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Rapid Responses: Rapid Responses published:
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Telephones in Hospitals
- Gary J Nicholls (19 August 2005)
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Breath of fresh air
- Vadakkuppattu D Ramanathan (19 August 2005)
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care for each other and patient care will improve
- Neha Sekhri (20 August 2005)
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Re: Telephones in Hospitals
- Peter KK Au-Yeung (20 August 2005)
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Re: Telephones in Hospitals-August 21 2005
- Phillip J. Colquitt (21 August 2005)
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Medical Ethics and patient benefits
- Riddhi Doshi (23 August 2005)
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Re: Re: Telephones in Hospitals-August 21 2005
- Alex G. Birkett (24 August 2005)
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Mobile phones need not be harmful in the hospital
- Satish Nagappa (26 August 2005)
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Medical ethics and implied consent
- SATISH NAGAPPA, SURESH GOPALAN (27 August 2005)
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Hurray
- Sae Gozashti, MD, PhD (27 August 2005)
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Re: Telephones in Hospitals
- Velupandian Guruswamy (29 August 2005)
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Re: Telephones in Hospitals
- Diane-Marie Campbell (8 September 2005)
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Gary J Nicholls, Physician Sydney 2010
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I am impressed by the author's honesty and humanity. This article touched on several 'taboos' in hospitals - including the appropriateness of intimate examinations, and the use of mobile telephones. I have been working in Australia for several years, where EVERYONE uses their telephone at the hospital - from patients and relatives to ancillary staff, nurses and doctors. In fact, it is so much easier to contact junior doctors on their mobiles rather than using archaic pager systems that this is a preferred communication technique. This may be a cultural phenomenon - I was amazed when doing a brief locum post in the UK last year to be 'ticked off' by a junior nurse when using my mobile phone in a corridor to contact my consultant. As far as I am aware a number of my anaesthetist friends use their telephones in the operating suites of the UK without too much patient danger, along with a large number of 'illicit' users around the hospital. There is no evidence to show that using a phone will affect patients safety in hospitals - unless perhaps the stores staff are on the phone whilst driving a buggy down a corridor and crash. I believe that NHS hospitals would do well re-evaluating telephone use by all and sundry - and coming out with facts rather than fiction. Since more or less everyone owns a telephone, the old pagers could be discarded rather than be replaced. Patients who are lying around all day without visitors can keep in contact with their friends and relatives and reality. Choosing a silent or quiet ringtone would of course be beneficial for everyone. Everyone should be allowed to chat away happily - just so long as it isn't in the middle of my ward round or clinic!! Competing interests: Mobile Telephone User. |
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Vadakkuppattu D Ramanathan, Deputy Director, Dept of Clinical Pathology Tuberculosis Research Centre, Chetpet, Chennai, India 600031
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It was really nice to read this Personal view. It is heartening to see that there are still left some doctors who have this kind of empathy with patients and still put profession before pay! V.D.RAMANATHAN Competing interests: None declared |
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Neha Sekhri, clinical research fellow Newham University Hospital, E13 8SL
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Individuals looking for a 9 to 5 job, I feel should not choose medicine as a vocation.A career in medicine demands much more commitment than one is ever trained for in medical school.Patient care is not the only focus of working as a team. Looking after each other is equally important and boosts morale. The caring instinct initiates a chain reaction from which all individuals benefit. I wish we move away from the hospital culture of saying to colleagues 'go back to your GP and he will refer you on...'. Competing interests: None declared |
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Peter KK Au-Yeung, Specialist Anaesthetist Hong Kong
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The question of mobile telephones in hospitals, or more importantly in critical clinical areas still remain one of balancing risks versus benefits. Portering staff in my hospital carry "walkie-talkies" to aid communication and they just take more care using it (guidelines promulgated to them) when they have to enter the ICU. The electromagnetic interference of mobile phones and "walkie- talkies" pale into insignificance when we compare it with surgical diathermy, yet we still allow the surgeons to use it in the operating theatre, even when much critical electronic monitoring of the anaesthetized patient is taking place concurrently. The surgeons I work with routinely use 30W cutting and 30W coagulation with blending in much of their surgery and even upwards of 70W of both in certain types of TURP. No mobile phone can hope to compete with this power output! We just make sure that the relevant precautions and procedures relating to electonic equipment (including but not limited to syringe pumps and cardiac pacemakers in the patient) are strictly adhered to. So if the benefits are great enough, then the risks are worth running (especially when steps are taken to minimize them)! During SARS, there was a stricy NO VISITING policy for all hospitals and the patients are allowed to use their mobiles in their beds to keep in touch with their family. This is particularly important because the whole society was gripped by the fear of an unknown epidemic. Mobile phone restrictions are applied more rigorously now that the epidemic is over! Competing interests: None declared |
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Phillip J. Colquitt, Independent comment Independent comment
