Recent graduate's guide to handling the specialist on call

Collaborating with other medical staff is an aquired skill
Collaborating with other medical staff is an aquired skill

 Ahhh, the SOC. For those of you that may not know, the SOC stands for “specialist on call”. In the emergency department (ED), it is the specialist on shift that gets called to answer any of our questions, give us guidance, or come in and see a patient if necessary.

When I first started working, dealing with the SOC would often give me palpitations or nausea. The funny thing is, many specialists don't like being called at two o'clock in the morning to answer questions, so if you have a question, it better be a good one.

As I progress in my career, I have become more familiar with each specialist, and I now know better how to approach each one. I know which specialists will come in for any reason whatsoever, which ones seem to be awake at all hours of the night, and which ones require a report be given in under two sentences or less. When I first started working, this was all new.

Handling specialists is actually an acquired skill, and here are two tips I learned to hopefully make it easier for you:

Write down the important facts

Perhaps one of the worst things ever is when you have a specialist call back right when you are in the middle of examining another patient. You have to quickly run out of the exam room and answer the phone because if you make some of them wait longer than two minutes, there is a chance they will have already hung up and you'll have to repeat the process again.

After you pick up the phone, you have to clear your mind of the patient you are current dealing with, back track to the patient you dealt with, and try and remember their history, physical, and vitals. If you're anything like me, Murphy's law will kick in and you will have three of the exact same type of patient, whose stories all start to run together, but only one of which will require the consult.

The trick to managing this? I write down bulleted facts about the patient in question on a separate sheet of paper. This allows me to quickly jump into the patient's case and the important details. It also buys me time to open up the chart in case I get asked any unexpected questions.

Always call with a plan in mind

When I graduated, I don't think I realized how many things I would be dealing with in the ED that weren't even remotely mentioned in my textbooks. I still watch emergency room shows on television that feature unexpected situations because I seriously find them educational. If we could somehow take all of these shows and bundle them into a textbook, it would probably be a top reference guide.

When I first started working, I began working with a lot of newer doctors, and it happened on multiple occasions that we would run into a situation that we had absolutely no idea how to approach.  I will not mention them here for HIPAA reasons but I will mention that they almost always happened in the middle of the night and often required the help of a specialist.

Through my experience, I have found many SOCs are more receptive of your midnight calls if you approach them with a plan, no matter how simple the plan is.

I've received many more positive responses by saying something like “I was going to suture it up and have an outpatient follow-up” instead of “what do I do?”. Granted, they may shoot your plan down, but at least they will give you a different plan they would like you to follow.

I am not speaking for all SOCs when write this post. There are many specialists that are unbelievably kind, will teach you anything you want to know, and will go out of their way to help you out. But there are always a few that do not fall into this category. 

As a student, you don't speak to a lot of SOCs, and it is one of those things that you just have to feel out as you go. But hopefully with these recommendations and a lot of television watching, you will do just fine!

Jillian Knowles, MMS, PA-C, is an emergency medicine physician assistant in the Philadelphia area.

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