For most people, the pager represents a sad, humorous relic of the past—a reminder of the primitive time before cellphones, Google, and the Twitterverse. But for doctors like me, pagers are still an important part of everyday life. It’s estimated that about 85 percent of hospitals still rely on pagers for communication, and during a recent episode of post-call delirium, I wondered why.
The first pagers—hefty 6-ounce boxes—were introduced to physicians in New York City in 1950. Over the next four decades, the device became a status symbol both inside and outside of the medical profession; after all, wearing one meant you were so in-demand you needed to be reachable anytime, anywhere. By 1994, there were more than 61 million pagers in service worldwide. But the advent of cellular phones led to a rapid decline in beeper use, and there are now a mere few million pagers still out there, many in hospitals, and all of them slowly and annoyingly beeping their way to obsolescence. If doctors were among the first adopters of paging technology, they will almost certainly be the last to abandon it.
Although the pager seems out of date, doctors often take perverse pride in carrying one, at least at first. I still remember the excitement and anticipation of receiving my first pager as a medical student. It meant the years spent hunched over a textbook were over; I was entering the fray of patient care. That feeling quickly turned to irritation as I became painfully aware of pagers’ shortcomings. During medical residency shifts that span a day and a night and then some, I have grown to despise my pager with a burning rage previously reserved for Boston drivers. The device’s rude, sudden blare, with a knack for jolting me awake on call just as I drift into a shallow, anxiety-ridden sleep, now triggers a visceral reaction. My heart leaps into overdrive and my palms transform into a sweaty wetland that occasionally facilitates “accidentally” dropping the bleeping thing. I don’t have children, but I wonder if the way my tiny pager loudly dictates its demands around the clock is like having a baby. Except my beeper will never love me back.
Surely there’s a better way for doctors to communicate, yet pagers remain the maddening norm. Why? For one thing, they’re low-maintenance. The batteries in pagers don’t need to be changed more than once every few weeks, even with heavy use. That means the system will work even during a disaster or power outage, when it might be hard to find a working outlet to charge a cellphone.
Another major benefit struck me recently as I chatted on my phone while strolling through the bowels of the hospital. The building’s seemingly unending corridors form a maze that leads unfortunate employees, and occasionally a stray patient, into the malodorous depths of the building. This labyrinth isn’t exactly amenable to good cellphone service, and as I turned a corner, my call was dropped. That’s no big deal when I’m talking to a friend, but if I were on the line with another staff member, a dropped call could lead to frustrated and possibly deadly confusion.
Paging networks have more broadcast power than those for cellphones, which makes the signals better at penetrating buildings. They also rely on satellites to relay messages. As a result, pager messages are broadcast to multiple towers in a given area at the same time. That boosts reliability because even if one pager tower stopped working, another could pick up the satellite’s signal.
The way pager systems work also makes it easy to send group messages that are received nearly instantaneously. In a hospital emergency—for example, if a patient had no pulse or very low blood pressure—a staffer would need to notify a full team of personnel as quickly as possible. Her best option would be to use a pager.
Of course, pagers have lots of disadvantages, too. The most annoying part of pager-based messaging is the fact that it only works in one direction. The sender types a brief message into a web page, or has a phone operator do the same, and then, a few seconds later, the text arrives on the tiny screen of the recipient’s pager with a loud beep. This can be a real hassle. When I’m on call, for example, someone might page me to find out whether or not I want to give a blood transfusion to someone with a low cell count or whether a patient should refrain from eating after midnight in preparation for the next day’s procedure. But even answering these simple yes-or-no questions turns into a labor-intensive task. To respond, I have to leave my patient’s bedside, find a landline phone, dial the right extension, and wait for someone to pick up. And sometimes the callback number I received sends me to the front desk on the hospital floor, at which point I have to wait to be transferred. All of this so I can give a one-word answer to a question.
This inconvenience really adds up. A colleague once tallied the number of pages he received during a single 12-hour overnight shift. He arrived at nearly 90 messages, or an average of one every eight minutes, beeping at him as he admitted new patients and tried to take care of old ones. The time we lose in this constant back and forth between returning pages and doing other work can be a real drain. (A 2010 survey of 60 junior doctors in Ireland confirmed that 59 of them preferred using mobile phones for work communications.).
Even when a hospital administrator has the motivation to upgrade doctors’ communications, the cost can be prohibitive. A New York City hospital recently paid between $10,000 and $20,000 to pilot a mere 16 smart phones, for example. Still, some hospitals have started trying new approaches. One is TigerText, a cellphone app that ensures secure messaging and automatically deletes messages after a certain period of time. (That’s important for patient confidentiality.) Special cellphones made for use in hospitals are another option. A Voalte phone, for example, works a lot like a regular cellphone but has extra security to ensure privacy.
We recently started using one of these systems at my workplace, and I was impressed by its efficiency. Still, I noticed that in some situations, pagers simply did a better job. For one thing, nothing beats that infernal bleeping when it comes to getting a doctor’s attention. On a Voalte phone, as on a regular cellphone, text messages blend together in your inbox—and since they all have the same alert tone, important messages get lost among the myriad other correspondence practitioners receive daily. If a pager goes off, the beeping indicates the message may be important enough to be sent via page. By design, messages via Voalte are often less urgent. Overall, there’s a quicker response and greater attention to a pager when it goes off than to a Voalte.
For all its inconveniences, a pager still offers benefits that have yet to be replicated by more modern forms of communication. It provides an alert that can’t be ignored and a reliability that is crucial in the health care setting. And carrying a pager has symbolic value, too: It connects today’s doctors with those from the past and represents the notion that we’ll always be available to take care of our patients. In the end, perhaps my excitement over my first beeper wasn’t so misplaced after all. Now if you’ll excuse me, I need to go return a few pages.