24 Hours in the Life of a Nephrologist

For practicing nephrologists, time often does not feel like their own. Between driving to multiple clinics each day, rounding on sometimes more than 30 patients, dealing with the challenges of running an office, filling out countless insurance and health-related forms, attending medical staff meetings and completing the required number of hours for continuing medical education, there are not enough hours in the day for career-related tasks, let alone a personal life that may involve a significant other and young children.

To provide insight into how many responsibilities are often squeezed into one day, I outlined below what a typical 24-hour time span can look like for me as a practicing nephrologist in the suburbs of Washington, DC.

A Typical 24-Hour Day

12:00 a.m. to 6 a.m. On call for the night; fielding calls from nine hospitals.

6:00 a.m. Wake up to organize information from the overnight calls and disseminate to the physicians in the nine hospitals so they know what happened in their territory overnight.

7:00 a.m. Drive 25 minutes for dialysis rounds in Alexandria. Remove a suture from a declot I performed a week ago.

8:45 a.m. Drive 15 minutes to the Fairfax hospital to see 10 inpatients. Field countless phone calls.

11:00 a.m. Drive 5 minutes to the home therapies clinic to see my peritoneal dialysis and home hemodialysis patients for their monthly visit.

11:45 a.m. Grab a quick lunch in the doctor’s lounge. Definitely skip the chicken, which looks questionable.

12:00 p.m. Attend a one-hour conference via phone.

1:00 p.m. Drive 20 minutes to Franconia for office hours. Call a college buddy who just lost his mom.

1:25 p.m. During office hours, am interrupted at least five or six times with phone calls from outpatients, the hospital and others.

3:00 p.m. One long-time patient seems to be not herself. I learn that her only child had died of a stroke the week before. Try hard to find the right thing to say. Probably fail. Give her a big hug while her husband sobs.

5:00 p.m. Head downstairs to see the last dialysis shift, complete some paperwork and meet with the nurses to discuss any other outstanding issues.

5:30 p.m. A dietitian brings in a list of elevated PTH levels and needs to discuss medication changes. Having been on call the night before, I’m exhausted, and have to head out for a college alumni meeting, but she is very organized and I don’t have the heart to say no.

5:55 p.m. On my way out the door. “Hi doc, how’s your son?” says the reuse tech. “He’s great. Thanks,” I say.  “You know we all prayed for him, right?”  I am not quite sure how to respond, but say, “Well you know what? God heard you,” as I walk out of the door of that special place.

6:00 p.m. Drive to the metro and take the train to DC for the alumni meeting. Only one hour late.

8:00 p.m. Ride the train back while reviewing the slide deck for a presentation the following day. Call my wife to let her know I’m on my way home.

9:00 p.m. Arrive home. Install a new car battery in my daughter’s car.

9:30 p.m. Review notes from the conference call today to provide comments. Prepare an invoice for medical expert services that I recently provided.

10:15 p.m. Catch up on daily email. Email the kids.

11 p.m. Head to bed.

The bottom line here is that nephrologists, like our dialysis teammates, live very busy lives. When nephrologists are at a dialysis facility, they are usually trying to be in at least two places at the same time and attend to multiple issues simultaneously. In the same way that our teammates must accomplish a huge number of patient care tasks efficiently, safely and compassionately in a limited amount of time, so must nephrologists manage their day across multiple health care settings. Being cognizant and respectful of the demands on each other’s time is an important part of supporting each other. Caring for patients in dialysis clinics can be very hard and also very rewarding. Empathy for and understanding of one another can strengthen clinical teams and ultimately serve as the foundation for our caring behaviors.