Monday, July 9, 2012

Ask Skeptical Scalpel-Why Do We Still Use Pagers?


Stephen Zintsmaster (@szintsmaster) tweeted me this question:

@Skepticscalpel - I need some wisdom as a new 3rd yr. Y do they still use the damn pagers? This will forever annoy me!”

Stephen, I believe there is still a use for pagers in medicine. This question came up in some comments on one of my more popular blogs called “What happens when a doctor is paged.”

Chris Porter, a surgeon who has a popular blog called “OnSurg,” took me to task by asking why my hospital still used pagers and hadn’t I heard about cell phones?

I replied, “I don't know about your area, but where I practice, cell phone service can be spotty. The hospital is one of the worst places. Some cell phone carriers have little or no coverage. You can be in the OR or radiology and have no bars on your phone. Since pagers work by radio, there is no coverage problem. When cell phones are 100% reliable, let me know.”

I also pointed out to another commenter that when the nurses have your cell phone number, they may call you when you’re not on call. This has happened to me. When they have to look up your pager number, they seem more likely to check the on call schedule.

To me, phone calls are also more intrusive and harder to ignore. I was debriding a pressure sore in a patient's room the other day when my phone rang. Because I was wearing gloves, I couldn’t hit “Ignore” and it went on for 30 seconds. A pager stops beeping after just a few seconds.

Dr Roy Arnold, ‏who tweets as @Cholerajoe, pointed out that another reason to use pagers is that there may be one pager for the on call doc that gets handed off when call changes. Nurses know to always call the same number.

Update 7/10/2012. Dr. Mary L. Brandt (@drmlb) tweeted a link to a blog that describes the history of the pager and another important reason we still use them--the "group page" for codes. The blog also mentions some new ideas for eliminating the pager.

Bottom line: I know in some areas, doctors are happy to completely rely on cell phones. This has not worked for me.

23 comments:

RegionsTrauma said...

I agree completely given the current state of the art. However, once hospitals decide to blanket the building with cell coverage, all sort of interesting paging apps will spring up, addressing the shortfalls you list.

Nicholas Swetenham said...

Some hospitals in the UK use DECT phones, wireless phones on an internal system similar to pagers. They save a lot of time compared to bleeps (British for pager)

Todd J. Scarbrough, M.D. said...

Cell phones work by radio, too, just a different frequency from the pager technology. Pager technology uses a lower frequency/longer wavelength radio signal than cell phones, allowing generally for better transmission through walls/obstructions. Plus, pager towers are very high-powered compared to cell towers.

The disadvantage to paging is that some pagers are only one-way, and thus can't transmit a signal back to the paging network relaying whether or not a message was properly received. Two-way pagers generally overcome that, but in general (especially with iMessage or the ilk) the veracity and fidelity of message sending/receiving is greater with modern cell phones than older paging systems. Even two-way paging systems can sometimes produce a "gobbledygook" message if the signal is not pure throughout the sending process. A modern cell phone will not be prone to this.

Skeptical Scalpel said...

Thanks for the comments. As usual, I learned a few things.

Anonymous said...

Only Pimps and Plumbers still use pagers!

Skeptical Scalpel said...

I hope this discourse can get back on track after that brilliant comment.

James said...

we also use wireless phones on an internal system. in OR the surgeon usually gives the phone to a nurse and she can hold it to the surgeon's ear if the call is really important. and there's also a forwarding an silence functon...

Old Rockin' Dave said...

There is no good reason why a hospital couldn't install a limited cellular system, with dedicated phones replacing pagers. There is also no reason why the on-call cell number in such a system couldn't automatically be forwarded to the correct phone. Smart phones could make a lot of things easier in the hospital - reports could be sent as SMS messages. Radiology and pathology images could also be sent, making a lot of waiting, phone calling, or going down to the appropriate office unnecessary.

Skeptical Scalpel said...

James and Dave, Good comments. I think I will see if my hospital can install theses features. We already have signal boosters for dead spots but only for one cell phone carrier.

Anonymous said...

As a hospitalist, myself and numerous colleagues have pushed back against efforts, by the hospital we work at, to encourage us all to use only cell phones. When working nights, or carrying the admit pager during the day, the ability to triage pages is much, much easier than trying to triage phone calls. Almost all pages I receive (at times 40-50a night) have a text message with a "FYI", "please call within 10 minutes", or "please come see now". When talking to a patient and/or family, I can quickly triage the page with only a glance.

Skeptical Scalpel said...

Anon, another excellent point for those who use pagers with text capability.

Anonymous said...

The anesthesia dept. at my school uses blackberries instead of pagers, and signal repeaters throughout the hospital to deal with the loss of service. Its convenient, as they can just text each other information if needed instead of having to call back and talk. I believe other services are in the process of switching over. The pagers at another hospital I rotate through were super tiny and unintrusive.

Skeptical Scalpel said...

Anon, many are predicting that RIM, the company that makes the BlackBerry, will be out of business soon. It just laid off 5000 workers. But any smartphone can text.

Unknown said...

You should consider something like OnPage. A app on your cell phone that works with a data connection. All you need in the hospital is WiFi coverage.

Skeptical Scalpel said...

Unknown, thanks. I will look into it.

Luis said...

Our main teaching hospital did install both Verizon and AT&T towers on campus, so reception on both networks is great. That being said, reception horrible (if it even exists) in places such as radiology. In these areas, the lead shielding and magnets make it impossible to rely on anything other than a pager and landline.

Skeptical Scalpel said...

Luis, thanks for backing me up on the issue of cell phone reception.

James Nikon said...

In our place the use of cell phones by medical practitioners in the hospital are encouraged. They have realized that communication and delivery of health services can be faster with the use of cell phones.

Skeptical Scalpel said...

James, thanks. If cell phones work for you, then do away with pagers. As you can see from some of the comments. they are not the sole answer for some people.

Seth Bilazarian said...

We have been told SMS is not HIPAA compliant so have to use a pager or expensive secure SMS options with subscription fees. Just another expense for practices

Skeptical Scalpel said...

Seth, thanks for commenting. You raise an interesting point.

Anonymous said...

Does no one here remember the days when having a pager was chic? My husband, a surgeon, carries a pager, never gets cell service at the hospital, and frequently gets a 'sweet old-school pager' comment when carrying it in general public. We think of the annoying little bit as a retro belt accessory, but necessary means of communication to provide good patient care.

Skeptical Scalpel - we've been laughing our heads off for hours tonight, reading your blog for the first time. Thanks for lightening the mood after 7 years of residency :)

Skeptical Scalpel said...

Anonymous, yes I remember when it was cool to have a pager. Maybe it will be again. I also have trouble with cell phone reception in the hospital. Some of those commenting are blessed with good coverage.

I really appreciate your kind words. I hope you will keep reading.

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