regroup / response

September 19, 2018

14 years of blogging, and just one deleted post.

I just could not leave it there if it was somehow giving people the impression that I am not a good clinician, or that I do not care about my patients.  I absolutely care.  I also always provide what I feel is appropriate advice overnight.  Is it always delivered in a warm/fuzzy/empathetic tone?  No*, though I do my best to provide the right instructions to keep the patient safe.  It can get emotionally and physically exhausting at the end of a long week, and (per my prior post), my coping mechanisms are not particularly effective.  Maybe this is a flaw of mine, but I would also venture to guess I am not alone.

In analysis of last week, Josh and I concluded that perhaps 168 hours on in a row is not the best setup for call, and for me the challenges have been compounded this year by a baseline of sleep deprivation that has lasted the longest of my 3.  A practical solution that we came up with is that I am going to see if there are other clinicians that would like to share the overnight calls over two weeks, so that there are breaks to get reasonable nights of sleep.  I also love the idea of creating more easily available literature (love this chart that a reader linked to) for our specific types of patients about what necessitates an overnight call, so perhaps in the coming years access to the right kind of care will improve.

To the few people who felt my post was a personal attack on their choice to call their after-hours pediatrician:  I absolutely NEVER meant it that way.  I know how scary things like croup or baby fevers can be, and have rushed to the ER with a severely wheezing child more than once (C, always C).  Just because it’s tough to receive these calls doesn’t mean people should not make them.  I believe I am allowed to find some calls more appropriate than others, but I absolutely accept that it is my duty to deal with all of them.  I was hoping to come up with solutions for how I, as the receiver, could better deal with the challenges that come with multiple nights of consecutive wakeups.   I do not believe that just because I have an MD after my name that the expectation is that I am invincible.

* and I do believe that as a woman I may be judged more harshly for this, but that is another story


  • Reply Gillian March 10, 2019 at 7:06 pm

    As a fellow physician who takes call, I totally get where you were coming from in the original post. It is hard to be on call. I know whether to call the on-call doctor is a judgement call, but it can be frustrating when something could obviously have waited. As a parent I get that our judgement about our kids can be clouded by worry. I love the idea of making guidelines for when to call available. I wish there was more of this type of resource for adults!

  • Reply BEH March 10, 2019 at 7:06 pm

    I really appreciated your previous post. I am a resident who will start a fellowship in the summer that requires a week block of call q3weeks, so I thought your comments on maintaining a positive perspective were good advice. I also really appreciate just knowing I”m not the only one who struggles with the responsibility of call – no one else in my program *seems* to mind being available all the time. Maybe it”s because I now also have three kids (youngest is two weeks old), so it requires a lot more logistical finagling, but I feel like call can be very intrusive on the time I need to recharge to be a good physician during the day. Thanks again!

  • Reply Anonymous March 10, 2019 at 7:06 pm

    I really loved the prior post. (I sent it to my husband to read which is a first; I was planning to send it to my sisters but I didn’t get around to it). It spoke to me so deeply, even though I am not a doctor/don’t have a job where I have to take call. (I just read right over the fact that it was about call as opposed to just a particularly stressful period at any type of work). I felt that I related to every single one of the lies; I felt like you were inside my head.

    • Reply Colleen March 10, 2019 at 7:06 pm

      I couldn’t agree more with this comment. I REALLY RESONATED your prior post and in NO WAY interpreted it as an attack on overnight calls to doctor (which I’ve done my fair share of). I also didn’t focus on the call and instead interpreted it as a "stressful period". It was really helpful for me to identify that I’m similarly telling myself "lies" and that I can find healthier stories & ways to cope. I can’t thank you enough for your willingness to continue to put yourself out there, even if it subjects you to criticism. Please know your story and your authentic voice are VERY valued and are greatly benefiting others.

