18 November 2011

Frozen in Time

We respond to certain "Code Blue" situations in our hospital. In the ED, of course, and in the outpatient areas and radiology, and if needed as back-up in the inpatient units. The hospital issues one of those overhead calls when there is a code blue -- a cardiac arrest or other collapse, person down, injury, etc, but we also carry a pager in the ER in case we don't hear the overhead call. The pager also signifies which doc is designated to respond to such a call, since we often have 8 docs working at once. It's a little ritual we have at change of shift, passing off the pager and the spectralink phone, like the passing of the torch to the oncoming doc.

So of course I took the pager home the other day and had to make an extra trip to the hospital to return it. Ugh.

As I was driving back in, I took a moment to really look at the thing, and it struck me that this pager is the exact same model I used in medical school and residency, way back in the mid nineties. The exact same one.

How bizarre is that, when you think about it? This device ought to be a relic in a museum of outmoded technology. This device was in use before the iPad and iPhone, before smartphones at all, before digital cell phones. When this device was first put to market, the internet barely existed, if it did at all, computers all had CRT monitors and the fastest computers out there was running a 200mHz Pentium Pro.

Yet it remains in widespread use, having never been updated, improved or (as far as I can tell) altered in any way whatsoever. Where else will you ever find a piece of technology still in use unchanged for a decade and a half? What industry is so ossified and hidebound that it would fail to adapt to the rapid improvements in communication technology?

Only in health care, my friends, only in health care.


  1. From what I understand, NASA does too. I heard it's because they have to test and retest every piece of technology before they deem it safe enough for humans in space.

  2. It's not just docs. I work IT for a hospital management organization, and our on-call rotations still use those little bastards. Oh how I love the sound of that thing going off at 3am when somebody can't access their SharePoint document. :-\

  3. I still have my original numeric pager from intern year. Same pager, same number. I hate it. I'd like an upgrade to an alphanumeric. Since all the residents have cell phones now, they just call me direct or text me. A blip from my cell phone indicating a text message is much easier to tolerate (for me and my husband) than the annoying shrill of the pager.

  4. Interesting post, and an interesting question raised by other posters, too: Why, in this day and age, does the pager survive?

    I think it's one of those things that is like a pen. We have typewriters and word processors and computers and stuff. But for the task for which it was designed, the pen is still most effective.

    The pager? It's cheap. It's almost disposable. It is single-function. It's reliable. It's reliably annoying. Function has pummeled form into the ground and left it for dead. It is easy to pass off from person to person in the most simple means of transferring control without having to update some somethingorother in the sky as to who's on call (and what their current cell number is, etc.).

    Though we may hate it, and though it may not be an elegant piece of hardware (see "Function has pummeled…" above), it is a decent tool—maybe the right tool?—for the job.

    And so it lives on.

  5. In theatre, up until a few years ago, you saved your light board full of all the cues for your show to a floppy disk. A FLOPPY DISK. Many theatres still use those boards, since it costs upwards of 40k to upgrade.

  6. As Bill said, it does the job you need done. Change for the sake of change, especially for the emergency pager where lives are literally on the line, is silly. Is there a feature that you need which it can't do? About the only thing wrong with it is that it can be accidentally taken home, as you did, and I would argue that 50% of that belongs to the oncoming Doc for failing to be sure they took it.

  7. I dumped my pager years ago when I realized that after I got paged, I would return the call with my cell phone.

    So I eliminated that step. Now there is no more busy signals, no more "we don't know who paged you", no more "oh that nurse is in another pt's room." Nope they get me, or my voicemail. I seem to get fewer calls than when I carried a pager.

    I abandoned my pager in 2005. When I got my iphone in 2007 the nurses also started to text me. It's much more efficient, especially for those questions such as can I take out the foley....

    I have no idea why people continue to use pagers

  8. Jason Inofuentes11/18/2011 8:26 PM

    So, the truth lies somewhere in all of the other comments. Essentially, these things are reliable (even if the batteries die at the worst time), and are cheap to replace. And the service plans for these is startlingly cheap, much less than a cellphone w/ texting plan. But there's one very big reason why they persist. Hospitals, even newly built hospitals, have dungeons. Long hallways buried beneath the rest of the hospital where every other form of electronic communication is snuffed out, except for pagers. Their little chunk of spectrum is really good at penetrating walls, so no matter where you are in the hospital, your pager will go off.

  9. as others have pointed out, pagers are much more reliable at getting a message to you than cell phones.

    crowded cell towers? not able to get your cell signal out to talk to the tower to say "yeah, i'm here", too much electronic noise to punch through?

    pager doesn't care, the little blip of data from the cell tower goes through barriers, both physical and electrical that cell phones give "no signal" to.. and you get the page.

    cell phones are more *convenient* for you, but pagers are more reliable.

