I have a shiny new Bluetooth device. So now, as I zip around town, I can speak without my hands touching my phone. It’s relevant because our county is passing a ban on cell phone use, unless it is hands-free. This is a national trend, of course, and the catch phrase is “distracted driving.” Everyone knows that distracted driving is bad. I’m told, in the media and by friends, that it’s even more dangerous than drunk driving.
Mind you, we’ve all done our share of distracted driving. When I was in high school, I attended college classes half-days during my senior year. On the way to dear old Marshall University, I would often stop and buy a bag of ham sandwiches and a large Coke at Kmart. I was pretty good at juggling drink, food and driving on Route 60 from Barboursville to Huntington, WV. Was I distracted? They were very good sandwiches and the Coke (old school, with sugar) was ice cold; so I’d have to say yes.
Of course, anyone who has ever driven down the highway to the awesome sounds of Radar Love by Golden Earring, or Sweet Child O’ Mine by Guns and Roses, understands fully the intensely distracting value of 80′s rock and roll, often compounded by the bright sunshine and warm air of a summer day. That’s distracting, to be sure.
Although I have to admit, the most distracted I’ve ever been in a vehicle was not when I was driving, but when my girlfriend, now wife, Jan was behind the wheel. We were in college, going somewhere together on a summer day. She was tanned and her black hair was blowing in the breeze. That was when she did that magical trick that gets the lifelong attention of every young man. She took off her bra while driving, and did so through her sleeves. Be still my heart! If I had been driving, I’d have rolled the car for sure.
So I get the distracted thing. It’s tragic for any life to be lost over something as trivial, as silly as the driver looking down at a text or e-mail. On the other hand, it occurs to me that every day, all day, we practice distracted medicine. You heard me. I can’t imagine that we could make medicine much more perilous than we do now. Because the opportunity to actually focus on a patient, complete a thought or finish a task is vanishingly rare.
Think about it. You’re up to your passwords in EMR, charting some complex interaction involving an angry mother, a drunk father, a sick child and a dog that apparently ate everyone’s narcotics. As you decide how best to describe the situation, a nurse thrusts an EKG in your face. “Chest pain in twelve. I need a doctor. Don’t forget to sign and time it.” You run off to the chest pain, knowing as you do that it isn’t a STEMI. However, there are risk factors. It’s concerning. “Nurse, I need you to give three nitro and four baby aspirin and get a chest x-ray.”
“Fine. Put it in the computer. Did you put it in yet? I’ll put it in, but will you sign off on it? Doctor, don’t forget to order it.” The same interaction is repeated every day with lab techs, EKG techs, x-ray techs … with almost everyone, because nothing can happen until it is electronically present in a hard drive. Otherwise, it’s a lie! A deception! A lawsuit waiting to happen! So, you were distracted by the EKG, and then your thinking was interrupted by the insistence that you make sure and document the things you want done, and everyone knows needs to be done.
You’re back at the computer, thinking about something else when Joe Dirt walks up and says, “Hey, you know how long it’s gonna be? Cause this is ridiculous. And can I get a cup of ice?” Your badge that says “Dr.” might as well say “Dr. Pepper,” because he has no sense that interrupting you is inappropriate. But then, neither does anyone else.
On the way to another patient the secretary says, “The urgent care has a transfer, and you’re the only doc here right now.” Thought process interrupted, as you field a call from across town and accept the patient. What was it you saw in the triage note that concerned you? Oh, never mind.
Next, you need to refer a patient to a specialist. Easy? Hardly. You have another form thrust in front of you, which you are supposed to fill out in order to make things easier on the specialist, by sending insurance information for prescreening. And almost without fail, large or small hospital, be assured that the transfer forms, ambulance certifications and medication orders for EMS will all be in front of you, either electronically, in print or both. Those are forms for doctors to fill out, not anyone else.
In the midst of this, considering the nuances of abdominal pain becomes problematic. Likewise, trying to use your years of insight to decide if that college student is suicidal, or that roofer is having a TIA, is all but impossible; every thought is interrupted by another request, another need, another demand, another form.
You go back to your computer and you realize it timed out. So you have to re-enter the password, then another password for radiology viewing. You spend as much time entering passwords as you do listening with your stethoscope. It’s hard to think about drug doses when you have to juggle the passwords of your life. But don’t worry about interactions or allergies, because every single order is stopped by a pre-programmed warning. “Warning! Tylenol may cause liver disease with prolonged use!” “Warning! Without adequate airway management, succinylcholine may be fatal!” “Warning! Phenergan may interact with Lortab to cause sedation!” After dozens of warnings, one ceases to process them. Or anything else.
It goes on an on. Another call, another form, another field to fill in. More data to enter, more orders to enter and all the while the patient may be very sick, or very complicated, but that matters little in the world of distracted medicine. And then, at the end of the day, when your mind and body should be free, there are more charts to fill out, more data points to enter to complete the record … but you’ve forgotten half of them because you were never allowed to complete a thought.
Of course, this doesn’t count the distracted practice that occurs from patients who have difficulty describing symptoms, or those who outright deceive us with discombobulated stories and misinformation that all lies on our cerebral hard drives like so much spam, so many cookies, so many viruses or bits of malware.
With every new rule, form or computer field, with every new drop-down menu that requires five minutes to navigate to find ‘fever” amongst choices like Lassa Fever and Metal Fever, we are distracted. With every electronic prescription that takes five minutes to a 30-second handwritten prescription, we are distracted. And with every demand that we take everyone seriously and treat every ridiculous complaint as a thing of inestimable value, we are distracted.
What we do is important! Shout it from the rooftops! And it’s too important for us to spend our shifts struggling through the brambles of endless, trivial, unnecessary distraction.
We need to push back. This isn’t funny anymore. It’s horrible. It’s devastating. It shortens careers and endangers lives. Just as the driver’s main focus should be driving, our main focus must be the timely and efficient care of patients.
And if our directors and politicians and administrators want us to continue to save life and limb, at all hours of the day and night, they need to realize that distracted practice is at least as dangerous, and maybe more so, than distracted driving.
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