11 June 2009

It's a compulsion

I was seeing a elderly gentleman for what appeared to be an acute stroke.  He was, by the history provide by paramedics, a potential candidate for something called t-PA, which is a clotbuster medicine that if given within a certain time can completely reverse the effects of a stroke.  But this time frame is not generous -- three hours -- and a lot has to happen in that time, so there is a real sense of urgency when a potential t-PA candidate comes in.   He was alone when he arrived and I saw him and examined him immediately. His stroke, however, prevented him from speaking, and I needed more information in order to determine whether we could in fact treat him with t-PA.  So it was with a sense of relief that I saw his adult daughter come into the room.  She was a professional, middle-aged lady who was very appropriate in her demeanor as I explained the situation and the treatment options.  I barraged her with a series of rapid-fire questions: information that was absolutely necessary to guide the decision to treat with t-PA. What time did the symptoms start?  Was she there when it began? What did she notice first?  Was Dad normal before the onset of symptoms?

Then her cell phone rang.   I saw a moment of panic flit across her face as she reflexively pulled it out of its holster.  I very deliberately ignored it and asked her the next question on my list.  She was visibly torn.  She knew that Dad was ill and that time was essential.  She also knew the ER was very busy and that my time was limited.  She clearly knew that it was inappropriate to answer the phone in this situation and I had all but told her so by continuing my questioning.  I emphasized the point by repeating the question.

And then she answered her cell phone anyway.

She did so with a furtive gesture, held it open a moment while she tried to answer my question at the same time, then half turned away and held the phone to her ear.  "Yeah, I'm at the hospital. Dad's had a stroke. I can't - the doctor's here. I'll call you right back." She shut the phone and turned back to me with a chagrined look on her face.  I ground my teeth just a little bit and we continued on with the conversation.

Now this is an extreme example, but this happens all the time and it drives me nuts!   The crazything about this phenomenon is that these are normal, considerate people.  I'm not talking about the losers out there - the immature adolescents who are simply more interested in talking to their friends, the Medicaideurs who abuse the ER and have no respect for the physician, that sort of thing. (They're easy to manage; I walk out of the room and leave them for another hour.)   I'm talking about reasonable adults who clearly know that what they are doing is more important than the damn cell phone but they simply cannot prevent themselves from answering it!  They have the grace to be embarassed, but they do not have the willpower to just let the call go through to voice mail.

Here's a clue, people: Sometimes it is acceptable to let a call go unanswered.  Sometimes it is more important to focus on the person you are talking to in person than whomever is on the line.  Especially when the person you are talking to is the treating physician for your family member.

Please make a note of it.  This has been a public service announcement.

And all you kids, get the hell off of my lawn!


  1. Perhaps some practice is in order. They should arrange to have a friend call them at a certain time every day, so that they can practice letting it go through to voicemail. If they answer the phone, the have to snap a rubber band onto their wrist.

  2. Amen! Possessing a cell phone doesn't carry an obligation to answer it every time it rings! That's what voicemail is for.

  3. I carry a cellphone for my convenience, not for the convenience of those trying to reach me.

    Convincing my in-laws of this has been difficult.re

  4. When I first started, I had a very hard time dealing with people who started to talk on their cell phone in the middle of my assessment or if I were trying to explain something. Now, I just walk out on them as soon as they answer their phone. If you don't have the time for me, I don't have the time for you. Obviously that couldn't have been done in your situation - I hope you gave her cut eye.

  5. So, if we get most everyone to overcome that compulsion, can we also get them to overcome the compulsion to call two or three times in a row, because they know you've got your phone with you, so why aren't you answering? ("Oh, I just wanted to chat. Are you busy?")

    I have to carry a cellphone around these days, since I have kids in school and camp and such. But dear God, how I wish I could convince a few people that this doesn't mean that I'm morally obliged to answer their call as I'm driving down the highway in a rainstorm, or in the middle of a conversation with an old friend, or playing with my kids.

  6. the Mommy Doc6/13/2009 9:46 PM

    This one pisses me off in clinic. I have 20min to get through 20 drugs, 5 chronic illnesses, a decent physical exam, and the page-long list of complaints the patient wants to go over with me. And then they answer the stupid cell phone??!!.....

  7. Most medical facilities I've seen have a "No Cellphones!" sign on the door. Perhaps if Security began relieving the offenders of their "toys", it might get the point across??


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