I have a friend who’s a hospitalist. His team carries Voalte phones for communication within the hospital. The Voalte phone is an enterprise mobile device that allows communication by voice and text. For those trying to reach the doctor there is no waiting for a call back after a page. You just call directly.

On the surface this seems like it would improve communication. Immediate access as a means of making care delivery safer and more efficient. Communication in real-time. Medicine at the speed of now.

But a funny thing happened, he tells me. After having the Voalte for a few months he stopped answering the phone. He would look, see who it was, make a judgment about its importance and then make a choice to answer or call back.

On the surface this looks bad. But if you’ve ever functioned as a physician on a busy inpatient service you understand that there are competing priorities at any moment that require triage. You can’t always be available to talk at the moment the interested party wants to talk.

The strange beauty of the pager is that it allowed some control on the part of the doctor. While you were interrupted by the sound, you exercised the option to talk to the sub-intern only after wrapping up that lumbar puncture. Or between the sub-intern and the ICU, the call back to the intensivist would take priority. It’s a uniquely human algorithm that allows us to prioritize multiple demands so that patients get the right care in the most efficient way.

So it was the asynchronous part of pager experience that this hospitalist reclaimed through the calculated neglect of his Voalte. Requests to talk had to be considered in the context of competing demands.

Immediacy is a fantasy of the networked age. We want to believe that technology will allow us to work at the speed of now. We’ve seen this everywhere from the promise of social networks to cell phones and EHR messaging.

While the fantasy is that the Voalte phone would improve the immediacy of connection, the reality is that our capacity as humans to do one thing (or often two) at a time will always be the rate-limiting step. Technology will never change that. It can only work around us in a way that makes that reality more efficient.

Modified photo by Adria Berrocal Forcada