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    Words of wisdom: ‘Patients don’t choose when they get sick’

    Christopher Bayne, MDChristopher Bayne, MD

    UT Blogger Profile

    Dr. Bayne is a chief resident in urology at George Washington University School of Medicine & Health Sciences, Washington.


    “Patients don't choose when they get sick,” a senior attending once told me over the phone on a midnight of my second year of residency. A pillow muffled his scratchy voice as it downshifted to a deep drag through the progression of the sentence.

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    Patients don't choose when they get sick. If you’ve ever taken call, you know this to be true. Patients get sick. They get sick at 2 in the morning, not 2 in the afternoon. Several times, my pager has beeped as soon as I have sat on the toilet. I’ve stopped to help a patient who went into cardiac arrest in front of the hospital cafeteria only to have it close during the minute I intervened before the code team arrived.

    After 9 o’clock at night, my hospital funnels exiting traffic through the emergency room waiting room. Leaving the hospital every night becomes a bit of a mental cage match: Look up, see someone you know, and you may never get home.

    On this one particular night, I looked up. I spotted a familiar patient sitting in the waiting room with his wife. I had discharged him a few weeks earlier following his recovery from a large cancer surgery. His clothes told me he had spent the day on his couch. His wife had two hands wrapped around one of his.

    Our eyes locked. I wasn’t on call. The Accreditation Council for Graduate Medical Education doesn’t have guidelines for situations like these.

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    I greased the wheels and got my patient and his wife in an exam room. We talked about how he had been at home and what was wrong now. I made a differential diagnosis, ordered some tests, and called my attending. After entering admission orders and writing a note, I left the hospital, this time detouring through the ambulance bay.

    Next: ' “Off the clock” and “off call” don’t really exist.'


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