Anxiety while on home call

[Hanmari]

Hey everyone. So I'm a new PGY1 who's just gone from being junior resident on a service where I always had a senior resident with me on in-hospital calls, to another service where I am the only resident on call for the day/overnight for home call. After a few pages/calls where the ER bombarded me with questions I could not answer over the phone without actually requesting for consults, I am finding I have significant anxiety about not having help readily available to me. Of course the staff is always available via pager but I cannot imagine paging them about every issue that comes up esp. at night, and I do not feel confident enough in my knowledge to answer any question over the phone about treatment/disposition, etc. At the same time, I am reluctant to go in for a full consult for every question I receive over the phone because a) most often the calling services just want a quick answer and b ) my service depends on me not being post-call and if I go in for consults at night, my call converts.

Any advice on how to deal with my own anxiety? Should I just be comfortable with paging staff each time, or is there another way I can go about this? I am surprised by my own anxiety over not having other residents around me. Mad respect for seniors on every service who do this on daily basis. Thanks in advance for any good words!

[ArchEnemy]

39 minutes ago, Hanmari said:

Hey everyone. So I'm a new PGY1 who's just gone from being junior resident on a service where I always had a senior resident with me on in-hospital calls, to another service where I am the only resident on call for the day/overnight for home call. After a few pages/calls where the ER bombarded me with questions I could not answer over the phone without actually requesting for consults, I am finding I have significant anxiety about not having help readily available to me. Of course the staff is always available via pager but I cannot imagine paging them about every issue that comes up esp. at night, and I do not feel confident enough in my knowledge to answer any question over the phone about treatment/disposition, etc. At the same time, I am reluctant to go in for a full consult for every question I receive over the phone because a) most often the calling services just want a quick answer and b ) my service depends on me not being post-call and if I go in for consults at night, my call converts.

Any advice on how to deal with my own anxiety? Should I just be comfortable with paging staff each time, or is there another way I can go about this? I am surprised by my own anxiety over not having other residents around me. Mad respect for seniors on every service who do this on daily basis. Thanks in advance for any good words!

Have you tried speaking to your peers, or even a senior resident that you are closer to about this? Often times, we think that we are the only ones who feel this way, but in fact, every one of your seniors have been through a similar rite of passage and can offer you valuable advice. 

I am a new PGY-1 like you and I was on home calls for the past 2 rotations. In both rotations, I was "buddied" up with a senior resident (PGY-3 and up) whenever I am on home-call, and I would send him/her a text message summarizing the question/consult whenever I get a call from Emerg or from the floor requesting for a consult/question. Perhaps you can suggest such a system to be implemented in your program, at least for the first block or two that the PGY-1s are on-service. You are on the other side of the fence now. There's no pressure to appear like the "superstar" elective student that can recite Harrison's backwards.

[ralk]

48 minutes ago, Hanmari said:

Hey everyone. So I'm a new PGY1 who's just gone from being junior resident on a service where I always had a senior resident with me on in-hospital calls, to another service where I am the only resident on call for the day/overnight for home call. After a few pages/calls where the ER bombarded me with questions I could not answer over the phone without actually requesting for consults, I am finding I have significant anxiety about not having help readily available to me. Of course the staff is always available via pager but I cannot imagine paging them about every issue that comes up esp. at night, and I do not feel confident enough in my knowledge to answer any question over the phone about treatment/disposition, etc. At the same time, I am reluctant to go in for a full consult for every question I receive over the phone because a) most often the calling services just want a quick answer and b ) my service depends on me not being post-call and if I go in for consults at night, my call converts.

Any advice on how to deal with my own anxiety? Should I just be comfortable with paging staff each time, or is there another way I can go about this? I am surprised by my own anxiety over not having other residents around me. Mad respect for seniors on every service who do this on daily basis. Thanks in advance for any good words!

We're residents, staff should always be available. Doesn't matter if it's inconvenient for them or for the consulting service, we always have a right to consult staff - that's why they earn the big money and we get paid resident salaries. We should be starting to be able to handle some things ourselves and within your comfort level, you can start making more of those calls independently. But it's still early in our residency and we're being shunted around among many different services, so it's ok to be a bit uncertain about even some seemingly simple things.

When it comes to home call, I find the best thing to do is set yourself up with whoever is 2nd call to establish some ground rules. Get in touch with the staff before the call shift starts, feel out their expectations and indicate your comfort level. Try to preemptively plan for some common or anticipated problems, such as how you're expected to handle typical consults, or patients who have known issues that might pop up overnight. Helps make you feel more confident in those simpler situations, might save them a call they'd rather not get. Even then, when in doubt, call. A pissed off attending - which they shouldn't be if they're on-call - is still better than a hurt patient.

[Lactic Folly]

4 hours ago, ralk said:

When it comes to home call, I find the best thing to do is set yourself up with whoever is 2nd call to establish some ground rules. Get in touch with the staff before the call shift starts, feel out their expectations and indicate your comfort level. Try to preemptively plan for some common or anticipated problems, such as how you're expected to handle typical consults, or patients who have known issues that might pop up overnight. 

Good advice above. Don't hesitate to call if unsure. You'll find that you will start to encounter the same types of issues, and once you've developed a basic approach to these, will need to call less frequently over time.

