It’s been a long week on call, and now, at the end of the week, I find myself with a few minutes of quiet leisure time. Working at Western University teaching and remaining clinically active, while also doing administrative work, usually leaves me with little time to actually recline and reflect. Now, in the wee hours of the evening, as the week comes to a close, I find myself with a few minutes before my next activity. As a result, I’ve had time to consider some random thoughts regarding patient care and teaching. So, without further ado, some thoughts during my time on call…

Trust but Verify - When teaching residents, it’s easy to fall into the comfortable habit of actually believing what residents tell their attending physicians about the patients they see. When starting call, I received a patient that a couple of my residents had been working with in the hospital. When they signed off, I heard a rather benign story (nothing to do, patient’s about to be discharged, yada yada). Of course, I wasn’t born yesterday, so I rounded on the patient the next day and completely changed the course of care. Trusting is good. Verifying is better.

Watch Out for Confirmation Bias - When the history and physical examination don’t match, then something is wrong or an unanswered question must be addressed. I’ve seen many a patient who had been previously seen by another provider but just wasn't improving. In almost all cases, there was some aspect of the patient’s disease that was not recognized. For example, a patient with recalcitrant heel pain previously diagnosed as plantar fasciitis will commonly present to me because they aren’t getting any better. They will have undergone various treatments without improvement. After obtaining a history and physical, it turns out the patient had a lumbosacral radiculopathy. The prior providers make the common error of stopping to look for a diagnosis, instead fitting the patient’s diagnosis into their preconceptions. This confirmation bias is the enemy of all good diagnoses.

The Body is a Machine - When my students are seeing a patient, it seems sometimes they have trouble diagnosing the problem. The student comes up with some odd explanation for the patient’s complaint. Something about the history and physical examinations don’t match up, but instead of looking for a new more reasonable diagnosis, the student makes every attempt to jam their own diagnosis into the clinical situation. This problem is especially rampant at the beginning of a student’s clinical education and, thankfully, diminishes to a great extent as their training progresses. This is another form of confirmation bias and does nothing but get providers in trouble while prolonging appropriate patient care. The fix for this is to think of the body as a machine. If it doesn’t behave in a way you expect, remember the body is a machine that behaves by normal physical principles. It’s not out to stump you or ruin your day. Logic guides its function and pathology, not whim or caprice. We’ll leave that side for the mental health professions.

The World doesn’t Stop for Call - Unfortunately, being on call doesn’t give us a pass to do nothing during the rest of the workweek. While on call, I dealt with my regular clinic hours, scheduled surgery, multiple work meetings, and student and resident academic sessions that ran after regular hours, and then came home to a son sick with the flu. Meanwhile, national politics goes haywire, and just to top it off, we had an earthquake last night! So…the world goes on pause when I’m on call, right? Oh, that’s right; the world doesn’t revolve around me. It doesn’t? Are you sure?

All in all, the one conclusion to make from being on call is that it is simply a microcosm of regular life, just a little more intense. I’m glad to be off call now, and I hope those of you going on call have a successful and fulfilling one.