I slept about 4 hours over the course of 3 days I was on weekend call. The call day started off after a full day of clinic (about 10 hours).

Why?

Ophthalmology receives too many consults that aren’t legitimate. Despite what the emergency physicians or floor team thinks, there are many reasons why ophthalmology should NOT be consulted. For instance, a patient with diminishing vision while having a stroke in the occipital lobe probably doesn’t need at STAT (get your ass over here in 5 minutes or I’m reporting you to your program director) consult, especially if the patient’s not even on the floor.

If we were twiddling our thumbs waiting around for consults, we’d be glad to see your floor patient by the time you round in the morning, but that is not the case. Moreover, ophthalmology consults take a LONG time. Dilation drops require a good 30 minutes of wait time. A non-bullshit consult could take more than an hour for an average resident. Ten consults spaced out thirty minutes apart could potentially run over the course of an entire day.

When you do decide that your patient actually would benefit from an ophthalmology consult, tell your medical student to make sure he/she knows some basic information about the patient before calling:

1. Vision. Use a Neer card. The one on the back cover of Maxwell‘s is adequate. Know if the patient can see LIGHT.
2. Know if there’s redness in the eyes or purulent DISCHARGE. If you don’t know what that is, search for a picture online.
3. Know the patient’s name and where to find them.
4. Don’t call for a STAT consult over the phone when the ophthalmology consult is sitting next to you, and you just spoke to him less than 2 minutes ago regarding another patient–and have your STAT patient not even be on the floor for the next 2 hours.

It’s unfortunate that we never learned certain key vitals to make interactions with other services prompt, but we train for a minimum of 3 years. Hopefully we can all learn the system in that span of time.

medicine ophthalmology, rant