This is another piece of advice I was given as a PGY-1: If something goes wrong and you didn't call for help, "I didn't want to bother my staff" is not going to hold water. Also, remember that if something goes wrong, the staff will still be responsible as they are supervising you, so it stands to reason that they would much rather be kept in the loop as things happen, than have to learn about something after the fact.

[Hanmari]

Thank you for the advice guys, all of your words make sense and I think it was mainly my anxiety that was preventing me from realizing that there is nothing actually stopping me from calling staff while on call. ArchEnemy, I will make sure to give that suggestion as part of my evaluation for this rotation.

As for the anxiety itself, I think a part of it is also just the feeling of not knowing when I'll be paged in. I've decided to mitigate this by sleeping over at the hospital. It's a short rotation, I don't have many call shifts left, I don't mind. It's better than making my way over there at 3am. Once I'm experienced enough to handle more things over the phone, I guess home call will be truly home call.

[ralk]

4 hours ago, Hanmari said:

Thank you for the advice guys, all of your words make sense and I think it was mainly my anxiety that was preventing me from realizing that there is nothing actually stopping me from calling staff while on call. ArchEnemy, I will make sure to give that suggestion as part of my evaluation for this rotation.

As for the anxiety itself, I think a part of it is also just the feeling of not knowing when I'll be paged in. I've decided to mitigate this by sleeping over at the hospital. It's a short rotation, I don't have many call shifts left, I don't mind. It's better than making my way over there at 3am. Once I'm experienced enough to handle more things over the phone, I guess home call will be truly home call.

Yeah, pager anxiety is a whole other beast. Can't say I've fully adapted to that either. Weekend call has helped that along, especially long weekends - after over 48 hours on call straight, exhaustion starts to override anxiety 

[NLengr]

On 9/9/2017 at 10:23 PM, ralk said:

Yeah, pager anxiety is a whole other beast. Can't say I've fully adapted to that either. Weekend call has helped that along, especially long weekends - after over 48 hours on call straight, exhaustion starts to override anxiety 

I'm actually on staff call right now for my health region. I'll be on call for the whole week until Monday morning. I'm anxiety free luckily.

I never really got rid of pager anxiety as a resident. Even as a PGY-5 it was always kind of there. It's mostly never knowing when the thing is going to go off and ruin your next few hours. Plus as a resident it was pretty easy to get bullied around by off service staff at my institution, so not only could your night get ruined because someone was ill, it could also get ruined by some a-hole off service staff on a power trip (which was not infrequently the case at our ER).

Now I'm in the community setting where everyone seems to be a lot more supportive of each other, which makes getting called much more pleasant. 

[LostLamb]

I'm PGY4 and pager anxiety continues although now I am only on service now, so feel somewhat prepared for what comes my way. Nevertheless, still get pages that throw me for a total loop! I am supposedly on a home call service but in the last 2.5 years of being on service I can count the number of times on one hand that I've remained home call. I alsoplan to be in house and that helps bring my call anxiety down significantly.

I have heard from staff in our large academic site that pager anxiety never really goes away...

As an off service PGY1 for 90% of that year I had a low low threshold for paging staff. If I was asked questions from ER or other services that I couldn't answer, I would ask if they were asking for a consult; if not, then suggested that it might be more appropriate to speak with staff directly. Often they were angling for the consult anyway.

Giving staff a head's up about your comfort level is an appropriate courtesy and they will appreciate your honesty. Practice safe medicine. Ask for help if you're in over your head. Yes, some people might get annoyed but everyone will be able to sleep at night. You'll only be faulted if you fail to ask for help when you should have that results in a bad but preventable outcome. 

Good luck!

LL

 

[Aconitase]

On 2017-09-09 at 11:13 AM, Hanmari said:

Hey everyone. So I'm a new PGY1 who's just gone from being junior resident on a service where I always had a senior resident with me on in-hospital calls, to another service where I am the only resident on call for the day/overnight for home call. After a few pages/calls where the ER bombarded me with questions I could not answer over the phone without actually requesting for consults, I am finding I have significant anxiety about not having help readily available to me. Of course the staff is always available via pager but I cannot imagine paging them about every issue that comes up esp. at night, and I do not feel confident enough in my knowledge to answer any question over the phone about treatment/disposition, etc. At the same time, I am reluctant to go in for a full consult for every question I receive over the phone because a) most often the calling services just want a quick answer and b ) my service depends on me not being post-call and if I go in for consults at night, my call converts.

Any advice on how to deal with my own anxiety? Should I just be comfortable with paging staff each time, or is there another way I can go about this? I am surprised by my own anxiety over not having other residents around me. Mad respect for seniors on every service who do this on daily basis. Thanks in advance for any good words!

Page the staff. Always. Never do the wrong thing for a patient bc you don’t want to wake someone up 

[Leon]

I'm on neurology right now as an off service resident. I make my specialty and level of training clear to my staff before call starts and have thus far been quite well supported. My priority is the patient and if there is something I can't manage I usually ask my seniors if it's not past 11pm and later, I just page the staff. The staff is responsible for what happens on call and given my limited expertise I have a pretty low threshold to call if I'm concerned.