The other night my pager buzzed at 2 AM with a call from the emergency room. I was technically not “on call,” but because I was concerned that the ER was trying to reach me in the middle of the night, I answered the page. It turned out that an emergency physician needed help with one of my patients, beyond what he could derive from our electronic medical record. I assisted the physician, who used what I told him to help treat my patient, and he thanked me.
However, if one of my medical trainees at New York-Presbyterian Hospital answered an off-hours patient call, it might be pejoratively described as a form of “nostalgic professionalism,” according to a recent viewpoint article in JAMA. Among the examples of residents’ practices that need to be remedied are, apparently, staying past the end of a hospital shift to make sure your patients are (to use hospital slang) “tucked in”; remote checking of labs from home; and following up on a patient’s progress while off duty.
The rationale behind eliminating these practices among medical trainees (our future independent physicians) is to limit their work hours, thereby improving patient care. Advocating for a “new professionalism,” the JAMA authors cite the need for systems and processes that are based on optimized “shift work” paradigms from law enforcement and the aviation industry. These changes would (the argument goes) make patient care more efficient and safe.
No one would dispute that, from a systems level, reducing medical errors by “overworked” trainees is desirable. But what happens when those trainees enter the real world? Perhaps it is a sign of changing times that (professional) concern for patients, whether we’re on or off duty, is no longer noble but rather deemed “nostalgic.”
As a physician who cares for — and about — individual patients and families (and as someone with numerous family members who have received such care from other physicians), I hope I never see the day when we as doctors don’t wonder about and help our sick patients when we’re not in the hospital.
A core concept that we strive to instill in all our medical trainees is to care about patients, not just care for them. Call me “nostalgic,” but to me that’s not a sin.
How often do you take off-duty calls? And what’s your opinion of “nostalgic professionalism”?