When modern hospital medicine was first conceived of in the late 19th century, doctors were almost exclusively male and resident doctors were so called because they were actually resident in the hospital. At the same time, the “on-call” model of the town or local shaman/medicine man/healer/doctor/barber-surgeon being able to be called upon in the middle of the night to attend a sick patient had already been in existence from time immemorial. With the 20th century seeing the advent of the household phone and increasing specialisation of a medical workforce, night hospital staff (themselves no longer actually resident) could increasingly call upon specialists at any time of the day or night for advice. The personal mobile phone has cemented this model and today we have the situation where, at least in Australia, specialists in training (registrars) most commonly take these calls overnight. But despite the pre-specialist status of these doctors, the move to post-graduate medical education and the ever-lengthening medical training pipeline means these doctors are now at least in their late 20s but more often in their 30s and 40s. The post-exams catharsis that heralds the onset of specialist training often coincides with nuptials for many of these specialists-to-be. The result is that many doctors who perform an on-call role overnight in Australia’s public health system are married, and not necessarily to a spouse who is an understanding medical professional themselves. This leaves one with three main choices on receiving a nocturnal phone call:
Escape: Assuming you select the escape option, here is a handy guide to doing this as quickly and painlessly as possible. Second 1 Turn over and unplug your phone from the charger (I’m assuming you charge your phone overnight and believe the phone manufacturers when they say that modern smartphones stop drawing power once fully charged and don’t overheat their batteries by staying plugged in all night). Second 2 Continue the turning motion commenced in second 1 to swing your legs out of bed and use the momentum thus generated to stand up in one movement. Pro tip: Once you’re confident in your skills you can also answer the call in this second, but this isn’t recommended for beginners. Second 3 Take two steps towards the door. Answer the call if you didn’t do this in second 2. Pro tip: Leave your slippers outside the room door when you’re on call, so you don’t waste time in the room putting them on in winter or trip over them in summer. Second 4(+) Take three to four steps towards the door (you’ve probably sped up since second 3). At the same time pin the phone between your ear and shoulder to keep your hands free. You may need to add more seconds here depending on how far your side of the bed is from the door but I’m assuming you don’t live in a mansion. Second 5 Open the door from the proximal side and begin to step through, taking care to keep the handle depressed or knob turned (Not relevant if your bedroom inexplicably has a sliding door, heavy drapes, butcher’s plastic fly stripes or other aberration securing its entry. If so, I can be of no use to you). Second 6 Grabbing the still depressed/turned door-latching device on the distal side, step through, swinging the door closed as you do so. As the door touches the jamb, release the door-latching device and begin whispering into the phone “Hello, this is [name], [specialty] reg…” May your on-call nights be qui… I mean, sedate and may your spouse not regret marrying a doctor.
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Medicine is full of craft groups, each with their own area of expertise, culture, lens with which to view the world, and even collective noun. But lesser known is how their colleagues view them. This is a more flattering take: You know what they say about haematologists? They're bloody good at what they do! You know what they say about endocrinologists? They've got a sweet job. You know what they say about nephrologists? Ur-ine good hands. You know what they say about neurologists? Becoming one is a stroke of genius. You know what they say about gastroenterologists? They have a wide scope of practice, if you can stomach it. You know what they say about cardiologists? They really know how to get to the heart of the matter. You know what they say about respiratory physicians? When you meet one you take a deep breath, then another, then another, now say 99, and again... You know what they say about rheumatologists? They're the only joint strikeforce that can act without Parliament's permission. You know what they say about cardiothoracic surgeons? They've opened more chests than Captain Jack Sparrow; built more bypasses than a Labor Government. You know what they say about infectious diseases physicians? Their enthusiasm is catching. The main advantage of working 2 days a week in the country followed by starting a PhD is the long spans of time one can listen to and reflect on audiobooks. The discovery of Google text-to-speech greatly expands the list of potential 'reads' to literally any electronic text. Over the last few months having now, on the basis of some strong recommendations, listened to 'On Death and Dying' and 'Being Mortal' my impression is thus:
At the same time, perhaps because of Kübler-Ross' legacy, the medical profession is more comfortable (though perhaps also not as much as it should be) with palliation and death so the friction of the 1970s remains but this time the other way round. Registrars and young consultants agonise over the most sensitive way to break the bad news to a patient's relatives that they have no chance of recovery, knowing full well those relatives will at the least question this and at most demand that "everything is done" to keep their loved one alive, not understanding (or wanting to understand) the suffering this may entail for that same loved one. Of course, sometimes professionals can be insensitive to a particular patient's needs and having relatives to advocate for a patient is definitely a good thing. But when those relatives, as happens all too often, are driven by guilt at not having had the connected relationship with their loved one they feel they should have, this synergises with the modern loss of understanding of death to generate an impasse between family and medical profession, played out at bedsides every day the world over.
I don't know how these trends will change in future, I suspect with the rise of single-person households, at least in Australia, and an ageing population these medical profession and society differences will only widen. We would do well to consider the lessons of the past when planning the healthcare paradigms of the future. |
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May 2020
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