Cell phones keep you connected (if you want to be or not)

Whether it's an emergency call about a patient or a colleague wanting to discuss a particular case, many physicians consider a cell phone the best way to stay connected.

However, the importance of a cell phone to a practice has to be balanced with its limitations and potential burdens, doctors said. Getting unnecessary calls from patients in the middle of the night and not being able to get calls because you had to shut your phone off in ICU are dilemmas that give physicians pause when considering how mobile they truly want to be.

About two-thirds of American households own cell phones, according to a market study last year by New York-based Scarborough Research. If that survey included only physicians, the number would undoubtedly be higher. Doctors may run the gamut on how they use them -- some have eliminated answering services in favor of cell phones, while others see them as useful only for absolute emergencies -- but very few would dare to be caught without one.

"It's absolutely vital," said Frank Boehm Jr., MD, a neurosurgeon in Utica, N.Y. "A conscientious physician wants to take full advantage of the latest technology to help the patient, including being available at all times."

For Dr. Boehm's practice, the need for immediate access is important because the status of a patient's condition can change on a moment's notice.

Legally, it's important to be available as well, because "the defense that you couldn't be reached doesn't hold anymore."

There's a pretty distinct line between being reachable and being bothered, though, and physicians have to be judicious in deciding who should be trusted with the cell phone number.

"The number is kept kind of private, mainly for internal use," said Karen Davis, a health care consultant in Chicago. "[Patients] would have to work pretty hard at getting a cell phone number."

Dr. Boehm said when he returns calls to patients from his cell phone, he activates the call-blocker feature so his number isn't revealed. After-hours calls go to his answering service, which first tries to page him and then calls his cell phone.

Michael Vaewhongs, MD, a Dallas-area hospitalist, relies on his cell phone as his primary line of communication because "this is my office." His business card, however, only has his pager number; he'll add his cell phone number if he trusts the patient won't abuse that privilege.

"After I talk to the patient, I decide," he said. "At least I can control my pager. It's rude not to answer the phone. I have had people call in the middle of the night, literally for a refill on antihypertensive medication. You have to train your patients well to respect your privacy."

There's a practical reason for carrying a pager along with a cell phone: dead zones. If you're in an area with a bad signal or in an old hospital that allows limited reception, your cell phone suddenly becomes useless, physicians said. The need to shut phones off in parts of the hospital also makes them less reliable.

Because cell phones can fail, Dr. Boehm said he would be hesitant to choose that option over an answering service. Under the Emergency Medical Treatment and Active Labor Act, not responding when you're supposed to be on call can result in up to a $50,000 federal fine, which Dr. Boehm said is a pricey risk to take with a $200 piece of technology.

An answering service can provide other protection as well. Dr. Boehm described a situation where a hospital emergency department claimed to have called his office but got no response until a physician called his cell phone directly. A call log pulled from the answering service proved the hospital had never called. The cell phone, meanwhile, proved to be an important backup option.

During business hours, though, you probably won't want to send colleagues through an automated voice mail maze. In those situations, having a cell phone can bolster efficient communication, doctors said.

As better technology emerges, cell phones may become a physician's one and only necessary mode of communication. Many phones already have paging capabilities, so it's only a matter of time before pagers become obsolete, physicians said.

"I would imagine in the near future, I'll abandon my pager and just use my cell phone," Dr. Boehm said. "I have text messaging capabilities too, so I will have my answering service contact me that way too."