Sunday, December 21, 2008

On call

Reading a catchy column on the editorial page this morning pleading with the President-elect to put down his Blackberry because it will make him a better President, I realize that I too need to be pager-less from time to time.

The problem of increasing connection through the series of wireless signals that span the globe is a hazard to both individual and collective health. As a medical student and even resident I was dependent on the page operator at the hospital calling me over the public address system or on the telephone in the call room, if I ever made it there.

"Dr. B please call 2116. Dr. B, 2116 STAT!" Anyone out there who trained in the same hospital I did will recognize 2116 as the oncology floor. Of course in those days the cornary care units and the intensive care units had their own live in residents.

I then graduated to a page that worked with certainity only in the hosptial. That meant that if I walked out the front door, got into my car and drove half a mile to my apartment I was truly off call. Of course, being the obsessive complusive resident that I was, the page operator had my home phone number. I also frequently left it with the resident who was on call covering my patients. Cell phones, Blackberries, even wireless computers and the Internet were in the future.

I remember marveling at the stories of my senior partner, who by the way lived in the hosptial during the first year of his training. All the interns, as they were called back then, lived in the hospital. One story he told was about a classmate who married his childhood sweetheart the week after medical school graduation. The couple had a two week honeymoon and then his internship began with the young doctor living in the hospital and the bride at her parents home. Surely there were conjugal visits and I believe he got two weeks of vacation.

Another story that my senior partner told was from private practice before pagers. If physicians wanted to go out for dinner, the phone number of the resturant was left with the answering service. Even the movie theater would take a call from the answering service and send an usher down the isle to summons the physician to the phone. This necessitated telling the usher who you were and where you would be sitting.

I remember purchasing my first cell phone to be able to go to the grocery store on weekends when I was on call. At the time I had two small children. Any emergency could be made worse by having a cart full of groceries, kids in tow and the pager ringing forcing me to look for a pay phone wondering all the while whether I would have time to go through the checkout line and get the food home before returning to the hospital.

These convienences of the modern world are costly. Without a cell phone the drive home was spent in silence. Or, I would look at the pager and immediately return to the hospital if it was an obvious emergency. Finally, the number of phone call was less. Currently I am trying to decide a fee structure for phone advice. Prior to this 24/7 access I would joke that the patient would call her mother and then call me. Now the order is reversed. And that is why I have a cell phone. I want my children to call me first.
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