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Not "everyone" Gary J Nicholls. And not at the large Australian public teaching hospital I have worked in for 15 years continuous and an RN. Yes, they(everyone who has a mobile) do use them, but not in any part of the hospital they choose, and not when and in whatever way they choose. For example, residents on call are paged not phoned, signs on walls indicate restrictions apply or that phones must be turned off, and written policy indicates what restrictions apply. The requirement of staff to report any suspected interference with biomedical equipment is not optional. For example, I have seen unexplained infusion rates in poorly shielded devices. Yes, some staff and some patients do ignore the policies and directives. Competing interests: None declared |
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Riddhi Doshi, intern(doctor) Lokmanya Tilak Municipal Hospital,Mumbai. zip code-400022
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The author,Nick Taffinder, has raised a number of issues which come under the domain of Medical Ethics but do not essentially benefit the patients or the doctors. A consent form is one of them and so is the use of telephones in the hospital. A consent form remains the basic formality followed before any kind of examination or procedure done on the patient.What if one is in a situation where there is no paper or pen available... but there is a patient-- a person in pain who needs your help? Is a surgeon incomplete with his green robes and gloves and surgical instruments just because he doesn't have a paper and a pen? Did Hippocrates forget something really important for patient care? Use of telephones while driving has been rightly banned.Communication between consultant doctors has been stressed on in earlier editions of BMJ but not the means of communications. I have worked for the past 3 weeks on post flood relief team in deonar in mumbai. We were a team of 3 doctors responsible for health care, education and timely referral of patients to higher centres. However there were no telephones there so I had no means of communicating with the higher centres regarding the referred case.Should telephones be banned at health care centres or are they an essential facility? Competing interests: None declared |
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Alex G. Birkett, Electrical Engineer UCLH NW1 2PQ
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There is not a great deal of evidence to demonstrate one way or the other that using mobile phones is causing any actual harm to patients or to patient connected equipment. This does not mean that there is no risk. Some time ago I investigated the effects of porter's radios on some infusion pumps and syringe drivers. I found that they did indeed interfere with their correct operation. Mobile phones can and do cause similar interference to the correct operation of some medical devices. MHRA giudelines and IEC regulations recognise that all electical and electronic medical devices can potentially be interfered with by any radio source. It is shamefully arrogant to decide that it is ok to use phones based on little more than private opinion or self interest. Just because hospital telecoms management is not up to scratch does not entitle anyone to put others at risk. Apart than the physical risk to patients there is, of course, a need to protect all from the sheer bloody nuisance of an environment full of cringe making novelty ringtones. Competing interests: None declared |
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Satish Nagappa, research fellow wrightington hospital, WN6 9EP
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Mr.Taffinder's article highlights a very common day to day problem seen in almost all the hospitals across the country-the use of mobile phones in the hospitals.It is not uncommon to see surgeons and anaesthetists receiving calls in the operating theatre whilst surgery is being performed. Opinion of an anaesthetist about it is that the patient will be in a well controlled environment[theatre] with necessary equipment and qualified competent people[anaesthetist and the surgeons] around to deal with any emergencies.It is true that the signals from the mobiles do interfere with the functioning of certain electronic medical devices and can lead to problems. Fortunately most places where there are large critical electronic equipments the strong electromagnetic signals often makes it impossile to use mobile phones as the network signals would be nearly zero. What happens if a patient who is confined to his/her bed makes or receives a mobile phone call in a regular ward? it certainly is not going to cause any harmful effect though obviously it could be a nuisance to other patients. Most of the UK hospitals unfortunately still have nightingale wards accomodating 20 to 30 patients.Imagine a relative trying to get through the busy switch board[which can sometimes take upto 15 minutes]to connect to the ward, the ward phone being engaged as usual due to various reasons.Finally if the call does get through ,with the staff being so busy [with all their paperwork and answering the phone],someone[could be a staff nurse ,the auxillary,a physio,ward clerk or the poor SHO nearby] will answer the phone and on being asked about a particular patient would have to call the nurse looking after the patient to talk to the relative.If that nurse is busy attending to another patient either the phone has to be put on hold or she can just shout out loudly about the patients condition to be relayed to the relatives which is not ideal but happens regularly.isnt the patient confidentiality breached by this action? By then the poor relative would have been on the phone for nearly half an hour.If the patient had rang from his/her mobile a more satisfying personal conversation would have taken place in a much shorter period without causing significant inconvenience to the others and lessening the burden of phone calls to the switch board and the wards. at at a time when everybody is talking about patient care, comfort and satisfaction to be the key factor in the NHS service why is the patient/relative communication being restricted? Competing interests: None declared |
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SATISH NAGAPPA, RESEARCH FELLOW WRIGHTINGTON HOSPITAL,- WN6 9EP, SURESH GOPALAN
