Why answering a cell phone during an office visit is a problem

Here is an unfortunate, but almost daily not-so-secret occurrence in my practice:

I am in the midst of an intricate follow-up visit with a rather complicated patient with diabetes, high cholesterol, and high blood pressure. I am feeling as though I am a CIA agent in a rather mission impossible assignment: she is here for lab results, is complaining of low back pain, and presents with an elevated blood pressure of 168/90. I have already spent ten minutes with this patient addressing her low back pain, and am starting to review her top-secret lab results with her. I have two patients, aka U.S. government agents, eagerly waiting to meet with me while they pace the lobby.

Me: “Your recent lab test shows that your diabetes is currently not sufficiently controlled with the current regimen. Your hemoglobin A1C, which is a lab test that tells me what your sugar level has been at home for the past three months, is 8.1. We need to add a medication at this point because…”

“Riiinnnggg!!,” a quite startling sound lifts me off my seat, as if signaling a new secret-agent assignment.

Patient: “Oh, Doctor, hold on one minute please.”

Is this a conspiracy? Before I can even respond, she picks up the cell phone and starts talking to this rather shady intruder.

Patient: “Hi, honey. I’m at the doctor’s office. What do you need? …”

I wait about thirty seconds, with what seems like an eternity in the secret agent world, and she is still on the phone with this suspicious invader. At this point, I decide to exit the premises. Many of my fellow CIA colleagues say they do not even wait one second, let alone thirty. They dissipate as soon as the patient picks up that cell phone, with the onset of the betrayal.

On my way to see the next patient, I pass by one of our many subliminal “No Cell Phone” signs in the hallway. How thoroughly it must have brainwashed our traitors, no? It is perhaps time for some newer and bigger signs with more deeply penetrating messages.

I see my next patient and then return to check up on this likely double-agent-of-a-patient. She ends up waiting twenty minutes before I walk back into the room; fortunate for her, it was not any longer (as it often is).

This undercover agent gives me a look of frustration as she exclaims: “Doctor, why did you leave the room? I have another appointment in half an hour!” Does she have a meeting with the enemy camp, I wonder? Hmmm…

What’s the big secret deal, you may ask? Here’s why answering your cell phone in the midst of the office visit is a grand problem of high security:

The cell phone call …

1. Interferes with the flow of the detective work. I spend a good deal of time looking over that chart in detail before I walk into that room to see this patient. I have a secret plan in my mind regarding what needs to be executed, and I’ve already begun discussing this detailed scheme to my patient. This phone call just interrupted my train of thought in a rather complicated patient. That means that when I return, I need to restart from the beginning of my conversation with this patient and re-explain my train of thought to her so that she fully understand why I am initiating a new medication for her diabetes. I cannot just simply pick up from where I left off, because this is an intricate issue of high importance that we are discussing and I have to make sure she understands the details of this intricate plan. Recovering this highly sensitive information is not an easy mission.

2. Intercepts the entire secret agent list. This mission compromises the patient schedule. I have patients pacing the premises, and this phone call is causing an even longer wait for my patients. My patients have jobs of high-importance to return to, child spies to pick up from spy-school, and other top-secret appointments to catch. The cell phone interruption is not just taking time away from the doctor, but it’s imposing on all my secret-agent-patients for the rest of the entire day, as well.

3. Makes a mission really impossible.
It interferes with the time I am given with this patient. My appointment slots are fifteen minutes. This patient’s history is already of sensitive and intricate matter. But she’s also expecting me to address her low back pain, and I certainly cannot simply ignore her elevated blood pressure. If we add a cell phone call to the mix, it is really just a huge mission-impossible.

4. Interferes with other CIA gadgets.Most hospitals and clinics ban the use of cell phones in their buildings, just as airplanes do. This is not because we fear that these cellular waves penetrate our brains and take over our thoughts, contrary to popular belief. This is because the cell phone waves may cause interference with other electronic devices. In the case of a patient, it can potentially cause medical harm if, for instance, a patient’s pacemaker starts malfunctioning. No one wants to be responsible for causing such catastrophe that botches the entire mission.

5. Disrupts proper agency etiquette.
It is simply inappropriate agent-behavior. I do not carry my cell phone into my exam room with my patients, and in fact, don’t even turn it on during my work hours. I expect this same common courtesy from my patients. Anything otherwise may be considered espionage.

Let’s make this a successful mission, Bond, by working on the same team – let’s all turn off our electronic secret-agent gadgets while at the doctor’s office!

Just don’t forget your bullet-proof vest.

Jill of All Trades is a family physician who blogs at her self-titled site, Jill of All Trades, MD.

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  • http://www.chrisjohnsonmd.com Chris Johnson

    As a pediatric intensivist, cell phones have changed my life for the better. A couple of decades ago I had to have a ready supply of quarters in my pocket when I was outside the hospital so I could answer pages from pay phones, and I couldn’t stray far from those ancient devices.

    Thankfully, those days are gone. Now, though, we’ve got the problem you describe — assumed, total, instant communication. Like your office has, we’ve got rather obvious signs asking folks to turn off their phones. Most do, but some don’t. The latter group always seems genuinely surprised when I ask them to put down the phone so we can talk — human style, face-to-face.

