This will be a short version of the story, of an aspect of being a physician that most readers are aware of but which has an enormous impact on their own health care, the personal lives of their own doctors and the future of health care in this country.
Being “on call” begins with a young physician’s first clinical experience as an intern/resident and ends when their either retire or arrange for another physician to assume that responsibility. It reflects the 24/7 nature of what we do. As I begin to wind down my medical practice, the first element to jettison is, you guessed it, the on call.
I cannot enumerate the numerous times that I would be awakened by a blaring phone call at 3AM, or a vibrating smart phone in later years to bring my attention from some deep, undisturbed REM state to immediate awareness. The “Service” would be calling. The adrenaline rush became instantaneous and that mili second a barage of thoughts filled my sleep deprived brain. As a gastroenterologist I knew that the problem I would be facing as I responded would center around a few specific disease states. Had they swallowed a piece of meat, now lodged in their esophagus. Or was it a relatively minor issue– Mrs Jones was ‘bloated’ or called at 3 AM to report her two week history of diarrhea. Even those minor calls were quite frankly major to me. I had to shake loose the cobwebs of my cognitive self and make a decision– to come in to the hospital, to defer for a few hours or have the patient call the office in the AM. At least these calls and decisions could be made over the phone. I could be half-asleep, grubby and disheveled. I could be wearing pjs or nothing at all. The consequence of such a call is the inability to quickly fall back to sleep. The adrenaline is still flowing. The self-questioning begins. Did I make the correct decision? Should I call back and change my opinion?
But it is 2015 and it is the dawn of a new era in medicine–Telemedicine. We are told that the future is rushing up to great us regardless of how we feel. The future will mandate a visual exchange between physician and ER, physician and patient. Telemedicine will require a Skype kind of communication. After all it will be far cheaper to connect patient with physician this way. And it won’t just be for the emergency on call interaction. Why go to the trouble of having a “hands on” visit when it is so much more convenient to do it via a computer screen.
So I do not envy my younger colleagues one bit. They will not have to sound competent at 3 AM, they may have to look the part as well.