  • Reply Katie March 10, 2019 at 7:06 pm

    Wow. I read your post and didn’t think it was out of the ordinary or off base. I did not look at the comments. I have a kid who regularly sees an endocrinologist (adrenal insufficiency) as well as other specialists (kidney disease and oncology). Calls in the middle of the night stink for everyone (those on call and the parents too).

    Our endocrinology group (which is affiliated with a very well regarded pediatric hospital in the midwest) has a chart with green, yellow, and red zones for adrenal insufficiency. It is helpful for med dosing and heading to ER/making calls.

    Good luck. I have a challenging job and three kids too (8, 6, and 3). It’s hard – and I never have to deal with receiving work calls in the middle of the night – just having 1-3 kids climbing into bed (which makes me a giant crab)!

  • Reply lapetitelumiere March 10, 2019 at 7:06 pm

    Sarah, as a non-medical person who has called doctors after hours for myself and my kids, I was not remotely offended by your post. I can’t imagine how challenging it is to care for an infant AND have to deal with random wake-ups from patients. That would cause me immense stress, so add me to the list of people who appreciated your honesty.

    On another note, I am heading back to work tomorrow after maternity leave and am so grateful to have your blog and podcast as resources. This is my second go ’round, and the reentry somehow seems harder. Trying to take it one day at a time!

  • Reply shellychlan March 10, 2019 at 7:06 pm

    I also appreciate the honesty you bring in your blog. We all have difficult parts of our jobs and I also felt like you were not trying to be disrespectful but were trying to show your process of working through the frustrating time period.
    I have been teaching at an applied college for 14 years and sometimes struggle when I have a few really challenging students in a group. Yes we all know that there will be parts of our jobs that will be difficult and challenging but it is really nice to share our lies to ourselves and how we can reframe things in different ways to make our way through the challenges.
    I’m a bit disappointed that you had to delete the post but can understand that there were too many misinterpretations of it that were potentially harmful to you.
    I hope you do continue to post about your struggles and successes! It’s what keeps me coming back. Plus my amazement at your planning systems!

  • Reply Cbs March 10, 2019 at 7:06 pm

    I missed the discussion as an early morning UK reader but read it in the spirit that I think it was intended – parents should call when they are concerned and you’re happy as a doctor to help but can still find it personally frustrating / draining, particularly when it’s not actually urgent. I teach university students and want them to reach out to me when they are struggling but find it irritating when they email me in a tizz for something that was in the syllabus or could be googled.

  • Reply Katie March 10, 2019 at 7:06 pm

    As another non-medical professional who has called the on-call physician after hours, I absolutely was not offended by your complaints about call. In fact, I resonate with them a lot in regards to my full time job. While I’m not on call, email and cell phones have kind of changed how "available" I am to my clients and superiors. Their emergency is not my emergency, despite the fact that they want it to be (and I can say that honestly because nothing that I do at work is life or death). I really appreciate your perspective, and I’m sorry that you felt like you had to delete that post.

  • Reply Jjiraffe March 10, 2019 at 7:06 pm

    Sleep deprivation is real. I once got a chance to talk to Arianna Huffington about her book "The Sleep Revolution." Her research showed that something like 95% of the population needs 7 hours or more quality sleep each night (people who need less than 4 hours are a tiny part of the population). There is research that shows when people are particularly sleep deprived they are cognitively impaired, similar to drunk driving. I asked her about working parents who have to up at night with infants / sick kids, then have to go to work the next day (which had happened to me that day!) and she suggested that companies need to provide their employees with nap rooms so they can catch up on sleep without stigma–which is what she did at Huffington Post. Interesting idea, but back on topic…

    Have you and your partners considered a service like Teladoc? I know you are specialists and I don’t know if there is a service like that for your type of medicine, but this is what my own internist uses. A relative of mine, a retired ER doctor, works for a service like this and loves it. The idea is "fresh horses" can be used for those panicked middle of the night calls.

    If there isn’t a way to reduce your on call hours, getting more sleep is definitely a good answer. Know you’re an upholder, but perhaps its time to think about sleep training/stop pumping/getting your husband to help at night…I know it’s so hard and such an emotional hot topic, but sleep is sooo important.

