Last week, I misfiled my pager (read: it fell off in the car and was hiding from me), so I tweeted about this exciting moment in my life. I got this reply:
@MCG_MedEd Pagers are anachronisms, why didn't we switch to cellphones yet? #medicineThis prompted me to reflect a bit about why I (gasp) like my pager. Here it is: ah, yes, the ST800 plus. Sexy.
— Nina Nguyen (@meimeian) June 29, 2013
Reliability:
Pagers are simple creatures - they are the technological equals, approximately, of a toaster. They are designed to do one thing well: Let you know that someone needs you at a certain number. To this end, it provides a few other simple services: reporting the date and time, and, importantly, vibrating and beeping to let everyone know that its batteries are dying.
In no small part due to their basic nature, they work well. My pager has reception in the bunker of a basement where I work, where my cell phone sadly displays "No Service". Although I had to upgrade, my pager works in the brand new Medical Building in which I teach, whereas my cell does not. Because it carries on like a snack-deprived toddler when its batteries are dying, I tend to them before they get to the end of their lives, whereas my cell phone just dies a quiet death at untimely moments.
This reliability is key because, as an attending physician, the proverbial buck stops with me. I take my responsibility to patients, nurses, and housestaff very seriously, and I don't want to be worrying about them not being able to find me in a timely fashion.
In the reliability wars - pager takes down cell, without question.
Managing my brain:
This is really quite simple: when I'm woken from sleep, I do better with a few seconds to wake up before I am expected to be coherent in speaking to another human, never mind being asked advise on caring for frail older patients. Quite simply, the pager buys me a precious minute where I can get up, head away from the sleeping family, and call the floor, during which time, I wake up. It also works when driving my car - even with hands-free set-up, I don't trust myself to talk on the phone and drive safely. The pager allows me to pull over and then call, again, allowing me to focus on the matter at hand - you know, sick, frail, older adults. Seems to be win-win for all, don't you think?
Managing my accessibility:
If we supposed that we could somehow deal with the reliability issues with my phone (I'm sure there are apps to tell me the battery is dying on my phone, and one day they may let me out of my bunker), I would have to confess I would still use my pager.
First, this article highlights a few points:
http://onlinelibrary.wiley.com/doi/10.1002/jhm.2037/abstract
For those without access, here is the CBC take on it:
http://www.cbc.ca/news/health/story/2013/05/28/smartphone-medical-residents.html
It is my experience that the more obviously present I am, the less likely it is that housestaff will try to figure out answers themselves - it's human nature. I would never, ever want to be unavailable to my housestaff, but I also know how much learners grow and benefit from working through issues themselves as far as they can (MedEd geek moment here - this is related to Vygotsky's "zone of proximal development"). Somehow, working through the problem is more likely to happen in preparation for paging me.
Don't get me wrong - communication is essential to good patient care. I ensure my housestaff know exactly when I'll be present on the floor, and I encourage them to page me if they need me in interim. It's possible that I would be called at the same rate that I am paged, but I don't think so.
I'm also very conscious of interruptions at work. If I used my cell phone for patient-related matters, I would need to have it on during a difficult conversation with a patient, only to have to field a call from the phone company. If I am about to enter a particularly delicate discussion, I sometimes hand my pager to a reliable person, and ask them to call back on my behalf if I'm paged, and only interrupt me if it's an emergency. Because the pager is only for work-related issues, I don't risk handing off my phone only to have someone answer a wrong number (rare with pagers), or to talk to my accountant.
(I suppose texting would be similar to paging, but that would imply that nurses could text me - they can't, without phones themselves, and they're stuck in the same bunker I am...)
I may also (ahem) have the same tendency as housestaff to engage with my phone when I should be attending to meetings, etc. Not having the thing with me removes the temptation, and I would have to have it with me if I used it for patient matters.
However, even if you don't buy anything that I've noted above, I would still use my pager. Why? Simple. I can TURN IT OFF.
Turning off the pager:
Because I only use my pager for patient-care matters, when I'm at home or out with my family (and I'm not on call), I can turn the pager off. The sole purpose of the pager is for patient care, so if I'm not on call, I can be with my family without the pager. Some of this is a purely psychological effect, as, in theory, no one would call me on my cell if I wasn't on call, but it's a huge relief for me to turn the pager off. Besides, call schedules and vacation notices are misread all the time, and the last thing I need is for the floor to call me during my vacation week about a patient I've not even met.
Again, I don't want readers to think I am not responsible for my patients. In fact, I often offer to be available to residents on call even when I'm not if the patient's case is particularly complex, or for various other reasons.
But for me, I realized that when I am truly not on-call, I need to be truly removed from my medical role. This last point is really the most salient - this is one part of my quest to maintain balance in my life. This is one of my examples of turning off work, by turning off technology (more to come).
Final words:
I understand that my cell-phone angst might not apply to all. Don't get me wrong - I use my phone a lot when I'm not at work. I do even use it at work when I need it (assuming I can get reception). I didn't always love my pager. Like most medical students, any novelty factor quickly wore off when I realized the terror that could come with that thing going off; and if I hear a pager go off with the pager tone I used in residency, I'm sure my blood pressure goes up. It really wasn't until I was juggling so many roles and that I had to make a conscious choice to prioritize my family when I was with them that I started to view the pager as my ally and not my enemy.
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