This review by John Halamka is worth a read. He discusses the emerging phenomenon of distracted doctoring – physicians preoccupied with technology at the expense of patient care. The review was followed closely by a New York Times piece on the same subject.
We’re experiencing a crisis of information. Our channels of input have crossed wires and messages infiltrate our world from different angles. The smart phones and iPads that serve us Epocrates and potentially our EMR also carry messages from friends. Technology has made it easy to participate in dialog happening outside of our immediate clinical space.
But it’s easy to take the isolated cases described in the links above and conclude that the wheels are falling off the wagon. I’ve found that while there are exceptions, most of the doctors I work with do a good job of compartmentalizing their professional and person inputs. And then there are cases of iPhone attribution error where the assumption is that the referencing doctor is up to no good. Nonetheless the issue of distracted doctoring needs discussion. Like privacy transgressions, one misstep is one too many.
Here’s the question: When it comes to managing the use of personal mobile technology, where does the responsibility of the individual doctor end and the institution’s begin?
This question’s important because the answer to the challenges presented by today’s communication applications won’t apply in the near future. Efforts to prohibit certain applications may be undermined by the appearance of new ways to connect. Technology is advancing faster than our ability to legislate its use.
Perhaps it’s time to consider the issue of medical mindfulness. We need to consider our focus on the immediate circumstances surrounding ourselves and our patients. This begins with the deliberate elimination of inputs that take us from our obligation to the patient. Mindfulness is as much a matter of self-preservation as it is an obligation to those we serve. The issue of attention crash and self-awareness should be part of an ongoing dialog among doctors, especially medical trainees. I suspect that this area of thinking will evolve.
Ultimately it’s the responsibility of an individual to figure out where their focus should lie at any given moment. While technology has its place in improving the way providers deliver care, there should be moments of clear, dedicated attention that center on an optimal encounter.
I suspect that if technology isn’t something we can manage ourselves, someone else will be glad to try to legislate it on our behalf.
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At my former hospital, Facebook was blocked until the hospital created its own page. An email then went out encouraging all employees to check out the hospital’s Facebook page.
Youtube is still blocked, which drives me crazy because I want surgery residents and students to see certain operations on video before scrubbing live. I send them links and tell them to watch on their iPhones. Even if it’s minutes before the case, the value of surgery videos is tremendous for orientation of the novice. For the chief resident and practicing surgeon, video is essential for learning techniques not yet seen or not taught locally.
When I see a student stealing a moment on their iPhone, I’m usually impressed. (Though probably making the opposite attribution error much of the time.)
CP
PS: I’ve gathered a selection of operations where I direct students here on OnSurg: http://onsurg.com/before-you-scrub
I love the term, “medical mindfulness”, Bryan! A nice antidote to “distracted doctoring” or “neglectful nursing”. Thanks for your thoughtful post — as one who trains physicians and nurses in mindfulness, I agree that mindfulness should be an integral component in health professional training.
All the best,
Pam (@pamressler)
All the recent discussions about “distracted doctoring” has gotten me to do a lot of self examination on this matter. I am a cardiac electrophysiologist with a very busy clinical practice. I also happen to be “connected” with daily active monitoring of twitter and email for predominantly business purposes. During downtime, I’ll also use the internet for diversion and decompression.
It’s become clear to me the worst interruptions are not electronic. It’s actually quite easy for me to ignore the twitter feed when I’m in the middle of something important. I and others have developed a skill of “focus” while finishing an important task (such as placing orders as recounted in the John Halamka piece).
The times that trip me up are when someone interrupts me with a question or request to take a phone call. This happens a lot in my practice and really does mess up my focus. It’s quite a bit harder to keep a person waiting than to ignore an electronic interruption. When I find myself making errors (such as forgetting to finish all my post op orders), I can usually trace it back to a human interruption.
As a result of this discussion, I’ve gotten more vigilant about protecting my focus. If a nurse interrupts, I’ll make he or she wait until I’m ready. This may look rude (and probably does), but it’s better than making a mistake. The nice thing about electronic interruptions is that they don’t get put off with you when you make them wait.
Jay
I agree with @EdwardSchloss. I am a consultant neonatologist and I often feel constantly interupted, mostly by the DECT telephone, but also by approaching staff.
The virtual environment (“online all the time”) has been transferred to the IRL world – we want to be constantly available for everything.
The digital channels (Twitter, medical journals etc) more serve like a fresh breeze from the outside world, when I get a slot to grab my smartphone during a busy day.
Greetings from Sweden! Stefan
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