    Anyway I’m a podcast listener, and love the advice you guys provide there. Thanks for doing that show.

    • Reply Abby March 10, 2019 at 7:07 pm

      I was going to say something similar to this, but Jjiraffe already said it way better. I have to take frequent call during my peds endo fellowship, which I hate but acknowledge as important for my learning. But I don”t intend to be in one of those places that has fellows to take first call when I”m an attending. And honestly, I find the idea of forcing adults to take overnight call while still being required to work a full and busy schedule the following day to be inhuman. We”re finally starting to see this concept with the importance of parental leave – why do we expect the doctors we are literally trusting our lives with to be able to perform normally after q2h wake ups? I”ve just decided that for me, I cannot take overnight call when I have young children. Especially when there are other options, like a teledoc service that could serve this need. I think many physicians would happy take slightly less pay to get rid of overnight call.

      Things I”m considering for post-fellowship to deal with my stance on this include non-clinical jobs (pharma, FDA etc), working a part time enough schedule to never have clinic or other scheduled work for the day after a call, or (if I can”t find such a dream job), doing locums or even marketing myself as being one of those people who can take overnight calls for large groups (and then not having a day job).

  • Reply Brooke March 10, 2019 at 7:06 pm

    I’m sure almost every physician with call feels the same energy-drain and frustration that you do. In the spirit of making things better for everyone, are there any studies about what other physician groups have found effective in reducing non-emergency calls?

    Also, would it be effective — for both patients and physicians — to look at the data for 3-4 months of calls for your entire practice (I’m sure you have to track this in some way for electronic patient records), then group the calls into categories by questions/concerns, then create patient education (videos, handouts, charts, a group class, etc.) for the 5 most common issues?

    I know that the above patient-education piece doesn’t tie directly into the number of patients seen billing metric, but I imagine that better patient education would improve both patient satisfaction (I imagine most patients hate the internal angst/debate of "Should I call or should I not? Is this really an emergency?") as well as physician satisfaction.

  • Reply Anon March 10, 2019 at 7:06 pm

    The problem with the comments/taking down the post is that [I think] you need space to think things through and really find a way to make peace with call. [To the extent the comments in the last post interfere with that, that’s unfortunate.]

    Although I am not a physician, many close friends are (including an endocrinologist), and I have been with them during their call periods. The statement that every physician feels the way you do, doesn’t ring true to me. I see people who seem to experience the week in a very different way than you seem to. It’s worth trying to talk to lots of physicians and finding those who are able to take the week the better and see what you can learn. Not just grit your teeth through it, but really try and find a way to just be and take things as they happen. (obviously with child care and other supports in place). Sometimes I make things loom large in my mind so the anticipation and dred are much larger and more negative than the experience itself. Honestly, when you describe and frame call (probably so others understand), that’s kind of what I see happening for you.

    Anyway, just some thoughts from the interwebs.

  • Reply Kersti March 10, 2019 at 7:06 pm

    I sensed envy in the negative comments in the last post. You are a very accomplished person with a beautiful family. I think you might see more and more of these comments as you become increasingly well known. In sum, haters gonna hate…please keep being yourself for those of us who appreciate you as you are!

  • Reply Rachel March 10, 2019 at 7:06 pm

    As a physician myself, I completely understand what you are going through and what you meant. However, after reading your last post I was concerned about the possibility that Some of your patients or patient”s parents have found your blog. If someone who called you that night read what you wrote, they may feel pretty bad. The post just made me worry about how your patients or partners might perceive you and the honesty you display and I certainly don”t want this blog (which I have followed since 2009!) or your career to suffer.
    Thank you though for your thoughtful reflection on this issue.

