Solving distracted doctoring from smartphones and tablets

Solving distracted doctoring from smartphones and tabletsImagine that your neurosurgeon, during surgery, was talking on his cellphone using a headset.

Unthinkable?

Well, no. A recent article in the New York Times cites a case where a patient was left paralyzed and the neurosurgeon was sued, in part, for being distracted. He made 10 personal calls during the operation.

The proliferation of portable electronic devices, smartphones, tablets, and the like, are driving the attention of health professionals away from patients.

Think distracted driving is a problem? Try distracted doctoring.

According to the Times,

… research on the subject is beginning to emerge. A peer-reviewed survey of 439 medical technicians published this year in Perfusion, a journal about cardio-pulmonary bypass surgery, found that 55 percent of technicians who monitor bypass machines acknowledged to researchers that they had talked on cellphones during heart surgery. Half said they had texted while in surgery.

About 40 percent said they believed talking on the phone during surgery to be “always an unsafe practice.” About half said the same about texting. The study’s authors concluded, “Such distractions have the potential to be disastrous.”

We’re encouraging more doctors to use “point of care” apps, which, in theory, should benefit patients. But unaccounted for is the fact that smartphones and tablets carry many other functions that are non-clinical — like Facebook, for instance:

“You walk around the hospital, and what you see is not funny,” said Dr. Peter J. Papadakos, an anesthesiologist and director of critical care at the University of Rochester Medical Center in upstate New York, who added that he had seen nurses, doctors and other staff members glued to their phones, computers and iPads.

“You justify carrying devices around the hospital to do medical records,” he said. “But you can surf the Internet or do Facebook, and sometimes, for whatever reason, Facebook is more tempting.”

A simple answer, some say, would be to ban non-medical use of smartphone and tablet apps. But like trying to ban texting and driving, that would be near impossible to enforce.

A better way would be to increase awareness and education of the phenomenon. The Times article is a good start. I had no idea how bad the problem was.

In medical school and residency, there are few courses on online professionalism. Perhaps that needs to be part of the curriculum. We need social media and health 2.0 role models who can teach physicians, residents and medical students not only how to act professional online, but also on appropriate mobile technology use in the clinic and hospital.

The problem is, there are too few of these role models. In their absence, much of what we do to address this issue will be reactionary, and likely after a well-publicized malpractice case.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • http://www.bryantsstatisticalconsulting.com Donald Tex Bryant

    Very interesting that this research should be coming to light.  Last night on NBC nightly news there was a discussion of pilots using iPads to assist in flight instruction and details.  I wonder how many of the pilots are being distracted by other apps on their cockpit iPads?

    Couple these ideas with distracted driving, it seems that the world is becoming more and more dangerous because of some technologies.

  • Peter Elias

    Take a couple steps back and think about this. Fewer than 10% are capable of quality multitasking. The rest of us serially unitask, and the accuracy and quality of our work is impaired by the time/energy cost of the transitions from task to task and by the data loss with each transition. This has potentially disastrous consequences when small errors can generate large deviations in outcomes.

    Hence, driving while using a cell phone (including using a head set) is not a major problem when nothing unexpected happens, but it dramatically reduces the speed and accuracy of response to a change or new data (the car changing lanes or the person crossing the street but not in a crosswalk). The impact is comparable to being legally intoxicated.

    This article and all the commentary I have seen so far are interesting and true, but I think they miss a key point. Those of us who have adopted a computerized record have already sold ourselves to the devil, and we are just arguing about the fine print in the contract.

    Think, for a moment, about the office visit. Before the computerized record, the clinician focused on and interacted with the patient, collecting historical and examination data, assembling and integrating it in order to synthesize an assessment and plan, which was likely dictated after the cognitive work had been largely completed. Now, the clinician multitasks, switching attention back and forth between the patient and the multiple and often user-hostile and non-intuitive screens used for data entry. 

    If talking to my wife about a grocery list on a headset is a complex enough task to impair my ability to react properly and quickly to a dog running into the street, think of the impairment that must be occurring while I am using a mouse and a keyboard and struggling with a $50K electronic record designed by people who never practiced medicine.

    (Actually, it is not just the complexity of the tasks that come into play. Brain function is modular, with many – most – modules having a necessary inhibitory effect on competing modules. It takes time to shut one down and crank another one up.)

    So, before we get all excited about how terrible it is that people are checking Facebook in the ICU or texting while in the OR, let’s remember that we are currently setting as national policy and a major goal that every clinician will be impaired during every office visit with every patient.

    Peter Elias, MD

  • ckbm

    Sigh.  So now we are going to add regulation of people’s level of distraction to our over-regulated society.

    The hard truth:  Talking on a hands-free device while driving is NO different than having a conversation with a passenger.  Talking on a cellphone is probably less distracting than eating a meal behind the wheel.  Shall we regulate these activities, too?  What about chewing gum and walking at the same time?

    I agree that the neurosurgeon making personal calls during surgery was ill-advised.  Was it the etiology of the patient’s bad outcome?  Maybe not.  I haven’t seen proof of this in any of the media coverage.  Bad outcomes have also been known to happen in surgery even when the surgeon is not talking on the phone.

    I guess, as a neurosurgeon myself, I won’t be able to talk to the ER doc about that patient who is dying of a brain hemorrhage while I am stuck in a case in the OR.  Giving lifesaving orders on that patient would distract me too much.  Never mind that we’ve managed to do that for years.

    The nanny state is going overboard here, and not for the first time.

    • http://www.facebook.com/brianpcurry Brian Curry

      “The hard truth”? Really? Could you cite for me the source of your claim that the two are equivalent? To my knowledge, the evidence seems inconclusive, with some showing no increase in risk, and some showing a significant increase. Don’t get me wrong, I grant you that there is a point beyond which regulation goes too far, but let’s not overstate our case in the process.

      • ckbm

        Yes, really.  The source of my claim is common sense, having done both for a number of years.  While talking on a headset, it is easy to keep one’s eyes on the road and one’s hands on the wheel.  While talking to a passenger, it is an instinct to look at the person you are talking to, not at the road.  It is also an instinct to gesture during conversation with someone who is physically present, not during a hands-free phone conversation. 

        I don’t need a study with p<0.05 to tell me that talking to a passenger is at least as risky as talking on a hands-free device, any more than I need a study to tell me that people who are tall are better at dunking a basketball than people who are short. 

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