Any Doctors with on call committment and tips for stress coping mechanisms/ tea and sympathy ?

[ooohstressed]

Hi all.. I am a Middle Grade Doctor in General medicine, and do a 1 in 9 on call.. I find it a real strain and wish I could be a bit more laid back about it, a bit more positive.
Anyone else in the same field or have any tips?
Thanks

[ooohstressed]

.

[Feckbox]

what do you find stressful about it? is it the fear of the unknown, not knowing what the next patient's problem will be, fearing you won't be able to diagnose or treat?

[ooohstressed]

Its just the enormity of pretty much being the senior go -to doctor for anyone becoming really seriously ill.. the responsibility of it and having to maintain peak performance throughout the 13 hours.
The suddenness of the med emergency team bleep and being the team leader.
Its scary. Its also good but I do find it a mental and physical strain.

[BartletForTeamGB]

Are you a new medical registrar then?

Do you know about Doctors.net.uk? People might be able to give you more advice and more openly than here. (Most of the doctors around here prefer not to reveal too much about themselves at work here!)

Will PM you.

[Lonecatwithkitten]

I am not a doctor, but work in a very similar field with a 1 in 4 on call. After 14 years my top tips are:-

When you are not at work do not think about it.
You can not change the past you can only change the future by this when things don't quite go as they should learn from it for the next time.
Take on fluid whenever you can you don't know when you are going to get a chance again the same with food. With that eat well nothing makes on call harder than a crappy diet. Monday night I had a horrible night on call and in my industry we work right through the next day, we were then hellishly busy so I ate breakfast and then ate again at 4pm this left me quite frankly weak and teary.
Run through likely scenarios before hand make a plan. I have plans now for most emergency cases of things I do and the order I do them in so that to a certain extent I do them on auto-pilot. I always feel that if you always do things in a certain order you will never forget a step.
For example Gastric Dilatation Volvulus for me is

Two of the largest bore catheters I can achieve as fast as possible with fluids running as fast as they can go.
Anaesthesia
Intravenous Antibiotics
External stomach decompression with 14G catheter
Clip
to theatre
open patient
Identify stomach
correct rotation
Check viability of spleen remove if necessary
assess whether gastrotomy necessary if so perform
Run guts to check foir any other nasties
Close
Additional pain relief
Wake up

Always remember that sometimes you can do your very best and it will not be sufficient. Don't beat yourself up about this.

[ooohstressed]

good tips thanks

you get used to it, and its not for fun, its work but I don't enjoy it much

[ooohstressed]

I regained my thirst for learning and improvement.. feel less stressed when working hard and striving to be the better :)

[missingmumxox]

Make friends with the nurses, it is a myth that female nurses don't like female doctors and male nurses are intimidated by female doctors I am a nurse,worked in leicester, JR, Canterbury you name it, and I have never seen a issue with female doctors by nurses.

the point of this is not to do with your post but I suspect you feel you can't talk to anyone in case you look weak or not competant, well you won't, my advice is open up to a doctor of your grade you trust and listen to their tale of fear, then find a nurse you like and trust the judgement of and if you are a registar, then you need to look to a nurse of similar grade, junior charge nurse or charge nurse (sister) they will have seen it many a time, it is normal, god knows it is a huge responisibily and we nurses are very aware of that,
nurses CAN make your life hell, believe me there is nothing worse than a arse, we made their lives hell, doctor who dithers,we always had a soft spot for the dithers and would cover up so long as we knew they knew the job just lack confidence, the incompetant we would almost do their job for them but you sound like you are in the middle ground of competant but scared?

seek out a nice competant nurse or fellow reg and thrash it out, I bet you are just fine, trust me I am a nurse :) not all nurses are the same.

top tip to keep nurses on side, have a gossip, talk to them, listen to what they say about the patient and what they think should happen next ...and this is important, if you don;t agree with what they think, tell them exactly why, not just a NO! or ignore, I wanted to learn why I was wrong and a none eplaination would win you a 3am paracetamol write up the next time I was on nights and they where on call.

really we are nice...

[BartletForTeamGB]

"I wanted to learn why I was wrong and a none eplaination would win you a 3am paracetamol write up the next time I was on nights and they where on call."

Hmm, remember that just because the nurses are ringing you up about nonsense at 3am, it doesn't mean you need to do anything about it. Either get a junior to write it up next time they are on the ward or leave it for the day staff if it doesn't need to be done. I just really can't imagine a doctor writing that they "CAN make your life hell". I think that's pretty close to bullying.

I don't think people, including the bed managers or nurses or even the surgical SpRs, realise how busy a medical registrar is at night. Sometimes I don't have time to teach a nurse why what she did was wrong, because I've got three in resus that are now mine and sick, a patient bleeding in another ward, 10 admissions from 6pm that still haven't been seen, two referrals from the surgeons etc etc. I'm lucky if I get to the end of a shift and post-take ward round having eaten or drunk something during the night!

I've worked with plenty of good nurses in my time, a lot of great nurses, and would second the advice about talking to them, thinking with them, admitting when you don't know something. The good ones will realise how busy you are. I can't tell you how much I've appreciated the nurses who, while I've been writing up the notes after a sick patient, have offered me tea and toast in the middle of the night.

Remember that a lot of your job is delegation - delegation to the nurses (being told "I just need to cover my back" does not mean that you need to do anything about it - do something if it is clinically indicated, of course), your juniors (they are there to work too!), your consultant (if you are thinking about calling him/her, then do - that's why they are paid to be on call), the day team (not everything needs to be sorted out right there and then or in the middle of the night), the bed manager (this patient needs admitted, this is their problem) - so you can be dealing with sick patients.

[ooohstressed]

missingmum I do listen to the nursing staff carefully and take their concerns on board. I have had great support from them and enjoy working with them.

I take what you say about making the docs lives hell with a pinch of salt.. as on call is these days, any non essential or lower priority extra work just means other patients not being reviewed .

Bartlet I agree about the delegation ..its all about finding a new way to manage the workload, instead of just ploughing on we have to oversee and advise, review and consult upwards as well as seeing the most sick in resus. Its not meant to be easy, its training and I'm sure will get easier.