  • Reply Andrea March 10, 2019 at 7:06 pm

    As doctors we definitely are not super human, but when discussing medicine with lay people, we do have to talk about our jobs VERY carefully. I made the (stupid) mistake once of describing a situation in obstetrics I had encoutnered as a resident as "gross" to a few friends, and I really ended up hurting someone’s feelings. She said it made her really self-conscious about her delivery and wondered if the providers there thought it was gross. So that was a reminder that it’s really important to remain sensitive when making public comments about our job to non-physicians. Sometimes when venting it’s best to just keep it between other physicians who understand where you’re coming from 🙂 Although it is a shame, since I really appreciate reading about all of your experiences as a fellow physician. It’s a tough balance.

  • Reply Reader March 10, 2019 at 7:06 pm

    I’m sorry you are experiencing this level of stress right now. I’ve been in a very tough spot recently, too, and I’ve always admired your ability to share your story. I’ve read your blog and LV’s for the better part of a decade and listened to some of the earlier podcasts. Recently, however, I stopped when a true family crisis made every suggestion to tweak my schedule, scale up my career, make the most of my time and earning power seem absolutely ridiculous. You reference your coping mechanisms, and I think we share some similar tendencies. I thought I was doing everything right: maintaining exercise, eating healthy, paying for more than enough child care and house hold care, date nights, vacations, etc. I was the surface-level of upper-middle-class "we have everything together." And yet there is a reason why one can make an entire academic career out of studying work and family: it is complicated, and there is so much more research to do to understand how families (the individuals and the unit) are impacted by career stress. I regret that I ignored mental health issues in our family, some of which are outgrowths of a dual-career couple and some of which are not, and focused too much on tangible solutions like planning my way out of our stress. An academic who studies the work-life relationship gave me a copy of "Work Won’t Love You Back." It’s a bit dated, but it has been eye-opening. It does not advocate leaving one’s career; rather it is an honest look at the impact of dual-career households on one’s stress levels, marriage and family. In one of your recent posts I was caught by a reference to a mother of young children you observed during residency who seemed to "give up." We have no idea what was really going on in her life. I have no doubt some of my colleagues would categorize me this way. I’m not giving up because I’ve lost my ambition; I’m recovering from and managing some very serious family issues, and I’m coming to terms with the up and down side of my coping skills. Thank you for sharing your story, Sarah, and for being brave enough to host a blog that fosters genuine dialogue that dips below the surface from time to time into the real issues.

  • Reply Tara March 10, 2019 at 7:06 pm

    I don’t often comment on your blog posts, but have been reading your blog religiously for nearly 9 years because I very much look up to you and the journey you’re on to find balance in your life. I’m sad to see that your previous post, which I found to be transparent and vulnerable (and truthfully, makes those of us who also feel all of those things seem a little less crazy) didn’t get the sort of response it deserved.

    All of the drama aside, I just wanted to drop in and say, what your doing here in this corner of the internet is valued, appreciated, and enjoyed by so many. I have learned so much from you and hope that you have at least 10 more years in you!

  • Reply TRL March 10, 2019 at 7:06 pm

    I am a follower but rare commenter. Although not a physician myself, I am married to one and can totally see where you”re coming from with the unnecessary after hour calls. My husband often receives calls from the hospital staff that mix up his specialty with another or BP/ECGs that aren”t clinically significant. It”s def frustrating esp. in the late hours. I”m sure you”re a fantastic physician, just like you are a mom, and your patients are lucky to have you.

  • Reply Irene March 10, 2019 at 7:06 pm

    I think it”s damn impressive you went 14 years without deleting a post! I think you made the right call; you are clearly a wonderful caring doctor and that post just came off wrong, even though you are completely entitled to your opinions in any form!

    I am not a doctor but I have lots of friends who are and your call schedule sounds unusually horrible to me. Even without other night wake ups from the kids! I hope you can find some way to make it better. My mom is a nurse at a pediatricians office and during flu season she will team up with a doctor for weekend call (screening out the non-urgent calls you describe and making sure a doctor responds quickly for the truly urgent stuff. It seems to work well for them; any chance you have some one you trust to do that?

