TY - JOUR T1 - Last night on call; reflections on out-of-hours JF - British Journal of General Practice JO - Br J Gen Pract SP - 882 LP - 883 VL - 54 IS - 508 AU - David Hannay Y1 - 2004/11/01 UR - http://bjgp.org/content/54/508/882.abstract N2 - It was last Christmas, with no surgeries open and a rota covering three practices for a rural population of about 8000 patients over 24 hours. In all there were six home visits and four calls to the minor injuries unit at the local community hospital, the first at 8.40am on Christmas morning, and the last at 5.30am on Boxing Day. The cases were oesophageal stricture, epilepsy, appendicitis, depression, asthma, tracheitis, chronic obstructive pulmonary disease, cervical spondolosis, suturing, and the ‘morning after’ pill. None were dramatic, and none unnecessary. Indeed in 40 years of ‘on call’ I have only had two really unnecessary calls.It started in 1964 at Hyde Park Corner where the traffic noise in central London is constant for 24 hours a day — apart from a brief spell between 2am and 3am. As a junior hospital doctor at St. George's Hospital, before it became a hotel, we lived in for 6 months at a time, and were ‘on call’ five nights a fortnight. Consultants at the time said that was what they had to do in training, but this ignored the fact that even 40 years ago there were more investigations and greater patient throughput than in pre-war days. Today this is even more so, but such hours are now outlawed by the European Time Directive. It was stress training by sleep deprivation, rather like the army, but there was a camaraderie in the hospital mess, which is much less today. The only time we were officially allowed outside the hospital was to put up drips at private clinics for consultants who played the system for private patients. Partners were required to leave the hospital each morning clutching camp beds and sleeping bags, with no distinction made between wives and girlfriends; in those days junior hospital doctors … ER -