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.