  • Reply Amanda March 10, 2019 at 7:06 pm

    I”m a fellow doctor mom and totally understand all of your last post! But I also get why some patients/people could take it the wrong way- just another example of something we need to vent about with friends and other doctors instead of potential patients and public audience. I”m a long time reader and will keep reading for sure- hope you don”t censor too much!!

  • Reply Rinna March 10, 2019 at 7:06 pm

    Oh my goodness, we live in such a ridiculously over-sensitive time that I wonder how people deal with actual real problems in their lives when they can’t manage even minor perceived slights. As a non-medical person, and somebody who definitely called my saintly pediatrician too much when my oldest was a baby, I found nothing whatsoever insulting about your post. Does any parent actually believe that a doctor enjoys being woken up in the middle of the night? I mean, unless you were overtly rude, which I highly doubt, they should be thankful that somebody is available to answer their questions (some of which could definitely have waited until the morning, but didn’t have to thanks to the availability of said physician). Many parents around the world definitely don’t have this access. In fact, I see no problem with you saying what my ped eventually said to me: "I understand your concern and am here to help. In the future, this type of issue could wait until the morning." Ultimately, everybody is entitled to his/her opinion. I just wish people didn’t feel so easily triggered/judged by normal human behaviour. Stay strong, Sarah, you’re doing great and lots of us love your blog.

    • Reply Wyla March 10, 2019 at 7:07 pm

      My thoughts precisely. But your wording is way better than I could’ve articulated it.

  • Reply Christine Cortese March 10, 2019 at 7:06 pm

    Wow, I’m so sorry people came down on you for that post! I read it and had a very positive response and good feeling about what you had written. It made total sense to me and it still baffles me how anyone could take it otherwise. I guess that’s one of the downfalls of writing on a public platform – maybe those who misinterpreted what you wrote were exhausted or frustrated or otherwise compromised and just saw things through a cloudy filter as a result. Anyway, in my book you did a great job with that post.

  • Reply Hannah March 10, 2019 at 7:06 pm

    Of course you have the right to feel stress from being on call!

  • Reply Sneakers March 10, 2019 at 7:06 pm

    Late post – from reading your blog, I know that you would always be professional, and more importantly, provide the information required to keep your patient safe no matter what the situation – I’m sorry others couldn’t see that. We’ve only had to call our pediatrician once in the middle of the night to date (our daughter is 8) – and so so grateful that there was a nurse who picks up the phone and screens, who then passed on our request to the doctor on call who called back and allowed us to skip that ER visit. I’ve got several close friends who are physicians so I somewhat get the long hours for those weeks. Your blog is honest and rare these days.

  • Reply Anne March 10, 2019 at 7:06 pm

    I didn’t get the time-chance to read the post, but I have to say… I chose a career that is stress free, creative, intellectual, yes, but stress free, and it comes with a very very humble salary. When you are a doctor, it is full of stress and BIG responsabilities… but the salary is proportional. You see my point? Every call should be taken and all. Without a word, when your are paid in the high 1% (or even less?) of the social and economic pyramid. But it is a crazy difficult profession, I believe that!!

  • Reply Caroline March 10, 2019 at 7:01 pm

    My colleague, who had been in solo practice for a LONG time, speaks fondly of a fellow surgeon’s tactic for dealing with after hours calls. He set up a 1-900 number. Thereby, patients could always get in touch with him but there was a charge. Although this seems drastic, I myself am unclear why physicians are supposed to be on-call without patient payment. Lawyers charge by 15-minute increments for calls, so there is a professional precedent. Another way would be to use the telephone encounter code for billing, but at least for us, our after-hours documentation is not formalized into the EMR.

    • Reply Anne March 10, 2019 at 7:06 pm

      Oh, come on! I know doctors who get paid 500 000-600 000 a year. Extra cash for calls?? Even a professor who get paid 120 000-130 000 will work extra hours, nights and weekend, without having bonus. This is ridiculous. Big salaries come with big responsabilities. Final.