  • Jake

    Patients so often have long waits for medical care that it should not be surprising that they might want to make or be available for telephone calls while waiting.

    For example, when being ushered into the 2nd waiting room, one realizes (from experience) that a statement such as “the doctor will be here in a few minutes” is often a prelude to a 10 to 15 minute wait.

    Making a call in that circumstance is a very reasonable thing to do. If talking on the phone when the doctor enters, you say “The doctor is here, will talk later, goodbye” and terminate the call, If the doctor (especially if you have been waiting for 10 or 15 minutes) is offended by that, the doctor needs to re-examine her attitudes.

    The patient should than shut off the phone, but having failed to, should not conduct a 30 second conversation. The patient should not even answer the phone (just shut it off).

    It is an annoyance of modern life. It is not a “grand problem.”

  • zoe

    Why don’t you just you just say, “Excuse me, but you need to hang up now, this is important.” I wait just long enough to make sure I am not interrupting the emergency room telling her that her kid is there, and then I touch her knee or hand lightly and firmly give her the order. All secret agents know when they are outranked.

  • justin

    The problem is that doctors do not bill by time. In the scenario described, the patient should be billed for an extra 15 minute visit w/copay, as needed, until the visit was completed.

  • solo dr

    If a patient starts talking on the cell phone during an office, I print the refill prescriptions. I hand them to the patient and ask them if they are done with their concerns, since they are talking on the cell phone. Most of them hang up and get back to the office visit. Ditto for my own cell phone. I don’t answer pages or cell phones during office visits.

    • Alina

      Thanks for mentioning that it should go both ways. I once had a physician who interrupted the visit because her daughter called her to talk about her day in school (no emmergency). This after waiting for 20 minutes just to see her.

      • Amon

        I agree with Alina. I just had an appointment with my Endo and after waiting in the exam room an extra 15 minutes after my appointment was to begin, he took a cell phone call while reviewing my lab work??? His inability to follow HIS schedule became my problem and cost me an extra 8 bucks (16 total) for the parking garage. It is beyond inappropriate for a physician to take ANY call while seeing a patient. My GP, on the other hand, would never do something like that. So Docs, please, just try to remember there is an actual HUMAN being in the room with you, and YOU are not that special.

  • Dr. J

    I think this is a problem of politeness that is common to a lot of our interactions. In the doctors office it is disruptive to the schedule of the day and the task at hand, but it is really a problem present in everyones day to day life.
    A phone call always seems to take precedence over a face to face conversation and a call waiting call over a phone call already ongoing. It’s part of the lack of basic manners that has become normative in our rule-less society.

  • http://donna-justme.blogspot.com/ Donna W

    #5, to me, covers it all. In fact, I consider it rude to talk on a cell phone in any public place. Turn it off. If you forget, and happen to receive a call, tell them you will call back in a few minutes.

  • PCP MD

    Doc’s shouldn’t take calls during visits, it’s not respectful ot the patints time. Keep it on vibrate or leave it on your desk.

    Some patients I guess don’t realize that you don’t have to actually answer the phone. It has a mute button, and the flip phones can be flipped off. Or just take the battery out.

    When I encounter the same problem this author has described, I just keep talking, going through the motions of the visit. Usually they get it and end the phone call. Sometimes they don’t and keep talking. It’s not that I find that disrespectful to me, I find it disrespectful to the ten patients I have waiting on me and my nurses’ time.

  • Taylor

    That is so ridiculous that a patient would answer their phone while the doctor is seeing them!! It is beyond rude and I cannot believe anyone finds that acceptable. I think what PCP MD does is a good idea.

  • http://fertilityfile.com IVF-MD

    Does this take the prize? I blogged 3 years ago about a patient who talked on the cell phone throughout an entire medical procedure. http://fertilityfile.com/2007/11/29/a-tale-of-two-inseminations/

  • http://skepticalscalpel.blogspot.com/ Skeptical Scalpel

    While I agree with the author of the cleverly written piece, I am unaware of any published evidence that cell phones actually cause interference with medical devices in hospitals or clinics. Similarly, I do not believe they interfere with airplane navigation systems either although I certainly am happy with the fact the cell phone use is prohibited in flight.

    • Jake

      I am glad you brought up the myths about RFI (ie. radio frequency interference) problems from cell phones in hospitals and in aircraft. Another myth is that cell phone use while pumping gas can cause gasoline explosions.

      For the record, I am also happy that airlines forbid their use, but that does not mean that it is a hazard to navigation or aircraft functionality.

  • Reuter

    I actually coined an eponym (Reuter’s sign) related to this: If the patient is well enough to send text messages while you are taking her from the OB floor to the MICU stepdown unit, then she’s well enough to stay on the OB floor.

    • Maryann

      great one, Reuter.

  • http://www.aruplab.com Kris

    Great post!! You have to wonder sometimes what people are thinking.

    Thanks for sharing your “insider perspective.”

  • Dr Synonymous

    Great post about a challenging situation. We all could use a refresher course on how best to honor our fellow humans with respect. Nice CIA metaphor , too. It lightens up a subject that can get pretty intense. Thanks.

  • Dinah

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