Sleep disruptions, poor eating habits, lack of exercise, and general malaise can all be a part of those on call hours for every clinician. Endocrine News spoke to a few experts for their advice on simple ways to combat the ill effects of being on call.
Being on call — working after hours to provide patient care, either at your medical facility or from home while being available for patient phone inquiries — is a reality for many physicians, especially during residency. With such long hours, what are the best ways to stay sharp while working on call? Maintaining healthy habits, asking for help when needed, being nice, and taking call seriously will all help, say experts.
Mary L. Brandt, MD, professor of surgery at Tulane University School of Medicine, in New Orleans, La., runs the blog WellnessRounds.org. The site gives advice on how to “really succeed in medical school and residency, not just academically, but personally as well,” she writes. Brandt launched the blog in at 2010 to share information with medical students and residents about how to live healthier while working in medicine.
“When people call you, no matter what time it is, be very nice to them,” Zilbermint says. “The reason people call you late in the evening is not just to bother you, but they really need help. Be kind, and not grumpy and don’t blame them. People will appreciate it.” – Mihail “Misha” Zilbermint, MD, FACE, chairman, Department of Medicine, chief and director, Endocrinology, Diabetes, and Metabolism, Suburban Hospital in Bethesda, Md.; assistant professor, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins School of Medicine, Baltimore, Md.
“The faculty, residents and students I work with struggle with how to find time to take care of themselves, as do I,” she says. “The blog serves as a toolkit of how to incorporate exercise, better nutrition, stress reduction, and other wellness habits into busy schedules — all of which benefit a physician working on call.”
Mihail “Misha” Zilbermint, MD, FACE, is the chairman of the Department of Medicine and the chief and director of Endocrinology, Diabetes, and Metabolism at Suburban Hospital in Bethesda, Md., and an assistant professor at the Division of Endocrinology, Diabetes, and Metabolism at Johns Hopkins School of Medicine, Baltimore, Md. For a better on call experience, he suggests endocrinologists educate themselves, reach out to their senior colleagues as needed, and ultimately, train other healthcare professionals to be able to handle common endocrine issues.
For on-the-job education, the website UpToDate.com is a great resource, he says. “It offers you quick access, but if you’re not satisfied with the answer there, take the time to look up the long answer to see what others have done,” he says.
If fellows or junior endocrinologists take a call and don’t know the answer, “it’s OK to say, ‘Give me some time to think about it and let me call you back,’ Zilbermint says, who has taught fellows at the School of Medicine since 2015. In most cases in endocrinology, there are very few emergencies, he notes.
“It’s OK to sit down and review the patient’s chart to see if they have been admitted for a similar issue before. We all know rushed decisions may not be the best decisions. If you don’t know the answer, pick up the phone and call the attending. We all expect to get a call and it’s OK to bother someone. We have all been in a situation where we don’t know what to do. You utilize your own network of people you work or train with or train under to come up with the right answer for the patient.”
Zilbermint, who has organized more than 100 in service trainings, said that on-the-job education for nurses, hospitalists, physician’s assistants, and nurse practitioners helps them recognize and handle hypoglycemia, hyperglycemia, insulin pump, and continuous glucose monitor management. “If you invest your time educating them, you will get fewer calls,” he says. This includes letting patients who use insulin pumps and continuous glucose monitors to handle their own technology. “Odds are, those patients know what they are doing,” he says. “Please allow them to use their insulin pumps until they are seen by an endocrinologist. Because people are not familiar, their instinct is to take it off without realizing the insulin pump is the lifeline for that person.”
Above all, a good attitude about being on call goes a long way. “When people call you, no matter what time it is, be very nice to them,” Zilbermint says. “The reason people call you late in the evening is not just to bother you, but they really need help. Be kind, and not grumpy and don’t blame them. People will appreciate it.”
Implementing Healthy Habits During Call
Besides endocrinology-specific advice, general wellness recommendations can help all physicians. “Being on call can fundamentally disturb the things that keep us grounded and well during a ‘normal’ workday,” Brandt says. “The four things that are most disrupted by a call day are meals, sleep, social time, and exercise. Each of these requires a slightly different strategy.”
For eating, Brandt suggests stocking your work bag with nutritious snacks and meals to ensure there are healthy choices for when hunger strikes. “It’s important to eat, and to eat well, when you are on call,” she says. “That means it’s best to plan ahead and take nourishing and delicious food with you to work. In addition, put a couple of balanced snacks in your pocket (like a small bag of raisins and almonds) in case it is an overpowering call that keeps you from sitting down to eat.”
For sleeping, even small amounts help. “Don’t ever pass up an opportunity to sleep while you can,” Brandt says. “If it’s a sleepless call, make up those hours by going to bed early the next night, and if possible, take a nap.”
When trying to maintain social time with friends and family, virtual connections can help when in-person visits aren’t possible, due to long call hours (or pandemic-related social distancing). “Stay connected with occasional texts, funny memes, or just sending an appropriate emoji,” she says.
“It’s OK to sit down and review the patient’s chart to see if they have been admitted for a similar issue before. We all know rushed decisions may not be the best decisions. If you don’t know the answer, pick up the phone and call the attending.” – Mihail “Misha” Zilbermint, MD, FACE, chairman, Department of Medicine, chief and director, Endocrinology, Diabetes, and Metabolism, Suburban Hospital in Bethesda, Md.; assistant professor, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins School of Medicine, Baltimore, Md.
To get enough exercise, think about how to fit fitness into your schedule. “If your call is like most people’s, you’ll be able to squeeze in two or three sessions of weight training and three to five sessions of aerobic exercise in a week,” Brandt says. “Make it a priority, even if it has to be part of your call day. For example, taking the stairs counts as aerobic training, and pushups and squats are ways to do strength training without any equipment.”
Overall, working such healthy habits into the call schedule helps to maintain your body and mind so that you’ll perform better despite the long hours and potentially stressful situations that call can bring. Don’t ignore or minimize call’s effects, either.
“Think of a hard call night as the same thing as jet lag (minus the change in time zone),” Brandt says. “It is a real stress on your physiology and you need to plan to recover from it — both for your health and to be able to care for your patients.”
Alkon is a Massachusetts-based freelance writer who is the author of the book Balancing Pregnancy with Pre-Existing Diabetes: Healthy Mom, Healthy Baby. In the August issue, she wrote about coping with sleep deprivation.