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What does "On Call" Mean?

by Dr.Sal MD on author

on call doctors

Hell. Or that’s what on call felt like when I was doing it. At the first hospital I worked at, doctor "on call" meant working a day, that night, and then a full work day the next day. You caught any sleep you could during the overnighter. I remember this averaging about two to three hours, but some busy rotations like Obstetrics you might not sleep at all! The next day you felt like someone had smashed you over the head with a bottle of benadryl! The night when you finally got home I remember more passing out than falling asleep. The next three days were normal eight to five, before you got smacked again. In our lingo this is called a 'one in four' schedule, but during periods of acute staff shortage it can be contracted to even more gruelling 'one in three's' or the dreaded 'one in two' which stretches you to the brink of insanity then pulls you back from the edge like an elastic band.

On-call exists in large part because of staff shortages. It is expensive to train doctors and most localities have less than they could use; hospitals can't close their doors after business hours and need some doctors present 24 hours a day to provide continued care. But would you trust your pilot if you knew they hadn't slept the night before? Then why would you trust your surgeon? Some areas have already legislated laws to reduce exposure of the public to glassy eyed doctors. At the last hospital I worked at, we worked a day and night and went home by noon the next day. You have no idea how good those few extra hours of sleep felt.

Being on call means making yourself available after hours to respond to medical emergencies - a necessity in our modern 24/7 world. When I first started medicine, we used pagers for wards and staff to reach us: they'd leave a call back number and we'd zip to the nearest phone to make a call back. That's pretty much passe now with ubiquitous cell phones.

Has anyone died from being on-call?

Through car accidents, yes - but it’s slippery to prove. As a resident I remember one of my colleagues crashed his car into a wall after a night on-call and another killed a jaywalker as he was driving home. We ought to be deemed DWI (driving while intoxicated) when driving ourselves home after a night on-call. We would be safer to hand over our keys to designated drivers.

This past year I came across in the news, the case of 38 year old Beth Jasper, a nurse in Cincinnati, Ohio that after a 12 hour shift, drifted across the road and into a tree killing her instantly. A picture of her vehicle after the accident looked like it had been ripped apart by a tornado. She left behind her husband, a six year old son, and an eleven year old daughter. That day, she had reported to colleagues that she felt “really stressed”, and “hadn’t eaten”. What makes this case different is that her husband decided to sue the hospital where she worked. Other episodes go unreported and unrelated. The problem is that there isn’t a breathalyzer test to prove that functional intoxication from being overworked made you crash. But it ought to be listed as an occupational hazard as much as sticking your finger with a dirty needle. I know that for myself, I’ve crashed twice in the last decade. Each time was my fault, and each time it was on my way to work groggy from my day of medical actions the day before.

 


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