  • Reply Alyce March 10, 2019 at 7:01 pm

    To preface my comment, I’m a lawyer and thus trained to be overly cautious and conservative when it comes to risk taking. Also, I was in no way upset or offended by your earlier post. That said, I think it was quite wise to delete it. And if it were my blog, I would probably delete this one as well given that we basically get the full gist of the previous post in the comments. It’s just not worth the risk that a patient or an employer would find either the post or the comments, interpret it poorly, and use what’s written here against you.

    Even if every doctor in America totally understand where you’re coming from and is on the same page, I can easily see a scenario where, pushed by complaints from the right patient(s), an employer feels compelled to pursue some sort of disciplinary action. I certainly respect and appreciate the level of transparency you provide here on the blog, but it’s not worth it if it negatively impacts you professionally. I personally google every doctor I see, and I surely can’t be the only one. You do use your full (and fairly distinctive) name here and on the podcast, and I don’t doubt that the blog and podcast are easy to find.

    • Reply theSHUbox March 10, 2019 at 7:06 pm

      I think you are probably right; I actually think some of these comments make it seem like I posted something very specific as well (which I did not). I do appreciate your comment and all above this – but I agree, I’d just like to move on (which was the intention of this post). Thank you!

    • Reply theSHUbox March 10, 2019 at 7:06 pm

      PS: I’d like to think that most patients who googled me would not be upset that I get tired and cranky after being woken up all night, whether it’s due to Genevieve or patient calls or whatever. I have definitely had patients tell me they have seen my blog – and I write it with that in mind! Yes, even that last post. But I think there was a lot of projection and speculation on the part of some readers, and for me that is enough reason that it had to go if it was going to leave anyone with the impression that I am not a caring person or do not do my job well.

      Anyway, agree w/ everything you said and you have inspired me to also likely remove this post. (I think this will come your email anyway!).

  • Reply Dawn March 10, 2019 at 7:01 pm

    I would say that after 14 years and only one deleted post is a win! I also think the way social media has changed over those 14 years has been so dramatic that no one really knows how anyone is going to "perceive" what the person who is writing really meant and people have zero filters when it comes to their "typing mouth" –I know there are things people type that they would never say to a person’s face. I applaud and thank you for being as transparent as you are, I have found myself not wanting to post anything on my FB page for that very reason. Right or wrong, I just don’t want to deal with the potential fall out. It makes me sad b/c my timehop app often shows where I was 5-10 years ago and I sometimes think "oh I was stressed about the same thing then as I am now!" but I won’t have that luxury 10 years from now b/c I don’t want to "put anything out there". Anyway–thank you for your blog, podcast and sharing with us. I 100% support you!

  • Reply Sabrina March 10, 2019 at 7:01 pm

    Sarah you are doing such an amazing job, thank you for your inspiration and for keeping it real.

  • Reply Katie March 10, 2019 at 7:01 pm

    Wow. I read your post and didn’t think it was out of the ordinary or off base. I did not look at the comments. I have a kid who regularly sees an endocrinologist (adrenal insufficiency) as well as other specialists (kidney disease and oncology). Calls in the middle of the night stink for everyone (those on call and the parents too).

    • Reply Katie March 10, 2019 at 7:06 pm

      Sorry! This is a partial repeat post. I must have accidentally hit submit twice (second time when I came to recheck comments). Feel free to delete. Apologies!

  • Reply Kim March 10, 2019 at 7:01 pm

    Reader, but infrequent commenter here –
    Honestly didn’t read your last post (extremely busy the last two weeks!) but will say that it’s absolutely ok to be tired/stressed out by a demanding job, especially when you have a family and young children. That doesn’t make you a bad mother or doctor, only that you are human, who is doing your best.

