¶ Introduction to Unreachable On-Call Attending
All right , so we are back . If you missed the last segment , we just talked about a medical myth that Dr Nee thinks needs to be retired . Ie doctors ain't leaders , so stop running . Then we talked about days that we don't work , especially as locums , days that we just think are unacceptable .
Now we're about to talk about what Dr Nee we're about to talk about what Dr Ne .
All right , you know I be scouring Reddit , so let's talk about an unreachable attending on call person in the residency forum . They want advice . So it says hey , everyone looking for advice and sanity check from fellow colleagues . I'm currently doing 24 hour in-house calls and I share these shifts with an attending physician .
Here's the issue after finishing outpatient clinic around 5 pm , this attending routinely takes melatonin and lunesta to get good sleep overnight . He goes to bed around 6 pm and basically knocks out for 12 hours straight . We're both still on call during this time , but here's where it gets uncomfortable .
After taking Lunesta I don't know why this person is using the trade name . Anyway , he becomes oddly talkative , emotionally unfiltered and starts sharing inappropriate or personal secrets about his life . He laughs randomly over shares and clearly isn't functioning with normal inhibition . Once asleep he is completely unavailable , doesn't respond to texts or calls .
During the night I'm left managing everything , including some higher stake decisions , and honestly I'm not sure he'd even be capable of handling an emergency if one came up .
He wasn't taking Lunesta .
Has anyone seen similar behavior in their program ? I've asked other residents and I'm getting mixed feedback . Some say it's just how it goes , others are more concerned . I want to be reasonable , but I also don't want to be the only one awake and responsible by the attending . It's pharmacologically sedated . Ooh , that's a good question .
Before you answer Dr Renee that question or give advice , I want you to take a guess what specialty you think that is , cause I got thoughts you know .
I am . They take all I am In a residency program .
Yeah , I was going to say something like psychiatry or something like that . It can't be something like it is not surgery . There's no way that's surgery OB . There's no way it's OB .
Oh hell no .
There's no way . It's ER OB .
That would be a career . That's why I don't think it's hospitalized .
I don't think it's IM , but it could be IM because they just admit .
Or family med .
Family med , I'd have to say it's probably some , it's some specialty that . Once they said the office thing I was like , yeah , it's not like psychiatry or ophthalmology or something like that family med , family med , I think all All right . So they ended off by saying I want to be reasonable , but I also don't want to be the only one awake and responsible .
While they're attending this pharmacologically sedated she or he sound like they hate and roll there , but anyway , has anyone seen similar behavior in their program ? I've asked other residents and I'm getting mixed feedback .
Some say it's just how it goes , others are more concerned thoughts , renee , thoughts , thoughts , thoughts , thoughts .
Hey yo , you want to talk about inappropriate that is so inappropriate to take a nap or to be sleeping . No , no , no . What's more and more inappropriate to be sleeping and not responding to texts , or to be talking about your personal life no , no , it's fine that you sleep .
You must respond . But it's fine if you sleep . It is not fine that you take melatonin and lunesta that's what I'm saying .
This is not that hype . This is not a crazy type special . This is what I'm telling you . Most people who are like they're like I . I ain't taking both . I'm on call .
Me . We talked about a surgeon , a urologist , who was on cocaine during surgery . I mean , but he's , he's available though . Anyway , if you call him he probably do your surgery real fast too .
I need a Foley word . I got you know like I need a Foley Word . I got you know like , come on , I'm telling you , I think this , I think this is a psych . It's probably urology , it's probably psych Things , that things , that emergencies don't happen that often .
That's what it is when people do in first of all . It's inappropriate either way . When people do inappropriate things , they don't do it at appropriate times Like that , don't even make no sense . They inappropriate things , they don't do it at appropriate times like that don't even make no sense . They make no sense .
Why would it be the voice of , the voice of reason ? Here we go , go ahead . It's like it's it's family med . It's family med . What ? What was it ?
high acuity , high acuity stuff it's not high acuity stuff , I don't think what does it say ?
what does it say ?
they finish outpatient clinic around 5 pm . They take their Lunesta and they take their melatonin Melatonin .
Right and they're left to do what . What's the resident left to do ?
I'm left managing everything , including some higher stake decisions , exactly .
I'm not sure .
Exactly . Whatever it is , there's not many emergencies .
this sounds like this sounds like a , a resident who might be handling some , like you know , patients with multiple comorbidities coming in with things that
¶ Debating the Attending's Inappropriate Behavior
might be pretty high acuity and they they're having to stabilize on their own like uh-uh . I mean it's just inappropriate .
