Thursday, June 11, 2009

When The Psychiatrist Dreams

I was reading a recent post from The MSILF about her deliberations on what medical specialty to choose, and which residency program to aim for. In part of it she discusses comparative "on-call" schedules, i.e., the frequency with which you have to stay at the hospital working through the night.

Medical students aren't exactly encouraged to consider this, or other "lifestyle" aspects of residency programs (such as how much of a stipend they're going to give you) in making a choice. In fact, even asking about these things is (or at least, used to be) a risky move-- there were intimations that this would indicate more interest in your own comfort and luxury than in being a good doctor. And reading the post, I couldn't help but do what all older doctors do to younger doctors-- think "Well, it was worse in my day..." (In that, for example, we started with call every third night, rather that 7-9 times per month, and we had to work both the full day before and after an overnight, rather than going home the next morning after a meeting-- so, sometimes it was 36 hours awake and on-duty.) And of course, my mom certainly had it worse than I did when she was a resident.

But: call sucks. It really does. And it has, potentially, very negative impacts on your own mental and physical health. At its best it can be a collegial, invigorating learning experience. More of the time, it's like being kicked in the head. You get so tired that you could easily doze off in spite of the head-kicking, which would be a relief-- but you also have to wear an electronic device that prevents you from falling asleep. If you want a doctor who has put him or herself through the most rigorous and taxing training schedule possibly available, you may be accepting a doctor who is, or has become, a masochist. And that person may have little in the way of empathy for your minor medical issues.

I sometimes used to come home from call, make a plate of food, and fall asleep before I could eat it. Other times, after having been awake for who-knows-how-many hours talking to people who wanted to blow their heads off or have their children locked up or sue me I would just come home and cry. One OB/GYN resident I knew crashed his car three times during residency, trying to drive home sleep-deprived.

After reading The MSILF's post I had a nasty nightmare. In it, I was starting the first day of residency, on a neurology rotation. As sometimes happened, the first day consisted of taking call on a Saturday. Typically that means arriving about 7am on Saturday and working until Sunday morning. But somehow in my naiveté I thought I didn't need to show up until 5pm. Somewhere around 9am, lounging at home, I realized, with horror, that I was mistaken. I realized the the person who had been on Friday night was still stuck in the hospital hard at work, waiting for me, no doubt exhausted and furious (there was, in residency, no greater crime than being late to relieve a compatriot from call; this was almost unforgivable behavior.) My heart leapt into my throat as I realized I was screwed-- I hadn't even started residency and already I had made an enemy and ruined my hopes of a good neurology evaluation. I woke up in a panic. It took a while to calm down.


Blogger The MSILF said...

Heh sorry about the nightmare.

Here, I guess, it's really sort of different. For one, people are about 7 years older when they finish med skool than there, and they've BEEN through the military and their tolerance for shitty living is pretty minimal, and they are a lot less willing to just do what they are told. There are a few who really want to be X or Y or really love medicine, but a lot less than there used to be, and there's no shame in saying it.

I think also the general intern year that goes before committing to a residency helps you understand what is really involved. Everyone takes at least 6 months or so off before starting a residency to do some soul searching...and a lot never go back to medicine, or go back only a few years later after working in something else.

The only solid offers I had before finishing internship were orthopedic surgery and general surgery, and less firm neurosurgery. Don't matter how prestigious, cool, well-paid, or whatever - none of those specialties can attract people because they have such a fuck-you attitude about how they treat their residents (and sometimes attendings). They are desperate for house staff.

Incidentally, the psych place I interviewed said that even they have a cap for residents, and that when they reach it, they still have attendings doing call.

And a girl doing the internship with me, who was from Scandinavia, said call always begun at 3:30 in the afternoon or later, and ended at 7 AM. And that it was nothing like here. And paid something like $20 an hour. She couldn't believe what she had gotten herself into. And I don't think Scandinavian doctors are worse for it.

I, personally, have decided that for me, call was detrimental to me to a degree that I won't do it like that anymore. I don't care if the attitude is that that is wimpy or lame or whatever - fuck them, a group of *doctors* is the crowd that I about least want to impress in the world. Over the year, I was recommended by my doctor to reduce call frequency. I refused, citing all those reasons, "Everyone else does it, and I will too," etc. But in retrospect, that was the wrong decision, and in the future, fuck no.

But...I'm a lot less invested in "being a doctor" mentally and emotionally than a lot of people.

Ok, long enough comment. Thanks, though.

6/11/09, 3:24 PM  
Blogger The MSILF said...

Oh yeah, and for the record, I didn't ask about the call schedule (though I would have dug around to find out). During the interview, the head of department said, "There's something you didn't ask." He offered the information - somewhat apologetically...that they unfortunately have a bad call schedule.

I'm glad he said it, because I never would have assumed anything like that because it was so different everywhere else I inquired.

6/12/09, 3:07 AM  
Anonymous Anonymous said...

I'm an intern (almost a second-year!) in a psych residency in Philly, and I've had a lot of thoughts about call and the pros and cons of it.

Long calls, and the medicine floor months, served a useful "hazing" purpose -- and before I did this year I would have balked at even thinking that! But I do feel like the year stretched me and I'm much less likely to freak out at seeing a sick patient. I can honestly say "Well, I've seen worse." It's painful, but a good learning experience.

I think I've had it pretty easy. I still felt burned out and had my exhausted moments crying in the hospital stairwell, but not that many. The medicine months were q4 call, and psych ended up being q5-6, and not overnight. This coming year I will have overnight call maybe once every couple of weeks, and evening call (i.e. 5:30-10pm) once a week or so. My soul is still intact, and so is my empathy for my patients.


6/13/09, 2:14 PM  

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