Monday, September 03, 2012

The Doc and the Cell Phone

I debated calling this The Shrink and the Cell Phone, but I don't think the cell phone problem is unique to shrinks.  Maybe it should be called The Person and the Cell Phone.

Oh, I remember the good old days, before cell phones, before answering machines, before texting, chatting, Facebook, email, and even call waiting.  Okay, I remember black and white television with three stations and you stood up to change the channel and there were no curse words.  I remember rotary phones.  Oh my, just saying this, I feel a million years old.  

Unlike some old folk, I don't think many of these new-fangled inventions are a bad thing.  I remember waiting by the phone for calls, not wanting to leave the house if I was hoping a boy would call, missed connections where I was in one place and my friends were in another, and the general anger that one felt toward a parent or sibling who wouldn't get off the phone when there were important social engagements to be honored.

Almost everyone I know over the age of ten has a cell phone now.  They have their own numbers and you can text or call them and the expectation in our world is that one is available.  Unless of course they don't want to be.  Don't charge your phone? Perhaps you're passive aggressive.  Forgot it again, maybe you've a touch of ADD?   Harry picks up for everyone but me....could I be getting a tad paranoid?

So cell phones have replaced pagers and every doctor I know has a different relationship with theirs.  Some give their numbers out freely, others do not tell their cell numbers to patients.  So the first question is Who Gets the Number?  Is there a line of defense to screen calls and protect the doc from patients who might interrupt them with trivial concerns while they are with patients, sleeping, or simply don't want to be bothered?  Many doctors direct patients to an office number where staff decide what might warrant calling the doc's cell phone.

The second question is what to do about the calls that come?  Is the phone left on at all times, so that it interrupts patient appointments, bubble baths, dinner with the family?   This, I believe, depends on how crucial the doctor is (or perceives himself to be) and his/her individual personality.  If you're the only attending coverage for the ICU and the housestaff is to call you with emergencies, you probably are obligated to leave it on when you're on call.  I know plenty of psychiatrists who leave their cell phone on as an emergency number around the clock, take calls during sessions, and when they are busy with social obligations.   I also know plenty of doctors who don't return calls even if they are identified as being important.

I don't think there is an exact answer to this.  Individual psychiatrists are often their only coverage, besides the obvious, "If this is an emergency, call 911 or go to the nearest ER"....and while many docs feel obligated to take emergency calls, it may not be reasonable to assume a psychiatrist is never going to leave the phone in the other room, go for a swim, or turn it off in a movie theater.  

I think I have the ultimate love-hate relationship with technology.  I like all of it, but I feel compelled to check so many things, so many times.  My sanity hangs in the balance.  I give everyone my cell phone number, but if I don't recognize the number, I let it ring to voice mail -- I get lots of spam calls, I seem to be on every shrink head-hunter's list.  I also don't answer the phone during sessions, while I'm in the shower, when I'm asleep, or when I forget to turn the phone from silent to ring.  I don't answer when I'm at the movies or swimming laps, or in the grocery store, or in a restaurant or anywhere I can't have a private conversation.  I usually listen (except in the movies or if I'm submerged) to make sure it's not an emergency, in which case, I return calls sooner rather than later.  It's a mix, I hope, between being available, and having some control over my life.

I know shrinks who take all their calls immediately because they worry that a patient might be calling when they are on the verge of doing something bad -- and maybe the shrink can persuade them not to? -- or because a patient might be having a crisis or emergency.  Is any given shrink, I wonder, really able to alter an outcome, to talk a patient out of doing something horrible and irreversible, by being available immediately, 100% of the time?  Is immediate availability a standard we should set?  Does it set the stage to say that if only you'd answered the phone, then bad things wouldn't have happened?  

What do you think?