hospital the intern (and med students) will pre-round on the patient, then the interns, resident and attending all round on all the patients together. They discuss progress and complications that occurred overnight and how to continue or change the management plan. The intern and the senior then spend the day organising that care and documenting it.

That's life on general medicine, inpatient. I'll post some stories about my first patients soon.