Friday, April 4, 2014

Dated but Not Outdated: Why the Pager Endures as a Means of Physician Communication

In this post on the Huffington Post yesterday, Sachin Jain, a physician and presumably a technophile, bemoans the enduring use of pagers among physicians, labeling pager carriers as outdated and failing to leverage available technology to make communication more efficient.  As a devoted pager carrier, I will enumerate the many reasons why the pager is a preferred communication modality for many physicians, and the ways in which Dr. Jain is missing the point.

  1. Patient Safety.  I work in the ICU.  If there is something that the RN needs to inform me, s/he needs to know that I have received the message.  If said RN (or intern or resident or other physician) pages me and I respond, they know I know.  If instead they send a text message or leave a voice mail, they do not know that I received the message.  They assume I did, and move on to other tasks.  If I did not receive the message, time sensitive things can get missed or delayed and that's a big safety issue.
  2. Lost Messages.  If I allow unrestricted use of available technology to contact me, I will have to check my pager, my cell phone, my text messages, my voice mail, my e-mail, multiple accounts.  Directing all patient related communication flow through one simple device prevents missed messages.  How about Twitter?  Shall I set up a Twitter account and take tweets of X-ray reports?  I have had respiratory therapists message me through Facebook messenger with ABG results.  The pager forces electronic discretion and decorum in a world where they are often lacking.
  3. Reliability.  The pager rarely fails.  And it works in the elevator, the basement, etc.  You can drop it from the third story balcony and it will still work.  The battery doesn't take a crap after 12 hours of use.  If it does you can replace the battery with another widely available AAA battery.  You rarely lose a pager.  It's always on your waistband.  You don't check the stock market on it in a spare moment and misplace it on the counter.  Or in the bathroom.
  4. Signal and Noise Filtering.  If I'm seeing a patient and my phone rings, it could be a patient care related call, or a call from my wife, my buddy, or a telemarketer.  Why would I want to have to filter all the signal and the noise while I'm busy seeing patients?  The pager filters it all for me.  I can ignore everything else.  Likewise, should I be on a prolonged call stretch and I want to get some sleep and ignore all my needy friends and the headhunters for locum tenens, I can shut off the phone and respond only to patient care related pages.
  5. Physician Safety.  We should not be talking on the phone while we're driving.  This is especially true for me because I commute on motorcycle.  I could route the phone to bluetooth in my helmet, but why would I risk my life in that way?  I'll check the pager when I arrive.
  6. Path of Least Resistance.  A physician needs some uninterrupted time to get stuff done.  If I'm seeing a patient and my cell phone is going off all the time, I can't concentrate on seeing that patient.  This is, in my opinion far more likely to happen and happen frequently if the RN can just pick up the phone and call you directly.  It's a path of least resistance, of too little resistance.  Some resistance in the system is actually a good thing, because it forces people to get their act together before they contact you.  It does so because it requires more investment on their part.  They know they have to call and then wait for you to call back.  That investment of their time, I strongly believe, is an incentive for them to get their ducks in a row before they page you.
  7. Who just called?  If the hospital has a generic number that comes through on caller ID and somebody calls from in house, you can't tell where that call is coming from.  The ER?  The ICU?  The floor?  Medical records?  Administration?  Not only can you not filter the calls, but also if they don't leave a message, you have no way of knowing who was trying to contact you and you can't call them back.
  8. Who's paying for my cell phone?  I do.  And if I voluntarily use it for patient care, so be it.  But unless my employer furnishes me with a mobile phone (as they do with a pager) I should not be required to use that device for patient care, unless I elect to.  It goes both ways too.  What if I want to call the bedside nurse, but I don't want to bother being put on hold?  Should we make the RNs carry their personal cell phones at work too?  Should I have all of their personal numbers programmed into my phone?  Should I send them orders and queries via text message?
  9. Security and Privacy.  NSA.  HIPPA.  Etc.  I won't get into all that, but when you start sending texts and tweets and emails and voice mails and it becomes a free-for-all, there are indeed security and privacy issues.
  10. Peace and Quiet.  When I'm not on duty, I don't carry the pager.  And everybody knows that if they call my mobile phone, I won't answer if it's a hospital number on caller ID.  My voice mail even states that I will not respond to voice mails and texts related to patient care.  So people just don't call it.  (Interestingly, I have found that if I do answer the phone, just once, say because an agency nurse doesn't know my policy, they start calling it all the time.  It's like a stray dog on the porch - feed it once....)  And what this means is that when I go on a trip, on vacation, on a run, whatever, when I'm not on duty, I don't have to worry about being bothered by work related issues.  There's a doctor on duty for that.  So I can have my personal life to myself and not have to reverse filter (see #4 above) things when I'm not on call.
  11. The Memory Factor.  I just remembered this while on call the night of this post:  When I'm called at 0300, and I'm sound asleep, the last thing I want is to answer the phone and have an ER doc or ICU RN , without delay, start blurting out some long drawn out story about some case of whatever.  I'm not even awake yet!  And, lacking theory of mind, they never consider this.  When the pager goes off, I orient myself ("where am I anyway?  What window am I facing?") spend a few minutes to wake up and guess what I'm being called about, and when I'm fully conscious, I call back.  Thusly, I'm far less likely to have complete amnesia of the episode the next day.
Thoreau was right:  Our lives are frittered away by detail - I say simplify, simplify, simplify.  It's the simplicity and reliability of the pager that makes it perfect as a means of communicating with a busy physician.

5 comments:

  1. his tagline... Academic Physician and Pharmaceutical Executive .... says it all

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    Replies
    1. And that is supposed to mean...? I am an RN and I totally understand what he is saying. Most physicians do prefer to have only one means of contact as it does cut down on on the need to carry more than one device.

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  2. Every single objection you raise here, including billing your employer, could easily be addressed in software in the new Aberegge Medical Pager App.

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  3. ya right, pagers play an important in communicating with a physician in hospital.

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