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Beeper Obliterans: Clinical Staging and Natural History

By Neil Izenberg, MD, and Steven Dowshen, MD, Albert Einstein Medical Center, Philadelphia, PA.

From JAMA 267(9):1209, March 4, 1992.

To the Editor --

In this report, we describe a common but previously uncharacterized clinical entitity affecting hospital staff physicians: "beeper obliterans." The essential element of this syndrome is the periodic emission of high-pitched electronic tones secondary to an ever-increasing abdominal girth that impinges on the test button located on the superior aspect of the wearer's pager-beeper.

Using a modified version of the Disease Staging[1] methodology, we (two staff pediatricians with 25 years of combined experience) have described this condition's inexorable march (see Table).

Advancement to stage 4 is directly correlated to a body mass index of 35 kg/m^2 or greater, clinical service of 10 or more years, and knowledge of the code for the patient pantry-door lock. Of interest is the notable "silent phase" seen at the level of departmental chairman (when beeper is shed and all calls are taken by the secretary, program director, or safely ignored). Further research on the natural history and treatment of this ponderous problem is suggested.


1. Gonnella JF, ed. Disease Staging, 3rd ed. New York, NY: SysteMetrics McGraw Hill; 1986.

Table: Clinical Staging and Natural History of Beeper Obliterans.

StageStatus and Description
0Condition-free. Beeper functions as designed. Physician alert and ready. Reaches phone within 15 sec. 100% of time. Body mass index (BMI) = 22 (BMI defined as wt/ht^2 in kg/m^2).
1Pager Paunch. Truncal flexion by wearer sets off beeper test button. Physician frequently confused. Answers less than 85% of pages. BMI = 25 kg/m^2.
2Beeper Bulge. Abdominal overhang intermittently muffles audio tones ("souffle effect"). Worsened by consumption of high-fiber meals. Sufferer strains at listening, ameliorated by loss of high-tone hearing. BMI = 28 kg/m^2.
3Pager Inversus. Tone set off even by quiet respirations. Roll of pants at the belt line causes pager inversion with characteristic "echo effect." Wearer disoriented by microwave beeps in hospital snack bar. Greater than 125% of pages answered (paradoxical irritability). BMI = 31 kg/m^2.
4Beeper Obliterans. Beeper completely enveloped by adipose tissue. Associated with increased risk of coronary artery and gallbladder diseases, as well as non-insulin-dependent diabetes; less than 3% of pages answered. BMI of at least 35 kg/m^2. Surgical removal or elevation to chairmanship may be indicated (see text).

To: duncan@csmc.edu
From: izenberg@KidsHealth.org (Neil Izenberg)
Date: Fri, Apr 26, 1996 20:17
Subject: Beeper Obliterans

My colleague Steve Dowshen and I are amazed and flabbergasted that you saw fit to post our opus Beeper Obliterans on your site. How did that come to be? You must have a heck of a lot of time on your hands. By the way, is the Spitzer in the other article neonatologist Alan Spitzer? If so, coincidently we're all at the same institution now: The Alfred I. duPont Institute Children's Hospital in Wilmington DE (We even have a web page http://KidsHealth.org).

Thanks for the honor....now we're waiting for that call from Stockholm.

Neil Izenberg

Created 11/27/94 / Last modified 4/29/96
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