Even though I completed residency almost 15 years ago, it is easy to remember the dread I experienced before taking hospital call. The sinking feeling in my stomach as the call date loomed near, the hypervigilance and terror every time my beeper went off in the middle of the night, the fear of imagined catastrophes that would by necessity be my fault. My anticipation of call was usually worse than reality. During my bleary-eyed post-call walk home, I’d think something, like wow, it really wasn’t that bad, until the next call, when the entire drama would repeat. It caused a lot of suffering during training. The tools I am going to introduce below would have been very helpful, and I wish I had known them back then. I hope they help you today. Recently, one of my coaching clients found herself thinking thoughts on call like, “I am missing being with everyone at the beach.” These thoughts created dread and made call very unpleasant. It is a perfect example of her primitive brain taking charge. Our primitive brain(brainstem) is motivated by seeking pleasure, avoiding pain, and keeping things efficient. It’s that voice that whispers that we need a second serving of ice cream while we’re trying to lose weight (pleasure!) and has us snoozing the alarm and putting a pillow over our heads at 5:30 a.m. when we have said we’d go exercise (avoid pain!). It is also the voice that creates anxiety when it paints the worst-case scenarios of call in our imaginations. This is the “avoid pain” part of the primitive brain gone awry. It might have helped avoid being eaten by tigers when we lived in caves but trying to avoid the pain of call by terrifying us does not help. No one would choose “dread and fear” as the most effective emotions to have on call. Yet many of us operate from reactive, primitive-brain territory. We think things like, “I hate call. Call is awful. I shouldn’t have to do call. I don’t get paid enough for this. I’m scared I might kill someone.” These thoughts generate feelings of dread, resentment, powerlessness. The feelings then are heavy stones we drag around with us, making it hard to do our jobs well. It is only when we look to our prefrontal cortex, the part of the brain capable of higher-level thinking, that we find ways to think about call that will serve us. Most of us need to work to find these thoughts on purpose and ahead of time. I’d like to help you do that here. First, perhaps you might consider that taking call itself is neutral. The thoughts we think about it determine how we feel and how we experience it. How do I know? Because not everyone feels the same about call. Some people love taking call from home, and some people hate it. Some people love a call where lots of patients need resuscitation; some would give their right arm to avoid that. Different brains and different thoughts create different emotional experiences for each unique human. If call is going to happen anyway, because we agreed to it, we get to choose. We can either let the primitive brain run amok making call worse for us or give the task to our prefrontal cortex and find believable thoughts that help us. Practice is key. We have long-established neural pathways primed for the primitive brain route. With practice, we retrain our minds. A requirement for this approach of intentional thought creation is for the new thoughts to be believable. This is not about false positivity or invalidating feelings. If you lose a patient or get pulverized on call, those feelings are valid and need to be processed. I’m suggesting that when and if you decide your negative feelings aren’t serving you, a shift in where you focus your mind and attention before and during call can make a huge difference and give you back your sense of control. Back to my client. I put out a request out to my network of physicians for some tried and true thoughts that help them with call. I have listed them below and suggest you use a few of them as follows: 1. Pick one or two thoughts that feel believable and practice thinking them on purpose when you start to go into a negative thought loop. 2. You’ll know you are in a negative loop because you will feel negative emotions (i.e., stress, resentment, overwhelm, annoyance, etc.). These always stem from thoughts you are thinking. Pay attention and try to identify these subconscious thoughts. Ask yourself if they are even true. Often, they are not. 3. Repeat step 1. Notice how you feel when you think the new thoughts. If they don’t help, try different ones. You are creating awareness of your thoughts and feelings and separating them from your reality. This practice of learning separation is what ultimately helps you change your experience as you retrain your mind. I hope this is helpful. Thank you for your dedication to our profession. New thought list: It is a privilege to practice medicine and help people who need help tonight. I can handle anything that comes my way. I have worked before on little to no sleep. I will catch up eventually. No matter how hard it is, Monday morning at 8:01 will come around. I can do hard things. Call is a big and important responsibility. I am a superhero. I have been caring for patients during a pandemic. I am awesome. I can do anything for 24 hours. I’m helping others, and I’ll handle whatever comes up. Helping the patient is worth it. Since I am on call now, my next call is far away. I only have x more hours left, and then it will be someone else’s turn. This time is not mine right now. It will be over soon, and I will have my own time back again. Every new patient helps me learn and will make me a better doctor. My job, including call, enables my current lifestyle. Call is dedicated time to catch up on charting and get take-out. I have the coolest job in the world, helping people. I am stressed right now, and it is OK. I’ve spent my life training for exactly this. I am overwhelmed right now, and that is OK. It is normal to feel exhausted on call. Everyone feels stressed on call sometimes, and that is OK. Source
