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On-Call Survival
Overview
On-calls are where most anxiety lives — especially in your first NHS job.
They are busy, unpredictable, and often overwhelming.
But there is a truth new doctors rarely hear:
You do not need to know everything. You need to be safe, structured, and calm.
This page teaches you how.
What On-Call Actually Tests
On-call shifts are not testing rare diagnoses.
They are testing whether you can:
- Prioritise sick patients
- Recognise deterioration
- Escalate early
- Communicate clearly
- Stay organised under pressure
Clinical brilliance is less important than safe decision-making.
The Golden Rule of On-Call
If you remember only one thing, remember this:
If you are worried, escalate early.
Seniors would much rather be called for a false alarm than called too late.
How to Prioritise Jobs Safely
Not every job is equally urgent.
Highest priority:
- NEWS high or rising
- Chest pain
- Shortness of breath
- Reduced consciousness
- Sepsis
- Hypoglycaemia
- New confusion
- Active bleeding
Lower priority:
- Routine bloods
- Cannulas
- Discharge paperwork
- TTOs
- Rewrite drug charts
Sick patients first. Paperwork later.
A Safe Mental Structure for Any Patient
When reviewing an unwell patient, anchor yourself with:
- Airway
- Breathing
- Circulation
- Disability
- Exposure
You don’t need the perfect diagnosis.
You need a safe initial approach.
How to Escalate Effectively
When calling a senior, structure helps:
- Who you are and where you are
- Who the patient is
- What is happening
- Why you are concerned
- What you need (review, advice, attendance)
Clear escalation builds trust quickly.
When You Feel Overwhelmed
This happens to everyone.
Safe responses include:
- Pause, breathe, write your jobs list clearly
- Prioritise again
- Escalate workload to registrar
- Ask nurses to update you on sickest patients
- Acknowledge when you cannot manage volume alone
Struggling silently is unsafe. Asking for help is professional.
Common On-Call Mistakes
- Trying to manage everything alone
- Delaying escalation
- Focusing on paperwork while sick patients wait
- Not documenting concerns
- Being afraid of “bothering” seniors
These are system traps, not personal failures — but you must avoid them.
Reality Check
On-calls are uncomfortable at first.
That discomfort does not mean you are incompetent.
It means you are learning a complex skill under pressure.
Competence grows with repetition.
Reassurance
Doctors who become excellent are not those who never felt scared on call.
They are the ones who escalated early, reflected honestly, and kept showing up.
You can become safe and confident on call.
It is a process — not a talent.