1 Oct 2009


My colleagues often consider me unlucky on call days. As an on-call gastroenterologist, I have to get back to the hospital in the middle of the night if a patient requires urgent endoscopy. Suffice to say, my hit rate is consistently above 50%, while many colleagues hardly ever come back. The difference cannot be explained by chance alone.

On the last on-call day before my overseas training, I had so many cases at night that the patients and their accompanying nurses had to line up in the waiting area, much like what it would be in a busy morning session. I also used up all the endoscopes in the cupboard and had to cleanse (I confess – I did not know the proper disinfection procedures) and reuse them myself. Last week, I also entered the endoscopy unit after office hours for three consecutive days.

I do not strongly believe in the play of luck. There must be a reason.

First, I thought there was recall bias. My colleagues were underreporting and I was just whining. However, after over 50 person-years of prospective follow-up, there was indeed a pattern.

Second, I hypothesized that my colleagues actually received as many calls as I did, just that they would turn down the requests. In other words, the difference should be apparent by composite end point analysis. LL and DS disagreed and said they really slept through the night. Of course, I can never confirm this.

My latest view is the presence of confounding. For borderline cases, people are ready to call me because they know I would say yes. When I was young, I was too shy to refuse. Now that I am older, I have become so used to coming back that I no longer bother to refuse. To test this possibility, we can blind the hospital staff to the call list.

Last Sunday, my Boss gave an excellent lecture in Taiwan entitled “Is emergency endoscopy necessary?” To this, KL had a wonderful idea. We can conduct a prospective study. When physicians are on-call, the best supportive care will be provided. When surgeons are on-call, emergency endoscopy will be performed at every request. Yes, this would be ground breaking.

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