  • Reply Holly March 10, 2019 at 7:01 pm

    I’m sorry you felt like you had to delete the whole post – I think it could have just been edited to better reflect your intentions! As I said in the comments over there, I think the difference was (or why this struck a chord with some readers as opposed to other posts you’ve made about call being hard) was that it was related to particular patient calls being annoying, vs. call in general just being hard and draining and exhausting. I don’t think it’s unique to medicine, to be honest (though I realize patients have super-human expectations of their physicians)–in general people probably shouldn’t complain about the people they serve or their bosses on the public internet, as a rule of thumb. [A non-medical example–for me as a consultant, it’s the difference between being like "wow these hours are long and hard" vs. "ughhh this client is making ridiculous requests and it’s making my hours so long."] I’m not trying to re-play the discussion on the other post, but I’m just trying to make sure you understand why people reacted that way to that post in particular so you don’t feel like you can never write about call again.

    I’m so glad you and Josh were able to come up with a potential solution!! I hope it works out and that patient education gets better in general over the years. And that the sleep deprivation situation can get better once you stop breastfeeding!

    • Reply theSHUbox March 10, 2019 at 7:06 pm

      I did share one example in the comments of a symptom/call-in time to demonstrate some of the frustrations, but nowhere in the actual post was any reference to any particular call, type of patient, etc. I may have mentioned diabetes, but it goes without saying that in my profession that is what 90% of after hours calls relate to, in some form or another! That said, I definitely appreciate the feedback and get what you are saying. I definitely will make sure to be clear and careful never to give specifics, but I probably will write about call again just as a part of life! Hopefully the next post will be about how much better I am handling it 🙂

  • Reply Irina March 10, 2019 at 7:01 pm

    Sarah, thank you for taking the time to address this… I am a commenter on the previous post and I am the person who is referenced in this post as a parent of a child who had croup who called her pediatrician at 10pm. I would like to clarify a few points as well: 1. I was not offended by the previous post, not did I ever feel that Sarah is not a caring physician. I did feel that, after having read on multiple occasions Sarah’s feelings regarding the on-call duties, that the post did not take into account the point of view of the patient. In my comment I attempted to provide the perspective. I also attempted to do so in non-combative manner and if it did not come across this way, I apologize sincerely. 2. I am very grateful we have professional and civilized medical care in this county and doctors we can call, however, after paying $2000 per month in health insurance costs I would expect it to be pretty exceptional. I grew up in a country where medical care is free and doctors make house calls. But this is a different topic and not an invitation to debate. 3. I do not feel that I am overly sensitive and I am not easily offended. Not everyone who disagrees with a statement in a blog post is offended, rude or lacks perspective. (the irony of spending time typing this comment is not lost on me either 🙂 ) I do not know any doctors on a personal level, and reading this blog has been very interesting and educational. I like this blog and can relate to a lot of challenges of working and raising a family. Just like with many public forums, it is very hard to have an honest discussion in the comments, so from now on I am sticking to the "tried and true" rule – I will keep my comments to myself when I find something that I disagree with. I am sorry about the typos…

    • Reply Anon March 10, 2019 at 7:06 pm

      There are parenting forums that do address things from the parents’ perspective. They can be very helpful and validating.

      This particular venue is a blog. As such, I think it’s fair for the author to discuss things from her point of view. If the issues she’s having with breast feeding or call or any other issues are triggering to anyone, including me, it can be good to take a break and/or seek support on a parenting forum or other parents you know in real life. This here is just a blog written by one person expressing their experiences, feelings, etc.

      • Reply Kristin March 10, 2019 at 7:07 pm

        Yes, and this blog is linked to her real name, and her real career, and her real patients and colleagues can find it and feel really taken aback by the complaints they find — complaints that, FWIW, are perfectly valid and normal, but should not be publicly posted online in this context. I think you were right to delete the post Sarah, not because you should be ashamed of what you wrote or feel, but in case of inadvertently causing offense.