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What Mr.Taffinder did at the early hours of the morning is really commendable and ethically correct. It just reiterates the fact that people working in the medical profession dont just work from 9 to 5.They do realise their duty to the patients goes beyond that, which explains why most consultants and the junior doctors do not just leave the hospital at 5 pm.In fact on an average most doctors work 1.5 hours extra every day .As regards to the concern about not obtaining the written consent for the rectal examination it is not a significant issue as a clear verbal communication was made and the fact that the patient[ the male nurse in this case]lied down on a bed to be examined fully understanding what kind of examination is being done sujjests that an implied consent was in place. The implied consent concept has been in practice for ages and still holds good for most of the day to day medical and surgical examinations of the patients. Of course if it were to be a female patient such an examination in the absence of a chaperone would definitely be an issue that can be viewed seriously. Competing interests: None declared |
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Sae Gozashti, MD, PhD, Physician po box 470626, brookline village, ma 02447, usa
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Thanks Nick for sharing this very moving experience. It reminded me of my nights on the ward as a clerk and being told to do the full physical by my residents or attendings. Not too many clerks volunteered to do the rectal exam, and some residents would differ the exam to us-sometimes with a chuckle. It wasn't pleasant, but absolutely within the required role of the physician. Not only does Nick do what is his duty, but he does it when he is not required to by the book! Hurray for Nick! As for the use of mobile telephones, in the early days we had telephone booths on practically every floor of the hospital. Then Bell Telephone broke up and the booths were taken away. Why do we not design low electro magnatic interference areas for use by patients and staff in the hospital? Cell Booths? Or Mobile Telephone Booths? It should not cost much and it will settle the issue. Competing interests: Makes sudden stops and provides care for beings in need |
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Velupandian Guruswamy, SpR Anaesthesia Theatres and ICU
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I fully agree with the authors view that it is much easier and quicker to contact and reply using mobile telephones in hospital. I have worked in Singapore for a year and most of staff use mobile phones in hospitals and they have a very high quality care for patients and doctors response to calls /bleeps is very quick and efficient than here. The mobile phones which we use these days are highly advance and digital ones than the older ones which used to be analog ones and the interference with medical equipments was higher with them than the ones which we use these days. I have seen my colleagues including seniors and juniors using mobile phones in theatres and anaesthetic rooms with no problems of interference with medical equipments.In some hospitals I have seen it being used even in intensive care units with no problems. I think it is time that the policy of - Do not use mobile phones in hospital - should change provided that hospital doesnot have medical equipments of very old days which might get interference from use of mobile phones. Competing interests: None declared |
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Diane-Marie Campbell, emergency physician itinerant ; currently Burnie,Tasmania 7320
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As usual it seems that those asserting "there is no evidence" are ignoring evidence that is there but contrary to their self interests (1.) Also as usual common sense and courtesy would win. An anaesthetist caring for a patient may well choose to use a mobile rather than leave the room - its not as though he's going to be indulging in long sessions of telephone sex during working hours, is it? The "acceptance" in many hospitals is simply that staff get tired of being policemen. Its true that distance matters and its true that some phones are less likely to cause problems - but relatives in the Emergency Department are often ignorant of the monitor/infusion pump on the other side of a curtain, which may be literally within 20 centimetres. So unless alarms keep blaring we usually don't push it - which of course leads to arguments from the argumentative on the odd occasions there are problems because "everyone else says its okay." I have certainly had to repeat ECG's - the commonest finding looks like a pacemaker artifact - after asking for surrounding mobiles to be switched off, and that removes the artifact. Come to think of it, I have a CD/tape player that buzzes when my mobile rings 4 or 5 metres away. Hospitals spend huge amounts on IT services which often allow the switchboard to identify which bed/waiting area the patient is in, even in Emergency - why don't we have more wall phones for incoming calls? The amount of time I spend answering calls and either taking the cordless phone to the patient or trying to explain that the one cordless is in use, would probably pay for it! But mobile ownership in Australia is one of the highest in the world and people expect to be continually "in touch." The result is that if mobiles were to be switched off we'd be inundated with calls. Half the callers demand to speak to a friend who we are expected to find, although the caller doesn't know which patient they are with. Of course common sense and courtesy would also suggest that a patient who has waited an hour to be seen shouldn't answer their phone and start a long description of the causative football game when I go to see him - not because its rude to me but because I have nowhere else left to see patients and we are keeping others waiting. A last thought on courtesy - Dr Taffinder should not use the "C-word" but "Emergency Department" or "Accident and Emergency" according to local signage. I hope he recovers and his colleagues see him back there; I am sure they appreciate his diligence and compassion. (1) Lawrentschuk N, Bolton DM Mobile phone interference with medical equipment and its clinical relevance: a systematic review. Med J Aust. 2004 Aug 2;181(3):145-9. Competing interests: None declared |
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