Six Hospitals. One Rheumatologist. Just a Quick Question.

“Just a quick question” is an excellent opening line. It conveys warmth, collegiality, and absolutely no reliable information about how long the conversation will last.

Some of my on-call shifts have looked remarkably like this simulation: several hospitals, one rheumatologist, a full clinic, and a telephone with no apparent understanding of geography. Remote access works beautifully—at the hospital that is not calling.

The calls arrive with wonderfully uneven introductions. “Lupus consult” may be the entire handoff. A quiet, almost apologetic request may contain the real emergency. Meanwhile, a medication seen in a television advertisement can apparently become an overnight agenda item. The answering service passes the message along. Sorting it out is yours.

This is why I built Rheumatology On Call: Six Hospitals. The rhythm, the interruptions, and some of the clinical situations are very familiar. The challenge is deciding what needs action now, what can safely wait, what needs a physician-to-physician conversation, and what does not require an on-call rheumatologist at all. Preferably before the next call.

In the simulation, unnecessary trips cost clinic time or sleep. In practice, they also require finding your keys. Under-triage is another matter entirely: the person who sounds least worried may be describing the problem that deserves your full attention. The comedy belongs to the logistics. The clinical stakes remain serious.

There are twenty calls, split between day and night. You make the disposition, choose the next response, and get the explanation. Nobody grades your bedside manner toward the telephone. I considered it, but the scoring system would have become unnecessarily complicated.

Try a shift below. The module is free, with no registration or subscription required. You can enlarge it without losing your place. For once, you are allowed to finish one call before the next arrives.

A note on resemblance: This simulation draws on aspects of my on-call experience and real clinical situations, fictionalized and adapted for teaching. Hospital names and physicians’ names have been changed; any resemblance of those names to real hospitals or physicians is coincidental. These are educational scenarios, not identifiable patient histories.