  10. Not only in health care.

    I work at an Internet hosting and support startup, and being in the Support team, we rotate an on-call schedule. Nowhere near as bad as the medical jobs, but it still means you get woken up at 2 or 5 AM by a pager.

    That. Exact. Pager.

    Once I responded to a customer page on a Saturday morning, but it wasn't a critical issue. I sent them our boilerplate response to non-critical criticals, and his response was:

    "Oh my hat! You guys still use pagers? That's so retro!!!"

    That made it worth waking up early.

  11. I am still deciding if the initial intent was to let the doctor know and allow them to get it at their own leisure, or if the system designers really wanted a direct nurse/allied health-to-doctor communications service.

    It's really simple right now: I page switchboard, I go clamber off doing what I need to get done while I wait for the doctor to get back to me.

    How would a direct-dial system work? Would I sit and wait for the call to come through? How does the doctor get different call priorities indicated on, say, an iPhone?

  12. I had one of those in the early 90s or so for work, and I still do.

    If I recall correctly in 1998 when I went to work for that Hospital to the south that used to have the same name as yours they were still using some of those "Bellboy" pagers from the '60s. so at least there is consistency.

  13. pagers are way more reliable, because they use satellite tech instead of cell towers. Using the pager also allows much better control of your comm tech-the expectation with a cell phone is that it is always on and you will always answer it and be ready for a conversation.
    When I am seeing a movie, or a rock show, or having a nice dinner, I don't want to answer my phone. Nor do the other people at the venues want me to answer it. Using the pager allows me to take sick calls without disturbing everyone around me.

    I am a techie for one of the electric companies. Tech people still use pagers because they are better than cell phones for some things.

  14. The fire service (especially volunteer companies) also uses pagers extensively to notify its members.

    Why? Cheap. Effective over broad spans of geography and building construction. Reliable (though that seems to be contingent on the number of times its been dropped...). Capable of providing adequate one-way transmission. Comparatively binary operation - it's either on or off, receiving or not (and therefore [mostly] firefighter-proof).

    Same reasons seem to apply regardless of profession.

  15. Where else will you ever find a piece of technology still in use unchanged for a decade and a half?

    Yeah... where else will a piece of communications technology last more than 15 years... I wonder...

    Maybe this?


  16. Fax is another almost obsolete technology deeply ingrained in the health care industry. Also used for financial documents, of course.

  17. I am with a volunteer fire department and we still use Voice Pagers. Not digital, pure voice. The "new" fancy ones record the last page so you can play it back if you miss it.

    We pay $550 a piece for these. We can buy 2-way radios, which also can receive the pages, for under $400.

    Apparently, we can't be trusted with radios, because they keep buying us pagers. Oh, they buy the radios too. They have to stay on our gear racks in case we get a call.

    So we buy radios and pagers. No one understands why I mutter under my breath every time this topic comes up.

  18. I have seem with my own eyes a Mac at Mass General that was in use and running OS 5. The first Mac OS that let you run more than one program at time. But I guess if it ain't broke...

  19. i'm another IT worker using a Pager. Why? Because it works. Our notification system will send messages to pagers or to cell phones as text messages. When I had it going to text, I was missing pages and that little beep when a message came in would not wake me at night.

    Besides, when I am off call, I have a great sense of satisfaction in yanking the battery out of the pager and tossing it in the bottom drawer of my desk. Also the command center now doesn't have my cell phone number to annoy me when they don't like the guy who is on the rotation.

  20. Fax machines.

    Don't get me started. My wife is a SLE patient in end stage liver disease so we have been spending a lot of time in hospitals and doctors offices in the last 2 years.

    I have most all of my wife's records on a DropBox account that I can access on a iPhone or iPad. Living will, medication list and so forth. I have lost count of the number of times when I offered to email a record as a PDF attachment I was told "We can't get emails, can you Fax it?"

    WTF!! Hello, it is soon to be the second decade of the 21 century and you still can't receive emails?

  21. Yeah, the pager looks a little old, but it’s still amazing on how it could still function with just the help of batteries. Imagine how strong and how high the quality of earlier technologies is? It is praiseworthy how it has kept up well with time and remains functional even with our modern needs.

    Cora Bullock

  22. Well, even though this pager looks old, its functions and usefulness isn't affected at all. This pager reminds me of something, that we shouldn't judge a book by its cover; we should open up the book and read all the important details. Just like the pager, we shouldn't look at it as old, but we should look at how useful it is even if it is old. :D


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