Back in the days of rotary phones and pencils, messages in the clinic were taken on pink slips, written by people with welcoming voices. In the staff room, covertly, we would compare the quantity of our pinks with our neighbor’s. Admittedly, it was childish. When slips were replaced with voicemail, you no longer knew who was popular.
These days, residents are even busier than we were, working in multiple locations at once. There are no pink slip phone messages. Often, there isn’t even voicemail. Contact is through the beeper. Beepers have been around for generations, but it’s different now.
For example, suppose you hear, through some cousin of a cousin, that your patient has been admitted to a hospital. You call the unit for the name of the resident, who has no answering machine. You’re connected to an automated paging system, where you enter your phone number, hang up, and wait. On your desk, there’s a backlog of forms that needed attention, anyway.
Waiting to hear is like sitting on a runway without being told which plane you’ve boarded; never taking off, never touching down. The resident is in the middle of seven emergencies, or off duty, or doesn’t recognize the tickertape number flashing on his belt. Five minutes, 10 minutes, 15 pass. The forms are done, and while you’ve been waiting, a patient’s been waiting for you. You give up and bring them in (you hate to run late). Halfway through that appointment or the next, the light on your phone flashes. You will have to call the paging system back and start over. It’s like watching a repetition compulsion in the making. Sometimes the light never flashes at all. Why should it? The beeper doesn’t know who you are.
These are times of unremitting technological contact, we just can’t avoid each other, yet patients are admitted and — even more often — unsafely discharged, without a word of communication. The first I hear about the event is from the local pharmacist, asking for refills on medications I did not know had been begun, for patients I did not know had been hospitalized. I return the call with confidence. Pharmacists always pick up.
Elissa Ely is a psychiatrist.