When you are handed your first pager, you are starting a long and perhaps quite ambivalent relationship with a device that is likely to be with you throughout your career – in various shapes and abilities.
Simon Ahtaridis put it well in The New Physician, 2002 “Your first breath will begin when you join your team and receive a pager. A pager may seem exciting, but after two days, you’ll abhor it and develop odd beliefs and behaviors. If a pager goes off next to you, you’ll breathe a sigh of relief and say, “That was too close,” as you peek from behind a desk as if there was a page-operator sniper hiding behind a gurney, seeking out new targets.” As with any relationship, yours with the pager will grow, change, have ups and downs. Throughout your career your pager is likely to have a considerable place of power- instantly demanding your attention, often immediately requiring you to do something and almost certainly quickly causing a shift (often to the negative) in your emotions. Included on this page are suggestions for managing the pager in your practice.
Reactions to Being Paged
This information is based on input from residents at the 2008 Resident Workshop seminar on Pager Management.
Early reactions to being page: Nervous, pumped up, felt like I’d be making a contribution, “wow, someone wants to talk to me,” “I’m going to get to do something!”, fear, excited, frustrated, tachycardia, tachypnea, “What should I do now?”, “How do I call them?
Thoughts that quickly run through your mind when paged: I hope it’s a mistake. I hope I don’t have to go in. Not again! Can I handle this? Why are they paging me? I wish it was someone else. Now what! Again! Give me a break! Somebody is dying. Am I on call? Please not the ER again. This better be important. I hope it’s not the trauma pager. What do they want now! Road trip, have to come in.
What are some of the emotions that you experience when paged?: Fear, increased heart rate, chest tightness, frustration, aggravation, disbelief Anger (when it’s the ER number)
All of these reactions to being paged are normal, average, to be expected and you’re likely to have them, too. Much like Pavlov’s dogs, this classical conditioning over time becomes ingrained and more difficult to change. So as you start your relationship with your pager, now’s the time to set the terms. Let’s address pager management.
Pager Management - Your Reactions
Developing adaptive thoughts. What would be a healthy, less stressful thought to have when your pager goes off? Perhaps tell yourself “Take a deep breath, relax, you can handle it.” “It’s not the end of the world, I’ll get through this.” “I don’t need to be mad at the world because I was paged.” “I have back-up if I’m not sure what to do.” Decide what you’d like to think.
Develop adaptive feelings. What would be healthier, less stressful emotions to have when your pager goes off? Perhaps calm determination, confidence. Decide what you’d like to feel.
Develop adaptive behaviors. What would be healthier ways to respond physically and behaviorally when your pager goes off? Perhaps take a deep breath, hold it briefly and then exhale slowly to the count of 4. As you exhale let your shoulders drop down. Walk at normal speed to get to the phone, desk, etc. (unless it’s a STAT).
Decide how you would like to react.
Now rehearse these thoughts, emotions and behaviors. Imagine yourself being paged and as you imagine it, deliberately practice the thoughts, feelings and behaviors you chose above. Then page yourself and practice these thoughts, feelings and behaviors in response to the page. Really, do this and do it 10-20 times until you get the routine down with your adaptive thoughts, feelings and behaviors. If you already have developed the less adaptive emotions, thoughts or behaviors to your pager, then change the type of alert and practice the adaptive reactions. It may seem silly but something as simple as changing the alert and practicing a few times with your reactions can make a huge difference. You are now taking some control over your conditioned response to the pager. A step ahead of Pavlov’s dogs!
Pager Management - Best Practices
Residents at the 2008 workshop on pager management offered these based on what they’ve seen and learned: respond promptly; respond with a polite voice and with respect; when your on make sure the pager is on, when off, turn it off; if you page then wait for the response; be succinct with text paging; politely excuse self from conversation when paged. To reduce pages, check in with nurses before you leave and be clear with orders in check out.
Pager etiquette when with a patient
Apologize for the interruption before looking at your pager.
Explain if you need to reply immediately and that you only interrupt patient contact if it’s an urgent matter. Do not answer the page in the room with your patient.
Before you leave the exam room, write down where you left off with the patient.
Before returning to your patient, stop, do an emotions check and make sure you are not bringing any negative emotion from the page contact back into the room with your patient. Do an emotion shift if you notice negative emotion. See Emotion Shift topic for details.
Return to the patient, apologize for the disruption and state where you left off- do not ask the patient where you left off.
An internal medicine survival guide. The New Physician, October 2002