A Day in the Life of a Duke Anesthesiology Resident

Joshua Dooley, MD, CA-3 Resident

A day in the life of… Pain

The pain service at Duke is multidisciplinary and includes specialists in anesthesiology, neurology, psychiatry, neurosurgery, psychology and physical therapy and provides care to both inpatients and outpatients. Residents have a month-long rotation with the pain service during residency. They rotate through both outpatient and inpatient pain services.

The typical day in the pain clinic on Morreene Road starts at 8:30am and finishes by 4-5pm. Each morning you check the schedule to determine which attending you will be with for that day. Patients can be either new patients requiring an extensive evaluation or patients returning for follow-up after an interventional procedure. The patients are checked in by the nurses and placed into rooms. As each patient comes in you review their chart and evaluate the patient which includes an extensive history and physical. After this is finished you discuss the case with the attending and review any pertinent imaging and laboratory values. Since the patients are sometimes referred from other pain clinics they often have undiagnosed pain syndromes or difficult to manage medication regimens which can be extremely challenging. Many of the attendings have special interests and thus are referred very interesting cases. These interests include fibromyalgia, headaches, interventional treatments and acupuncture.

After you have discussed a plan your attending will accompany you into the room where he/she will do their own history and physical. A final plan will be made and discussed with the patient. This may include a change in medication, acupuncture, biofeedback, a visit to the on-site psychiatrist or an interventional nerve block. The final thing to be done for each patient is the dictation which is finalized by the attending. If you are assigned an attending who has the interventional suite for the day you have the opportunity to perform a variety of interventional techniques. You can expect to do this at least twice a week.

The Acute Pain Service provides support 24 hours a day, 7 days a week for inpatients. You will generally be on the APS for 1 week out of the month during your pain rotation. The day starts at 7am and finishes at 2-3pm early in the week and can be as late as 7pm by Friday. This is due to the large number of continuous nerve block catheters placed for perioperative pain control that the team manages. At the start of the day you split the patient list with a nurse practitioner and evaluate the patients and write a note. After this is finished you “round” on all the patients with the attending. The other responsibility of the resident is to evaluate new pain consults. These patients range from those who have a pre-existing chronic pain syndrome to patients with newly diagnosed pain syndrome to patients whose pain is difficult to manage by the primary team. Overall, the experience gained in the pain clinic and the acute pain service is vast and invaluable.

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