The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Friday, December 09, 2005

An Hour in the Life of a Pager

I read an interesting fact the other day-- as many as 25% of all beeper pages were unimportant or unnecessary and actually interrupted patient care (citation below, if you care that much). That makes one heck of a lot of wasted time answering pages and trying to find a free phone.

What immediately came to mind was an incidence of pager-abuse not too long ago, when I was paged *1 (meaning STAT, or emergency) out of a patient assessment to the emergency room. As I had three patients in emergency at that time that were admitted and waiting for beds to become available upstairs, I rushed out of my assessment and ran to the nearest phone. The emergency? I had forgotten to sign a radiology requisition, and the patient was on their way to x-ray. Nice.

So I decided to conduct an experiment. Today I actually wrote down what I was being paged for every time my electronic leash went off. This lasted for little more than an hour before I couldn't keep up with it, but it was interesting while it lasted. Now keep in mind that during this hour I am trying to see three surgery consults in the emergency room with the help of two clinical clerks.

10:02am: The floor pages me to tell me that Mrs. W's urine output was low. I ordered a bolus of fluid over the phone.

10:04am: The emerg (two feet from where I was currently sitting) pages me to let me know my patient is waiting for me in emerg. Um, thanks. I know.

10:04am: Senior resident pages me to remind me that Mr. D's CT scan needs to be set up before lunch. Thanks, I know. I've done it already.

10:09am: Radiology pages me with results of an ultrasound on one of my patients.

10:12am: The floor pages me to tell me that Mr. P's PICC line fell out. I inform her that it didn't fall out, we ordered it removed last night because it was infected. She is satisfied with that.

10:12am: One of the clerks pages me from the other end of the emergency room to tell me he's finished assessing his patient.

10:12am: Who knows who this was? I tried to call it back three times and the line was busy. Don't page me and then get on the freaking phone!

10:19am: The floor pages me to ask if I'm sure that I want Mr. H's heparin stopped. Yes, I do. That's why I wrote the order "discontinue heparin".

10:21am: The floor pages me to tell me that Mr. Y has spiked a fever of 40.2. The nurse has given him Tylenol, but she just wanted to make me aware. Um, thanks.

10:34am: The floor pages me to tell me that Mr. L's nurse thinks that his abdomen is becoming more distended. I tell her I'll be up to look at it when I get a chance.

10:34am: Senior resident calls me from the OR to let me know that we'll be running the list with the staff (i.e. discussing the patients) after their next case. I agree to meet them. I wonder how the heck I'm going to get these consults done before then when my pager keeps going off.

10:40am: Hematology resident pages me to tell me about another consult on one of their patients. This day is not looking any better.

10:52am: Nurse from the floor pages me to ask me if Mrs. M's additional bloodwork can be done tomorrow morning when the tech comes back because she's a difficult stick. The bloodwork isn't urgent, so I tell her it's fine.

10:54am: Nurse from the floor pages me to tell me that Mrs. W's bloodwork showed that her INR (measure of how easily blood will clot) is too high. I change her dose of coumadin (drug that makes blood less clotty) for that evening.

10:57am: Another page from the ER (this time, 10 feet from where I am sitting) to ask if we're going to be sending one of our consults home. If I had time to deal with the consult between pages I'd be happy to answer the question.

That made 15 pages in the space of one hour. A page every four minutes, on average. Of these, maybe 6 were useful or necessary. This hour might not have been representative (I don't usually get THAT many useless pages in such a short period of time) but I'm now starting to understand why I can get through a 12-hour day without having time to eat or sit down and yet still feel like I've accomplished nothing.

There is good news, though. As of today at 6pm when I finally left the hospital, I am on vacation. For a whole week. Thank God.

Blum NJ, Lieu TA: The effects of paging on pediatric resident activities. American Journal of Diseases of Children 1992; 146(7):806-808.

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Blogger VitaminKMD said...

WOO! Peds! But...oh, so true. Honest to the almighty, it's exhausting. Not necessarily answering all the pages, but not responding with a whole-hearted I-don't-give-a-rat's-ass when you ARE paged.

I actually had a moment this week when I woke up before my alarm (at 0530) because I thought I had heard my pager. Which was in my locker at work. And turned off. How sad is that?

9:30 PM

Blogger Kim said...

Oh man! Seems as though the ER needs to turn around once in awhile and see who is in the department! Yikes!

If the pages aren't stat, can you let them collect and answer them, say, every half hour?

I've never had a pager and I never want to...I don't even turn on my cell phone...

4:36 PM

Anonymous Anonymous said...


I'm sending my med-student brother in law the link to your blog. He's leaning towards Emergency Medicine right now, and I thought he would get a kick out of reading about your experiences. I enjoy your blog quite a lot and read it regularly -- there you go, you got fanmail! Will you send me an autographed glossy picture of yourself?


11:46 PM

Anonymous Anonymous said...

ur a sex bomb

12:58 AM


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