When Did My Cell Phone Replace My Answering Service?

December 26, 2011 in Medicine by RangelMD

Question:   Do lawyers have to drag their butts out of bed in the middle of the night to go bail a client out of jail?

Answer:      It depends on how much the client pays them.

Doctors don’t usually have the luxury of choosing when they will need to be contacted for some “emergency” or whatnot. Throughout history, physicians have needed to depend on a messenger service of some type to remain in contact with their patients. Before 1950, physicians were paged over a hospital’s public address system or called at their home or office but then Charles F. Neergard,  a radio engineer annoyed by the constant overhead pages for doctors, developed the first wireless paging system. After this, pagers gradually evolved from radio voice paging to alphanumeric pagers and then digital. Answering services were added to streamline the service and add multiple physicians to the same service with a single number.

Then came cell phones. Now, it’s not that personal wireless phones are a bad thing. The biggest problem with having a pager and an answering service was having to hunt around for a land line phone while in a restaurant, or at the ball game, or the movies, or while watching naked midget wrestling, or whatever. With a cell phone, a return call was as near as your belt or purse.

But then the hospital staff or the ER physicians or whichever moron is in charge of these kind of things decided that since pretty much every physician these days has a cell phone on their person, it would be the best idea since ritual sacrifice to bypass the whole answering service-pager route and make the calls directly to the physician’s cell phone. Aquiring a physician’s personal cell number is as easy as taking the number from the caller ID and disseminating said number to any and all interested parties. So instead of having to deal with the “hassle” and time of calling an answering service and leaving a message to have Dr. So-and-so call them back, all they have to do is to place the call directly. It’s easier than ordering pizza!

It took all of a few days for the staff at the hospital where I started working a year ago to begin bypassing my answering service and call me directly. At first I just dismissed it as an occasional annoyance but then it became so common that my answering service was rarely used. It continued in mass even after I tried to politely ask the staff to use the answering service on every call. I found my cell phone number on slips of paper and on cards tacked up at most of the nurse’s stations.  After  several meetings with the hospital administration and department heads the calls became much less frequent  and yet they continued intermittently.

So what’s the bid deal? What could possibly go wrong? A direct call to a physician minimizes a delay that may occur when an overloaded answering service has a backlog of pages to send through and it eliminates the need to wait for the doctor to call back. Certainly in an emergency situation time is critical and this has to be the best way. Except it’s worst way.

First off, during business hours when I am seeing patients in the hospital or office, I treat my personal cell phone as my primary business phone. This means that I do not answer it when I am having a delicate and complex conversation with a patient or family. I am not going to stop to answer my phone in the middle of a conversation with a patient about their diagnosis of cancer (I have it on vibrate only). Nor do I allow phone calls to interrupt conversations with other physicians or consultants or the nursing staff.  And I hate to get interrupted with a cell phone call while I’m in the middle of a dictation over the hospital phone system.

So I started ignoring phone calls during these times and an interesting thing happened. I found that having initially allowed these calls gave the hospital staff a new sense of entitlement; an expectation that they would be able to reach me instantaneously and easily with one phone call. And when I didn’t answer I started to get complaints such as “Dr. Rangel doesn’t answer his phone when we call him and he is hard to get ahold of.” Amazingly enough, I was very easy to get ahold of when the staff utilized my answering service. Even more amazing was their reactions when asked if they had tried the answering service in the first place. They often seemed confused as to which method was supposed to be utilized first and which was intended only as an emergency backup. Or they didn’t particularly care.

The primary motivation for the hospital staff to call me directly appears to be laziness rather than any concern about efficient communication. With a single call direct to my phone, a staff member or ER physician need not hang around waiting for the answering service page to go through and for me to return the call. But my job description does not include being at the “beck and call” of the hospital staff nor to make their jobs easier.  Only after I stopped answering direct calls from the hospital did I realize how many were frivolous or inappropriate rather then for urgent patient care needs. I noticed that the nursing staff began to seek me out or to make themselves more available to talk with me during rounds about any questions they had regarding patient care rather then knowing that they could just call me later.  I had fewer confused calls from the ER docs about admitting patients who were already established with other physicians. It had been easier for the ER docs to call me directly than to contact the patient’s primary care physician.

What about emergent communications? Isn’t a direct call faster and safer? Actually, a direct call, in an age of texting and alphanumeric paging can be detrimental in the event of an emergency since the caller ID provides only the calling number and not the reason for the call. In other words,  I can’t tell which phone call is emergent and which is from a nurse asking for an order for  a stool softener. On the other hand, my answering service can text me the number to call back and whether or not it’s an emergency. This allows me to prioritize tasks so I know if I need to interrupt a patient’s detailed description about their bowel movements to return a call. Besides, there are multiple resources that the hospital staff can utilize (ICU rapid response team, nursing supervisor, in-house ER medical staff) for an emergency in addition to contacting me. They shouldn’t be paralyzed with inaction while waiting for me to answer my phone.

And there are many other excellent advantages to utilizing my answering service. The service knows when I am off or out of town and to direct calls to the covering physician.  The service will call the hospital unit back to confirm with the nursing staff whether or not I have returned the call and if not they will page me again.  The service keeps a log of every call which will help me defend myself against hospital staff who claim to have called me for an urgent situation when, in fact, they didn’t.  As mentioned above, the service can provide other additional information in a text that can’t be provided in a direct phone call.  And lastly, I’m paying for the dam answering service so the hospital better well use it!

Admittedly, there are many physicians why actually prefer to be called directly for reasons that I don’t understand (maybe they’re too cheap to pay for an answering service). I’m not one of them.  Just because technology has advanced doesn’t mean that we should automatically use it and abandon older proven systems.


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