I'm potting . I'm potting right now , but if I were to be a betting person , this is not surgery , this is not OB . This is not any of the things that you would consider . Like , yo , you need to be up Because the attendant can sleep , but if I call you , you need to wake up . All right , like .
Those are the things that occur , those type of specialties this is . I don't think this is one of them , but I do think on the real real , you know , you got to talk to your program director .
You got to talk to your program director like , listen , yo , you , we got an attending who is unreliable and , in essence , who's not teaching Right and granted , I'm making decisions and I have to go rely on the textbooks and all these different things , or I'm just flying at the seat , or I'm just flying on the seat of my pants .
This is some inappropriate like . This should not be going on . I'd be a little bit nervous , though , to go to my program director at first , because I'm sure they're going to be like this person's going to be like .
So I was on call last time and I was with this resident , or maybe every time I'm on call , I happen to be on this resident and now I hear this complaints and stuff . I'd be a little bit nervous and stuff . But you gotta talk to your program director and get this handled because this is , unless the person is the program director what do you do then ?
you go to the chair .
You have to go to the chair now you can't go to the chair , man but , what do you do ?
if the person you can go to the chair .
I could not go to the chair . Rest in peace . Rest in peace to my chairperson . He will always , forever , be my chairperson . I love my chairperson , but these type of issues I could not go to my chairperson for , no .
So who would you have gone to ?
I don't know , but I call my residents . My residents are always available , even the residents who aren't called . They're like yo Gonzalez , yo Keyway , yo Babalolo .
So one of the things .
And , to be honest with you , we didn't really call the attendings . We call like we go to the residents go to the residence ?
well , of course , but like when it's just you and an attending on right , like there you I don't know if you had those situations because there's a setup I don't know if when you went to columbus , yeah , that's , that's where yeah ?
right , you have to talk to the attending right , because I I had situations like that where it's just me and the attending right , like when I went to Raritan Bay , right , my mentor , dr Brugge . Oftentimes I was on with her right , so it's like there was nobody else to go to . But you know , yeah , I mean . So here's one other thing you could do .
Now , this really really , really depends on how , like , what is the culture of your residency and what is the relationships that the residents have with the attendings , because sometimes , like , the hierarchy gets a little blurred depending on you know the hierarchy .
Like you understand what I'm saying , the hierarchy gets a little bit blurred , like as you get more senior . You know what I mean . Do you know what I mean ? Right , where you were now as a senior resident , you're like , all right , I'm going to just talk to my attendant , like my colleague now , because I'm done . I've been in this three , four , five years .
I just we're not going through this , no more . You might , might , if you can identify a senior resident who is cool with this person , tell that senior resident hey , yo , your boy or your girl is tripping . They're taking lunesta melatonin . I'm trying to figure out .
How do they know this , though ? How do they know that they're ?
they're speaking inappropriate stuff . Probably when they do wake up , they're like I took a melatonin and a lunesta . They're probably admitting it right right out because it's inappropriate and they're they're being inappropriate , they're talking about their personal life . They're talking about so it's .
I mean , it would be no small feat to say like they probably told them that they were taking Lunesta and melatonin . So I remember this one time . I remember this one time I was on call . I was on call , actually , at one of our satellite hospitals and I don't know what happened , but at the satellite hospital there wasn't anything going on .
So I was like wooo , whoo , I get to sleep . When I tell you , I was tired that day . I was so tired but nothing came in , thankfully . And I wake
¶ How to Address the Situation
up right in time for sign out . And when I wake up I look at my phone and I'm like look at my phone . And I'm like but there's a three minute conversation here with one of my junior residents from our main hospital , but I don't remember talking to anybody . I was like I don't remember talking to anybody .
So I call her and I'm like yo , did you call me last night ? She's like yeah , I'm like did we speak ? She's like yeah , I'm like what did we talk about ?
She's like yeah , I had this patient who was in preterm labor and I was asking you what I should do , cause I guess she didn't like the , she didn't like the senior who was on call at the main hospital , like she just didn't trust his judgment .
And she was like , yeah , so I called you , so I asked you what to do , and I'm like , what did I tell you to do ?
She's like you told me to drink soup . Make sure you put some bread in that mug and stuff scoop it up .
She's like you told me procardia , start her on mag , whatever the hell . I told her um antibiotics if she was ruptured . I can't even remember the whole story , but essentially it was the right management and I was like , hey yo .
