As I imagine every young doctor does, I vividly remember the feeling of getting my first pager. It was boxy and bricklike (much like my current pager) and felt obsolete. I’ll admit, it gave me trouble for a couple of days, despite having desperately few capabilities. I used the flashlight on my iPhone to read pages in the darkness of the call room, as I couldn’t figure out how to turn on the backlight. Any time I tried to learn a function, I managed to accidentally delete pages. So I decided I knew enough functions.
Nevertheless, I achieved adequacy quickly. I also became used to the surprise of patients when my pager went off: They didn’t realize how outdated some of our practices are. The only other place I’d seen the pager being used regularly was by drug dealers on The Wire to avoid phone tapping. I think it’s fair to say the use of the pager in modern day medicine doesn’t inspire much confidence given the other technologies we have available. Patients, and we ourselves, would like to imagine that medicine is cutting edge, and the pager is a shrill reminder of the slow pace of certain changes.
Of course, we do have other ways to communicate, which has brought us to a transition phase. I’m sure individual hospitals and medical groups out there have completed the conversion to more modern technology, but as a whole, our field has not. In my hospital, pagers remain our primary medium for being contacted by nurses, other physicians, dieticians, respiratory therapists, etc. But we are also phasing in an app for two-way communication. Essentially it’s just texting, though HIPAA-compliant. And as with any change or transition, there are road bumps.
First, there is the inevitable issue of generational differences: Imagine texting with your mom. While I am proud to say that my mom has become adept at texting over the years (she does still ask me what a lot of ubiquitous acronyms mean), I remember the early days. There is unawareness that a text has been received, there are duplicate responses and responses sent in three texts that were meant to be sent as one. In short, there are delays for numerous reasons. It’s kind of funny until inefficiencies in communication are translated to medical care. Just as adapting to an electronic medical record has been very difficult for many health care professionals, I imagine these newer forms of communication are, as well.
Another issue: How much does texting etiquette apply to messaging etiquette at work? Texting evolved as a method of informal communication between friends and relatives. As such, we often don’t have a sense of urgency about it, or feel a need to reply to every text, acknowledging its receipt. We provide commentary that is not always professional, but lines become blurred when you take something out of one context and plant it in another. When the line of communication has become so open, and the act of texting feels so familiar, it’s easy to slip from your professional self more into your personal one.
And then there is today’s overused phrase of “burnout.” Much like an email inbox becomes flooded with spam, someone available via our text system can receive an onslaught of messages. I get messages about patients arriving to the floor, I get FYI messages for things that I find irrelevant, and I get plenty of messages not intended for me, like asking where the bladder scanner is or calling for lift help. All this decreases my level of attentiveness to each text, and sometimes leads me to even roll my eyes at the ding I hear when a new message is received. I want the impossible, which is all of the important information and nothing more. It doesn’t help that I’m currently tethered to two devices, as I get contacted via both pager and phone.
Overall, a form of two-way messaging likely leads to better communication amongst health care providers. I looked to see if studies have addressed this, but most of what I found were studies about patients getting texts to take their medications. In this area, it turns out two-way messaging is more effective, and one assumes it is within the field as well.
This is a transition that we absolutely should be making; continuing to use an antiquated electronic device has reached the point of embarrassment. But it’s not hard to see why it is not a smooth and simple changing of the guard. (And I’m not even taking the technical and financial aspects into account!) With all the issues regarding inefficiency and burnout facing us, we have some work to do to make the process of communication as streamlined as possible.
Lindsey Ripley is an internal medicine physician.
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