^* RS, PB, and ML are part of the Post-Marketing Surveillance Group, which receives funding from Astra Pharmaceuticals.

1. Gosbee J. Communication among health professionals. BMJ 1998; 316: 642[Free Full Text]. (28 February.)
2. Kozak EA, Dittus RS, Smith WR, Fitzgerald JF, Langfield CD. Deciphering the physician note. J Gen Intern Med 1994; 9: 52-54[Medline].
3. Hobbs FDR, Parle JV, Kenkre JE. Accuracy of routinely collected clinical data in acute medical admissions to hospital. Br J Gen Pract 1997; 47: 439-440[Medline].
4. Coiera E, Tombs V. Communication behaviours in a hospital setting: an observational study. BMJ 1998; 316: 673-676[Abstract/Free Full Text]. (28 February.)

Message pagers may improve communication

EDITORCoiera and Tombs discuss communication behaviours in hospital settings,¹ a topic important to many junior doctors. In their discussion, however, they failed to mention the importance of two recent changes in hospital working practices which have contributed to an increase in the paging of junior doctors.²

The switch to primary nursing, with its objectives of improving the accuracy of communication as well as increasing accountability, often results in increased communication between doctors and nurses; each primary nurse communicates directly with the doctor about the doctor's patients. Previously this information was more likely to be amassed and delivered all at one time by or to a nurse in charge. The second change in working practice is the demise of the ward doctors who spent the bulk of their time on one ward. This has arisen partially as result of increased pressure on beds and partially subsequent to the increased specialisation of wards and the training requirements of junior doctors. This results in increased paging due to the absence of the doctor from the ward, and also militates against the development of trusting relationships between health professionals, which results in the "just to let you know" calls that are used to dispatch responsibility.

A method of communication which is exploited more often by senior doctors is the message pager. This has the advantage of allowing the sender to indicate the level of urgency of the call and the time and mode of response required, while being less disruptive to the receiver and permitting a range of response options. Sadly, it is perceived by many healthcare trusts as being an expensive option, and in my experience often has to be purchased by the individual. The alarming inefficiency of communication demonstrated by this study shows this up as an expensive and potentially dangerous false economy.