Of Phones, Pagers and Positions

I still remember carrying my first pager as a medical student. It was such an honour. I almost felt like I was finally someone important enough that people need to call me. Funny I felt that way, because the pager was really there just in case our tutors needed to change our tutorial times or locations. But still, I was proud. I fantasised about getting some pages from nurses desperately wanting me to help them resuscitate a patient, or of emergency departments wanting me to attend to a trauma call. Those pages never came. A few pages we did receive asking us why we were late for tutorials.

And then I actually became a doctor. I started  getting ‘real pages’. But after a few days of feeling all important, those pages became an annoying interruption to my day to day work life. “Please take blood on bed 5”, “IV re-site in ward 5”, “Drug chart lost, please re-write”, “Patient fell off bed, pls review”, etc, etc. The pager became a constant annoying interruption to my activities. I remembered a day when I was operating and had trouble with a life-threatening bleed while receiving more than 5 pages about scripts, discharge summaries, admission forms, and other menial paperwork tasks. The ward clerk wanted to fax the papers before lunch. The nurses wanted to administer the drugs before morning tea. And I needed to make sure my patient on the operating table wasn’t dying. I couldn’t have answered the pages, but still, the nurses weren’t happy with my late reply.

A study (Westbrook, et al.  The impact of interruptions on clinical task completion. Quality and Safety in Health Care, 2010) has shown that doctors are interrupted on the average, 6.6 times per hour. We get interrupted every 9 minutes or so! 11% of all tasks were interrupted, 3.3% more than once. Doctors multitasked for 12.8% of time. The mean time on task was 1:26 min. Interruptions were associated with a significant increase in time on task (We take longer!). And doctors failed to return to 18.5% (95% CI 15.9% to 21.1%) of interrupted tasks. Every 1 in 5 tasks don’t get completed. (We forget to finish the chart, left the tap running, left the sharps on the trolley, zip up pants, tie our scrubs, finish shaving legs, etc.).

And then I started being the registrar on call for the hospital. I did general surgery, plastics, urology, vascular and of course, ENT. When I was on call, the hospital had my mobile number and home phone number. I went home, but was always interrupted by phone calls from the hospital. Dinners were interrupted, TV was interrupted, even vacuuming was interrupted (my wife is laughing cos she has never seen me vacuum). These interruptions came at any hours of the day and night. Getting calls about nose bleeds and ear aches at 4 in the morning is just not nice. But I have to be nice on the phone, don’t I? Otherwise other doctors and patients will complain.

Those who call me at 4 in the morning probably do not realise that I am on call on top of my usual day job. I still have to do my operating despite having been in and out of the hospital 2-3 times overnight. Can you imagine me operating on you with only 2 hours of sleep?

So as I climbed up in my position, my pager and phone became the yoke I have to carry, the cross I have to bear. What started off as an item of status and position has now become a reminder that I am here to serve, help and assist. Yes I am on call. In all honesty, I hate being on call. But it is my duty and my privilege. Yes, I am ready to be interrupted. Despite my tiredness, I shall attempt to help you.

Doctoring isn’t for the weak-hearted. It is also probably not for those who can’t multitask and be easily interrupted. Yes, I am a Surgeon, Interrupted.