By Laura Vearrier
Americans check their phones an average of 46 times per day, (Eadicicco 2015) and they do so no matter what they are doing, including while driving, while at church, during sex, or out to dinner. (Rodriguez 2013) Are healthcare providers any different? In a survey of medical students, 46 % reported texting, checking email, or making a call on their personal devices during a patient encounter, and 93% had seen a senior resident or attending do so. (Tran et al. 2014) The answer to this problem is not as simple as turning off the device. Improvements to medical care afforded by personal devices include efficient access to electronic text books, up-to-date literature, medical apps such as dosing calculators, and improved provider connectedness, among others. The flip side is that the inevitable distraction created by smartphones creates a threat to professionalism in healthcare…
“Distracted doctoring” is considered a disturbing trend as consequences can be as fatal as distracted driving. Most hospitals operate under a “Bring Your Own Device” (BYOD) policy that allows employees to use their personal devices in the healthcare setting. Personal devices create a constant source of distraction – even when a phone is not buzzing due to an incoming call, text message, app notification, or email, the compulsion to check the phone, and possibly browse social media or the news, remains for many. Even if a provider takes out his or her phone for a professional purpose, such as to look up medication interactions, smartphone designs makes it almost impossible to ignore the texts or alerts that have appeared since the user last looked at the phone.
Some solutions to decrease distraction include putting phones on airplane or do-not-disturb modes during patient encounters and only using devices for personal purposes during breaks and in lounge areas are challenging to implement and do not resolve many issues. Due to BYOD policies, enforcing policies that limit personal use of smartphones would be infeasible. Personal monitoring of device utilization requires a degree of self-restraint that is unattainable by many Americans as evidenced smartphone pattern utilization. So how do healthcare providers respond to this threat to professionalism?
One of the first steps that is needed is to educate providers on the risks of distraction. Most healthcare providers are not only required to multi-task, but perceive multi-tasking as more efficient way to accomplish multiple tasks. However, multi-tasking is not performing several tasks simultaneously, it the rapid transfer of attention from one task to another. This transfer interrupts the cognitive process, which decreases efficiency and increases the risk of error. While texting or emailing while monitoring an anesthetized patient’s vital signs can clearly be detrimental to the patient, other less obvious distractions may impact patient care. Outside of a patient’s line of sight, pausing to respond to a text while writing or filling a medication order may seem innocuous, but it increases the risk of error.
Since checking a phone can be reflex, healthcare providers must increase their self-awareness and consider patient perceptions. Decreasing the personal distractions created by smartphones requires educating providers on the dangers of distraction. Medical simulation centers are one modality that could be used for further study and education on the consequences of smartphone distraction in the clinical setting.
Laura Vearrier, MD, is a clinical assistant professor in the Department of Emergency Medicine at Drexel University College of Medicine. She is active in both undergraduate and graduate medical education at both Drexel University College of Medicine and Hahnemann University Hospital. Dr. Vearrier is completing her Doctoral degree in Bioethics and Health Policy at Loyola University Chicago.
Eadicicco, Lisa. 2015. “Americans Check Their Phones 8 Billion Times a Day.” TIME.
Rodriguez, Salvador. 2013. “Most adults always have smartphone close by, 1 in 10 use it during sex.” Los Angeles Times.
Tran, K., D. Morra, V. Lo, S. D. Quan, H. Abrams, and R. C. Wu. 2014. “Medical students and personal smartphones in the clinical environment: the impact on confidentiality of personal health information and professionalism.” Journal of Medical Internet Research 16 (5):e132. doi: http://www.jmir.org/2014/5/e132/
2 thoughts on “Our Devices, Our Selves: How to Avoid Practicing Distracted Doctoring”
Thank you Dr. Vearrier for highlighting this crucial topic in medical professionalism! Your bio mentions you are obtaining your doctoral degree in bioethics – good for you…and the intersection with this topic is evident – medicine is a moral enterprise. And that includes the issue of distracted doctoring &risk of increased error. Indeed, your question “So how do healthcare providers respond to this threat to professionalism?” is spot-on. Put the phone down. Approach the patient who is putting their trust in you with intentional, mindful presence (http://bit.ly/2gG9DBQ), attentional focus and narrative humility (http://bit.ly/1v5s4P6) for meaningful engagement. Disconnect to reconnect with yourself and others…We are “addicted to distraction” and stuck in a “compulsion loop” (http://nyti.ms/1MWHYEH). “In a survey of medical students, 46% reported texting, checking email, or making a call on their personal devices during a patient encounter, and 93% had seen a senior resident or attending do so. (Tran et al. 2014)”?? Sounds like a public health crisis to me.
Dr. Vearrier, thank you for your essay. In an outpatient community setting, the distraction of devices is also an issue. The push to see more and more patients in a given clinic time slot encourages clinicians to enter notes in the medical record during the patient encounter. Personally, I found it impossible to connect with the patient and to connect with the computer at the same time. I resolved the issue by only using the computer to show the patient her lab results or to send her prescription to the pharmacy (so that she could see that it was done). I stayed several hours after clinic each day to update the medical record. It is a fact of life these days, but I strongly believe that the value in medicine and nursing comes from the connection made by one human being with another, and we lose that value when we allow our devices to run our lives.
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