Residents’ Corner

Reflections on providing on-call overnight care for psychiatric patients


 

A transition is coming. My fourth and final year of residency starts soon – meaning that from July 1, 2018, I’ll never again be on call overnight as a psychiatry resident. July 1 marks the end of 2 years as a PGY2 and PGY3, during which I’ve worked 60 overnight shifts.

In our residency program, the on-call shift is a continuation of daytime duties, and the experience is a formative physician-in-training/quasi-hazing process of care provision for 24 hours straight. Previously, I’ve recounted experiences from my overnight on-call shifts and reflected on the intensity of working with emotionally distressed individuals in the emergency department. I never thought I’d say it, but I will miss working in the middle of the night, particularly in the ED. In the small hours of the morning, the strange aura of hospital existence, and desperation of sickness isn’t washed out by daylight and the inhibitions of business hours.

A patient in a hospital bed talks to a doctor Thomas Northcut/Thinkstock
Being on call is a fact of medical training. No doubt it makes us stronger, more experienced physicians, able to respond to challenging clinical experiences in a less-than-optimal environment. But that doesn’t mean it isn’t painful.

As part of yearlong monitoring research, I’ve asked my fellow residents at George Washington University, in Washington, to participate in a quality improvement survey. It collects information on the number of patients evaluated overnight while on call and also asks residents to rate their on-call experiences on an “emotional pain scale” with space for a qualitative comment. The emotional pain scale is a simple visual analog scale for pain, with a smiley face representing 0 pain and the sad face with tears representing the 10 out of 10, worst pain imaginable. Initially, the emotional pain scale seemed a lighthearted and somewhat silly way for residents to vent about their on-call experience. A year of data collection later, I consider the emotional pain scale an important acknowledgment to my fellow residents that being on call is physically and emotionally taxing.

At the 2018 American Psychiatric Association meeting in New York, I presented findings from this survey data, examining the quantitative information showing that sheer volume of patients correlates with higher emotional pain scores. But while compiling and analyzing the data for my presentation, I also found myself reading and rereading the comments left by my colleagues about their hardest nights. As I read, I reflected on my own 60 nights on call, and my personal experiences between the highs and lows of emotional pain.

As an homage to the educational and emotional power of being on call, I’d like to share a few vignettes from my years of overnight calls from across the emotional pain scale. (Key demographic details have been omitted to protect patients’ privacy.):

  • 0: There is no such thing as 0 emotional pain when asked to stay overnight in the hospital.

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