I talk to Scott Williams once again to discuss an on call shift and some of the ideas we have that may improve how the shift works for you. Please listen to the podcast at the end and tell us of helpful tips you think may enhance how others manage their shifts. Our focus for the podcast was on some of the more personal factors that influence you on call. There will be upcoming episodes that focus on aspects such as assessment of unwell patients as a separate topic.
Being punctual is important. If it’s your first shift it allows you to greet people and introduce yourself but also means that the handover can occur at the alloted time. Nothing is more frustrating than knowing you cannot go home because another person is late, especially after a long and busy shift. Irrespective of your personal needs, handover running late potentially impacts patient care because it delays people returning to clinical work. These days, I always aim to be 10 minutes early before an on call.
How you greet people is important as well. Scott and I talk about avoiding the word “sorry” at handover. This is more my feeling than anything else. If you have worked hard and relentlessly for the day then why should you feel the need to apologise? Yes, it may feel more like politeness and we British are nothing if not polite, but you should never apologise for working hard. It’s not your fault you were referred more patients than you could clerk, it’s not your fault patients were sick and it’s not your fault you hand to spend an hour talking to a family either. So why apologise? To me, that apology becomes comparable to admitting you weren’t good enough and believe me, you most certainly are. So don’t say sorry, just lay the facts out and be judged on them. There will be days when you hand over nothing and days when you hand over a lot. Remember, you are setting the tone for the shift of the person taking over from you and it is much better to be given a positive frame at the start of the shift.
Keep yourself organised from the word go. Make sure you have a piece of paper or dedicated handover sheet ready to write on for your formal handover. You are about to spend up to 12 hours being permanently distracted from everything you want to be doing so write things down. As Scott mentioned, if you get a run of bleeps then write the numbers down to be sure you answer all of them in a timely fashion. Should you get called whilst with a patient then simply apologise and go to the nearest phone. They do understand as long as your polite and will forgive you – they heard your bleep go off too. Not everyone who asks for your review of a patient will use the SBAR mnemonic but that doesn’t mean you can’t guide them through it.
S – Situation: what is actually happening now. You might probe further with asking for the breakdown of the observations or other specific questions to ellucidate more information.
B – Background: Not necessarily the past medical history of the patient but may entail the events leading up to the current situation. This is you chance to find out more details. How was the patient last time the obs were check? What is their past medical history? What treatment are the already on? These are but a few of the questions you could ask.
A – Assessment: what the person you are speaking to thinks is happening in the situation they have called you about. It is not unreasonable over the phone with a good referral to ask the referrer what do they think is happening if they do not volunteer that information readily. It helps orientate you but may perk some intuition in them also.
R – Recommendation: what the person calling wants you to do. Often it will be to review the patient in person but if it’s to look at a result, then all they may want is verbal reassurance over the phone which will save yourself time and energy. Clarifying what they want means you both are expecting the same end result from the conversation. There are times when it is obvious but there are also some ambiguous moments.
Your breaks are even more important when on call. I regularly find it reaches 2 or 3pm and I’ve not eaten since 6am. It’s easy to lose track of time and forgoe a break in order to do just one more thing. These days I will set myself a time limit for on calls, especially those 12 hours long. If after 4 hours I’ve not stopped then I make sure I grab a drink of some description. I have a water bottle in a secure place I can grab and drink from. By 2 o’clock (day or night) if I have yet to eat then my next job is to do so. The main reason for this is that I do notice I slow down and do become less efficient. Others may cope better without food but this is a long and potentially challenging shift, food is important as it keeps me thinking effectively. After this, I do accept any other break may be unlikely but if at 6pm or thereabouts there is chance then I try get a snack and drink. What is important is to recognise the point that you need to stop and take a break. It will not benefit you to just keep going and may result in your thought processes slowing and being less efficient.
You are not alone in this. There is a team around you who are there to support each other. If you find yourself reaching a point where you are struggling then you need to be telling your senior. They may just be able to help with your priritisation and organise your workload or there may be certain jobs or patients you feel need senior input anyway. You do need to recognise when you are reaching the edge of your limits and know when you need help. Your seniors may not openly admit it, but they are here to support you as part of their job.
We do hope you find these points useful. The podcast goes into more depth about some and contains extra pearls too. We are understanding that there will be more thing to be included so please tell us and we can add them to our repertoire of advice. Together we can produce a guide for Foundation Doctors to help them rock their on calls and master them in no time at all.
Get in touch about topics you want to hear in the future!