Don’t Text and Treat: How Mobile Technology Is Distracting Physicians

Dr. Henry Feldman, nicknamed the iDoctor, of Boston’s Beth Israel Deaconess Medical Center is a hospitalist and programmer who is constantly armed with an iPhone and iPad.  According to Kaiser Health News, mobile technology has helped Feldman become a better, faster physician.  “It lets me do everything I could do if I was sitting at my desktop at the patient’s bedside, and actually some things I couldn’t easily do,” he said.  According to Kaiser Health News, this includes showing patients impressive apps, diagrams, medical records and even photos from their own surgeries.  Beth Israel, one of Harvard Medical School’s teaching hospitals, is one of the most technically sophisticated hospitals in the nation, particularly in terms of mobile technology.

A somewhat different viewpoint is offered by Dr. John Halamka, the hospital’s chief information officer who helped make Beth Israel electronically advanced.  Halamka warns that mobile technology has a serious downside — it can distract doctors from patient care.  Physicians who carry mobile devices often receive texts, e-mails, Facebook messages, tweets and other notifications that automatically appear on the screen, he said.  Because the vast majority of smart phones and tablets are personal devices, the problem can be virtually impossible for hospitals to control.  “I think all of us who use mobile devices have what I will call continuous partial attention,” Halamka said.  “We’re engaged in our work but at the same time we’re checking that e-mail or we’re glancing at that instant message.”

Last winter, Halamka wrote a case study for the federal Agency for Healthcare Research and Quality about an incident in which a 56-year-old man was admitted to have his feeding tube replaced.  A team of doctors decided to stop giving the patient a blood thinner, but as one of the residents was entering the new order into her smart phone, she got a text about a party.  Because she was busy responding, she never completed the drug order.  It wasn’t a minor mistake; the patient almost died.  “If you forgot to pick something up at grocery store, it’s an inconvenience,” according to Halamka.  “If you forgot to stop a blood thinner, it can result in significant harm.”

To avoid such errors from occurring at Beth Israel, Halamka has implemented policies advising doctors on minimizing distraction on their mobile devices.  The hospital is testing software products that separate the devices’ personal and professional functions and wants to launch the new programs within the next six months.  The problem is that new technology fast outpaces the policies that regulate its use.  “The consumer technology industry is bringing more tech to doctor hands faster than policy can be made,” he said.  “How long did it take to pass laws against texting while driving,” Halamka noted.  “And we had how many people die because they were distracted drivers. There was a lag. I think maybe we’re at that point in healthcare.”

Writing on KevinMD.com, Dr. Kevin Pho “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.  A simple answer, some say, would be to ban non-medical use of smart phone 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.  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.”

Jonathan Mack, director of clinical research and development with the West Wireless Health Institute, a San Diego-based non-profit that focuses on cutting the cost of healthcare through new technology, believes that distraction from mobile technology “is case by case, but it’s not a huge problem overall.  It’s a learning curve” as hospitals adapt to the new technology.  Hospital administrators should be comfortable calling doctors on bad behavior if they see it and offer training so that they don’t become a barrier to care.

Writing for informationweek.com, Larry Seltzer says that “But of course, like the rest of us, doctors are going to use these devices for non-business reasons from time to time.  Yes, smart phones are especially good distractions, but it’s not like they invented distraction.  If nurses and techs weren’t playing Angry Birds 10 years ago when they had nothing to do, they might have been reading People magazine or doing a crossword puzzle.  Surgeons might not have been making personal phone calls while sewing up patients, but they might have been having personal conversations with others in the room.  What’s the difference?  There are good reasons why doctors and techs might want to access computers or the Internet while working on patients, and there are bad reasons.  These are people who we already entrust with a lot.  It’s just common sense to expect them to use these devices responsibly.”

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