Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Salon

The overnight smackdown: avoiding on-call arguments

Mark Otto Baerlocher
CMAJ January 20, 2009 180 (2) 252; DOI: https://doi.org/10.1503/cmaj.081974
Mark Otto Baerlocher
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Responses
  • Metrics
  • PDF
Loading

Andy, the general surgery resident on-call, has had an exhausting night. His head finally touches the pillow at 4 am. At 4:10 am he's paged. When he returns the page, it is clear from his tone of voice that he's annoyed. It's Mark, the senior internal medicine resident, requesting an urgent consult on an 83-year-old man to rule out ischemic bowel. The patient was admitted several days before for an acute chronic obstructive pulmonary disease exacerbation; however, he developed vague abdominal pain and a borderline lactate within the previous 6 hours. Andy wants to wait until the morning or until a computed tomographic (CT) scan is performed. The CT was declined by radiology and Mark doesn't want to wait until morning for a consult. The argument begins and quickly escalates.

Situations similar to this fictional vignette play out repeatedly most nights during on-call at academic institutions. The cause of many (not all) of these disputes is simple: residents, who essentially run the show while on-call overnight, tend to have less confidence and knowledge, and therefore a lower threshold for ordering exams and requesting consults. Their rationale is simple: err on the side of caution. And it is easy to see their point. There has been evidence, for example, that mortality among patients admitted on weekends, (also a period when more junior physicians tend to be in charge1,2), is greater than among patients admitted on weekdays.3

Figure1
  • Download figure
  • Open in new tab
  • Download powerpoint

Photo by: Fred Sebastian

As a fourth-year resident in radiology, I'd like to offer some suggestions on how to avoid these late-night arguments:

  1. Don't answer pages with hostility and avoid walling off before you've heard the story. Many people seem to do this, perhaps in the hope that it will prevent future consults. Starting off in a cordial, friendly and professional manner will set the tone for the consult, and the subsequent discussion will likely go more smoothly.

  2. If you are skeptical about whether the requested exam or consult is urgent and must be performed overnight, clarify the request and listen to the whole story. You may have misunderstood the request. If you remain skeptical and believe it should wait until the morning, explain your rationale to the referring colleague in a cordial manner. Should this fail, call your fellow or staff for advice. This is a much better solution than starting a war over the telephone.

  3. If you do end up in a serious argument, avoid the temptation to send a nasty email when your on-call ends. Talk to someone in your own department. Support can be comforting and if they believe you were in fact wrong then you may avoid further escalation by apologizing to the person.

  4. If you believe you were unfairly harassed or intimidated by another service (student, resident, fellow, or staff), remember that this is unacceptable and no longer tolerated. Universities and hospitals have harassment and intimidation officers who are there to help you.

Probably the single best tip I've learned is to remember that the person on the line has not called simply to wake you up out of spite. They have a patient they are worried about and need help. Remember that residents and medical students are often unsure about some aspect of a particular case. On-call overnight, there are not that many others to turn to. If you are called, someone thinks you can help.

As a resident in radiology, we have to rotate through many of the medical and surgical subspecialties during our intern (first) year. The 2 constants that I learned during my intern year about these on-call arguments are:

There are 2 sides to every argument.
Everyone thinks that they're right.

Footnotes

  • Have you got an opinion about this article? Post your views at www.cmaj.ca. Potential Salon contributors are welcome to send a query to salon{at}cma.ca.

REFERENCES

  1. 1.↵
    Thorpe KE. House staff supervision and working hours: implications of regulatory change in New York State. JAMA 1990;263:3177-81.
    OpenUrlCrossRefPubMed
  2. 2.↵
    McKee M, Black N. Does the current use of junior doctors in the United Kingdom affect the quality of medical care? Soc Sci Med 1992;34:549-58.
    OpenUrlCrossRefPubMed
  3. 3.↵
    Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med 2001;345: 663-8.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 180 (2)
CMAJ
Vol. 180, Issue 2
20 Jan 2009
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
The overnight smackdown: avoiding on-call arguments
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
The overnight smackdown: avoiding on-call arguments
Mark Otto Baerlocher
CMAJ Jan 2009, 180 (2) 252; DOI: 10.1503/cmaj.081974

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
The overnight smackdown: avoiding on-call arguments
Mark Otto Baerlocher
CMAJ Jan 2009, 180 (2) 252; DOI: 10.1503/cmaj.081974
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • REFERENCES
  • Figures & Tables
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • The law and physician-assisted dying
  • Care, compassion, respect
  • Revisiting Rodriguez
Show more Salon

Similar Articles

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

Powered by HighWire