What does “On call” mean? A primer for the non-medical (or not living with anyone medical) person.

So, I just finished 7 days on call covering general surgery.  For the first 3 days, I was on call for two different hospitals, and then, phew, only covering one hospital for the last four days.  Yup, that was 24/7, for 7 days in a row. Now I am a surgeon,  and a lot of people do not know what “on call” actually entails for me, so I’m going to explain it to you.

  1. On call does NOT mean being paid to sit around doing nothing until you are called. While on call last week, I did two full day operating room lists of elective surgery, one very large outpatient clinic, and one half day of lumps and bumps clinic. When on call, I get to fit in seeing the emergency patients on top on this schedule. This on top of meetings, paperwork, and looking after my kids, pets, and household.  FYI as a surgeon, you HAVE to do on call to get operating room time in public hospitals.  And this is Canada, so all the hospitals are public. It’s not an optional part of the job as a surgeon. That’s just the way it works.  If you want to make surgeons REALLY mad, give somebody not doing on call operating room time, and then stand back and watch the fireworks.
  2. Just because I am NOT on call, does not mean that I am not working. Next week I will do two operating room lists, and two clinics, even though I am not on call. It’s called fee for service. It’s how I am paid, and it basically means, No work, No pay.
  3. I do not sit in the emergency room waiting for surgical patients to come in. That is why we have emergency doctors. Their job is to assess patients first and then call me to come and see the patient if they suspect or know there is a surgical problem. I come in and assess patients at the emergency doctors request, and then arrange either an operation (removing burst appendix, gangrenous gallbladders etc), more tests, admission to hospital, discharge, outpatient follow up, or any combination of these five things.
  4. There is a long list of things you cannot do on call. I do not drink alcohol, travel more than ½ hour from where the hospital is, swim, boat, take any sort of sedating or stimulating medication, get more than a metre from my cell phone, do any social event or movie, or generally have any fun of any kind whatsoever while on call. I DO get to make those around me, especially my family, almost as tired, stressed, and crabby as I am.
  5. Different hospitals have different requirements as to on call. Some larger, busy hospitals do require certain specialists to sleep in the hospital (anesthesia and obstetrics for instance). I do not have to sleep in the hospital, thank goodness as I live quite close to where I work. Medical trainees like interns and residents, sometimes need to do “in-house” call, which is where they sleep in the hospital (IF they sleep), while working, usually 24 hour shifts. Our hospital requirement is to answer your phone within ten minutes of being called, and be available to be present in the ED if required within 20 minutes of being called. How I am expected to do this as a surgeon who occasionally does long cases taking several hours, I don’t know. Nobody asked me, I just got the memo.
  6. Just because I have been on call does not mean I then get days off to recover. Even if it has been busy on call and I have been up all night operating . I am expected to mange my own fatigue level. But again, no work, no pay.
  7. Just because you have waited several months for an outpatient appointment with me does not preclude me having to run out of my clinic with a packed waiting room because someone is sick and needs my expertise at the hospital. I’m on call so it’s my responsibility to be available. If I did not do clinics while I was on call, you would have waited double the amount of time to see me electively. Now you know why doctors are late SOME of the time. Some doctors, like some people, are just always late.
  8. My on call schedule is every other week, from Monday at 8am, until Friday at 8am, and every 5th weekend (Friday, Saturday, and Sunday). I still have to be available by phone if I have inpatients, whether I am on call or not, plus I am expected to see them (round) every day in hospital. I have to make up my call before going on vacation or to a conference, or when I get back, usually a bit of both.
  9. I am not perfect, and occasionally let my cell phone battery die, take a shower, go out of range, and no people, I do not take my cell phone into the bathroom. I do not want to talk to you while you’re on the toilet, and I assume you feel the same about me. Leave a message!
  10. I am not always doing lifesaving surgery or interventions, or having life altering discussions with patients and families, but some of the time, I am. You don’t know what any given physician has been dealing with before you meet them. Don’t assume I’ve just come from a two hour massage appointment. I’ve never had a two hour massage in my life, and if I did, I certainly wouldn’t do it while on call. We’re human, and like the viral picture of the emerg doc who lost a young patient in New Zealand recently, we have to deal with some heavy stuff and cope with it the best we can. It’s our privilege to be doctors on call helping people through some of their worst moments. One of the best parts of my job is seeing somebody who was very sick in emergency come in for a follow up appointment, having been able to get back to their regular life after emergency surgery.

The irony is, I sort of like on call.  If I could just do emergency general surgery that would be great.  It’s trying to combine it with any other activity that gets stressful.  But because I work in a small hospital with only one other general surgeon, I simply cannot put the rest of my life on hold for the almost 40 % of the time that I am on call.  Some people handle being on call with a more relaxed attitude than I do, and I envy them, but it does not help me cope with the call any better.  I take my job seriously, because it’s a serious job.  It doesn’t mean I don’t enjoy it most of the time.  So the next time a doctor apologizes for being late, taking a phone call in the middle of your appointment, or forgets some aspect of something you have told them because they were or are on call, maybe you can understand what that means a bit better.

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