1435. The Psychology (or Psychopathology) of Neurosurgical Call

Authors: Gary Robert Simonds, MD, FAANS; Cara Rogers; John Entwistle (Black Mountain, NC)

Introduction:

Neurosurgery, as a specialty, bears the burden of a substantial volume of acute care call. We are interested in the impact call has on provider wellbeing and resilience. We have studied the issue in depth with our own team.

Methods:

We interviewed, surveyed, and evaluated “beat to beat”, the emotional states of all members of our own team reference their responses to their active participation in neurosurgery call.

Results:

28 faculty neurosurgeons, advanced care practitioners, and residents were studied. The general response to facing upcoming call and to being on call was uniformly negative. Call was seen as an invasion if not violation of the home lives of our providers. Residents maintained the most generous view in recognizing that call was a learning experience that also offered more autonomy and decision latitude than did their daytime environment. Faculty saw call of more than one in four nights to be unacceptable over protracted periods. All groups were particularly offended by “nonsense consults”, seeing them as belittling and abusive. ACP’s were the most likely to describe call as anxiety-provoking. Self-reported emotional states on-call included feelings of isolation, loneliness, sadness, anxious, irritation, frustration, anger, fury, being harried, being abused, exhilaration, being challenged, being overwrought, and more. Absent were descriptors such as happiness, productivity, joy, reward, meaningfulness, validation, etc.Emotional swings through a night of call were common for all. 

Conclusion:

 The psychology of neurosurgical call is seldom explored and yet may have a profound impact on the wellbeing and resilience of its providers. More attention needs to be paid to addressing and mitigating the factors that make call vexing for the majority of providers, with a particular focus on "CYA" consults. Fair distribution/sharing of neurosurgical acute care call needs to be addressed by our socioeconomic bodies.