So is this doctor ? Is this attending ? What do you call it ? Intoxicated Does ?
this count as intoxicated ? Yes , under the influence at least . Yes , yes .
I think , I would do . I probably would do a senior resident . I talked to a senior resident about it . I might even find another attending that maybe I have a better relationship with .
Yeah , like yo , you gotta talk to your boy , you know , like yeah right , you know right um program director ?
yeah , because , there's a fear of retaliation . Would you be nervous about retaliation ? Because I know you , you , you , nothing bothers you at all . I know you're gonna try . I would say I just want to know is there , would there ever be any like thought process in your mind ?
Like yo , this person could figure out who's like complaining about them and there's a little fear of retaliation it depends on who the person is .
Yeah , depending on who the person is . Yeah , depending on who the person is . I think that there are definitely I mean , I could think off the top of my head certain attendings who I think , yeah , would come after me because I put that out there , absolutely .
And then there's others who I think , you know , would just be like man , I was , I'm just really tired and I got to do X , y and Z and blah , blah , blah , but you know , and then say you know , like , no , you're right , I shouldn't have , I shouldn't have done that .
But more than likely , though , if someone is doing this like you're not the only resident that is seeing this type of behavior . Correct Nurses have seen this behavior Correct . Other you know patients may have seen this behavior and more than likely you're just one of many who's going to say something .
It's just that you know this is the first time that you've had to stand up and say something or you feel like you have to stay .
Yeah , yeah .
But remember it's all about . This is part of advocacy . You're advocating for yourself , Would you ?
tell .
Who me . In your program
¶ Fear of Retaliation and Advocacy
specifically , it depends .
In your program specifically , it depends .
In your program ? Yeah , because , like , the stuff that I was dealing with is really high acuity , right . Like that stuff , like I can't admit someone without their input . I can't really like if it's minor things like someone's potassium or you know something else .
Yeah , but that's things you don't call in attending for . So anything that attending for potassium at night , you think ortho ?
does that ? This might be ortho . This might be orthopedic surgery it could be ortho , because you know they'll be like , which I think they'd be like , they'll be like .
And Seth , I'll see him in the morning .
Yeah , man , Okay , I would so for me if I needed . Like I just remember my program , If I called my attending , it was always for something that was like major .
Yeah .
So if it was something that I could not get in contact with my attending for and I needed to get them in , get in contact with them , it's a problem , right ? This is someone I may have to crack someone's chest . This is someone that I may have to take to the op , or someone who may need an operating room .
This is someone who may need to go back on on pressers . Like I remember , at my program , we weren't allowed to just put people back on pressers without letting the attending know , because they didn't want to come in the next morning and be like yo . So first of all , why is ? this person on pressers ? Why didn't you let me know ?
And then what did you do about it ? You know .
Right .
So those are things that like were big deals , right ? And if you're admitting something like , you damn sure can't admit someone to the surgery service without letting your attending know . Are you crazy ?
Yeah , you know , I mean , yeah , I think in my program I definitely would have told I mean we could more freely admit people . Um , we could more freely admit people on , especially on labor and delivery . You know , patient comes in , she's eight centimeters , you know .
Or patient comes actually patient goes in , she's five , let's say five centimeters , because eight centimeters , you know . Or patient comes actually patient comes in , she's five , let's say five centimeters because eight centimeters .
Eventually you want to let them know hey , she's going to deliver , but like she comes in , she's five centimeters and she just kind of chugging along but you might not know , you're attending until this boils down to the leadership thing you're talking about .
This boils down to leadership again , like right , like you're gonna have to learn how to have some difficult conversations . You know these difficult hey look , these difficult conversations , they start with you . You know , like they don't start , I think sometimes people say like it's gonna be real clean cut and it's gonna be like should we discharge someone or not ?
It doesn't start like that , guys . No , it actually starts with something that's related with you , like how you're being treated or what you see at your job or what you see at your school , and you either see bad behavior or something's gonna come back and get you , or you feel like somebody's gonna come back and retaliate you what you're gonna do .
That's how it starts .
So I don't know that's a very interesting situation , but good luck to whoever that is . Hopefully , hopefully , they told somebody Thoughts and prayers , thoughts and prayers . Thoughts and prayers .
Peas and peas , Peas and peas . All right , y'all Listen . We're going to go into our next segment where we're going to make a little comment on a family medicine
¶ Final Thoughts and Wrap-Up
resident who actually wrote back to us after we gave them advice on the previous episode . So catch you on the next segment .