    • Reply S.M. March 10, 2019 at 7:06 pm

      Very little of the $2,000 per month we spend actually goes to doctors. In the US, 40% of the healthcare dollar (may be more at this point) goes towards the rising administrative costs. Compare that to like every other country in the world where only 15-20% of the healthcare dollar is spent on administrative costs. My interpretation of this (I am a physician) is that it is not valid to expect physicians to live up to any ideal based on the monthly costs of insurance… Instead, we might ask an insurance company to provide better service based on the amount we spend, but the system is so broken I don”t think this is possible.

  • Reply TAS March 10, 2019 at 7:01 pm

    Well, this post bummed me out. One of the things I love about this blog is your authentic voice. Talking about your feelings about call has made me more deeply apppreciate my care providers and understand their work. I would dare anyone who comments to work that many hours with sleep interruptions and have perfect feelings and emotions about it. We all have moments even in a 40 hour week where we don’t feel like or show up as our highest and best selves. Or we have to fake it because we are tired, have home challenges or personal challenges and still have to be present in our roles. so thank you for sharing your life and insights with us here, and I hope you won’t edit your future self because of those comments.

    • Reply theSHUbox March 10, 2019 at 7:06 pm

      To be fair, on a public blog EVERYTHING is a little censored 🙂 I share what I feel safe sharing. I wonder if the last post wasn’t very clearly written, and that is why (I feel) it was misinterpreted in a way that could be personally damaging. Therefore, I deleted it. I do want to continue to present honest content (I feel it has value . . . for both myself and others) so know that I will continue to try to do so!

  • Reply Anon March 10, 2019 at 7:01 pm

    I was the commenter who asked for better resources (thank you for that link!!!) but I have never read any of your posts to mean that you don’t care about your patients. It is so hard to work a demanding job with young kids (and sleep deprivation is so brutal) that I’m really grateful for your blogging because it’s one of the few places that discusses this topic openly and regularly. How does one do high-stress, high-stakes work on little sleep? What does it mean to be a good parent or a good [insert profession here] when you have full-time work hours and a baby still breastfeeding at night? What gives? What to prioritize? These are hard questions and I am so thankful to you for bringing them to light over and over again. There are not easy answers and these questions deserve the honest, difficult discussions that you pose on your blog. I hope the last post doesn’t scare you off from continuing to write. Your voice is so appreciated!

  • Reply Alex March 10, 2019 at 7:01 pm

    Sarah, I am a non-doctor mom of 1 year old twins who calls my after-hours pediatrician line all the time, and I absolutely did not interpret your post as a dig towards people like me. My goodness. It’s a tough part of your job and you’re allowed to feel like it’s tough. Having a nanny who does your laundry doesn’t make sleep deprivation any better. I agree that a longer call period with more breaks makes more sense than 168 hours straight. I’m pretty sure this is how my kids’ pediatrician group does it, because I have often called more than once in a week (I know!) and gotten different doctors.

  • Reply katie March 10, 2019 at 7:01 pm

    I came back to read the comments on the last post; I can understand why you deleted it. Glad you like the wait/worry/panic chart. My peds office is going to wonder why they are getting new website traffic! The non-medical comments on the last post were a good reminder to me of what the lay public does not know. Just because i have had a conversation 1,000 times about how a fever in an otherwise well child is not an emergency, this family who is calling may not understand that. I think the responses were also too generalized- no one is saying the parent with concern for croup shouldn’t call. They just don’t know about the three patients that called with rashes overnight. These phone calls add up over the days, weeks, months, and they are draining. I also don’t think the non-medical readers understand how medicine works (why should they?). No one likes 100% of their job. Taking call is a necessary evil- a trade off for having a fun, busy, academically challenging job. We all complain about it, get it done, and move on. If you can make it better, great. If not, keep getting your starbucks treats and know the week will end eventually. Mostly i’m saying solidarity, sister! 🙂

    • Reply theSHUbox March 10, 2019 at 7:06 pm

      If there is a visible traffic spike, I”ll be impressed! Thank you for your words of support. I do however want to again mention that expressing frustration about certain kinds of calls / casting negative judgment on the callers was never what I meant to express in my post. I regret that I was interpreted that way.

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