By: Perry W. Payne, Jr., MD/JD/MPP
Doctor, what do you think? Doctor? Doctor?
These are words uttered by a number of patients today as doctors use an increasing number of “screens” while simultaneously interacting with their patients.
These screens offer access to mobile devices such as touchpads, smartphones, and laptop computers. During the already restricted time that patients have with doctors, they are now being asked to compete with such devices.
The question for researchers, clinicians, hospital administrators, and most importantly patients is: does this integration of new devices distract doctors or enhance the care they provide to patients?
This article reviews this issue and prospects for future research.
Recently, NPR (through a reporter from Kaiser Health News) talked with Dr. Henry Feldman (hear full NPR broadcast ), Assistant Professor of Medicine at Harvard Medical School, about mobile technology and distractions. Feldman, who worked in the computer industry for 10 years prior to entering medicine, claimed that mobile technology makes him a “better physician.” In particular, he stated that the iPad helped him accomplish tasks faster and created a mobile desktop allowing him to do more away from his desk.
NPR also talked with Dr. John Halamka, Chief Information Officer of Harvard Medical School, who has warned that mobile technology can distract doctors. According to Halamka, the distraction seems to come from non-medically related material being viewed on the mobile devices – such as email, phone calls or an instant message.
The smart nature of the device equips clinicians with so many tools that can be used at once that physicians may end up multitasking and in turn being distracted from their most important task at hand (usually patient care). One part of the problem is that devices are often owned by doctors. The NPR broadcast indicated that 1,600 iPhones and 1,000 iPads at Beth Israel Hospital in Boston are owned by doctors.
The solution seems clear. If hospitals view the devices as beneficial – just as computers in hospitals are beneficial – then hospitals can simply began purchasing these devices for health care personnel working in their hospitals. This could be done with ongoing feedback from clinicians since they are aware of new ways to use this technology – i.e. new apps.
Halamka further explained his point of view in detail in a case study earlier this year published in Web M and M: Morbidity and Mortality, a publication of the US Agency for Health Care Research and Quality. The case study focused on a medical resident who was in the process of ordering a drug for a patient on a smartphone. While engaging in this task, the resident received a distracting text informing her of a party.
The resident began focusing on responding to the text about the party and forgot to finish the order for the patient which almost led to the patient’s death. While the case study is informative, what is not clear is how such a distraction is any different from past distractions such as a spouse paging an attending doctor while the doctor is writing orders for a patient.
Distractions are difficult to control with advancements in communications technology that allows people to stay connected to their personal life while engaging in their professional work. Management of distractions seems to be the job of the health care professional, just as people in other high pressure professions (i.e. judges) manage distractions on a daily basis. Halamka suggests developing policies to decrease mobile device distractions for doctors or blocking access to certain apps while doctors are working in hospitals.
However, Feldman states that doctors have always had to deal with distractions and at least mobile devices can be turned off unlike other distractions. I tend to agree with Feldman.
There are additional ways to deal with the distraction problem. For example, an article in the Washington Post provides a solution – education.
Medical students at Stanford and Georgetown are learning to incorporate mobile devices in their clinical care while still giving their patients appropriate personal attention. This approach seems like a more appropriate way to address this technological advance instead of blocking access to apps in hospitals which might push doctors away from certain work environments. Perhaps continuing education courses for current physicians could provide similar training as the education programs.
In support of Halamka’s view, a 2011 study from the United Kingdom explored the pitfalls of using mobile devices in the health care setting. The study reviewed existing knowledge on how mobile devices can affect patient safety and security as they are being used to improve health care quality and patient outcomes. One of the factors affecting patient safety was labeled as “distraction/noise.” The researchers reference three articles related to these categories. The articles focused on how noise from mobile devices – such as unique ringtones – can distract patients. The solution to the noise problem was to use the phones in designated areas.
Also, the researchers pointed to a study which discussed how phone calls can distract members of an operating team. The solution was to keep calls short and only respond to urgent calls. Perhaps focusing on the surgery and allowing someone else to screen calls is another solution which has been used for years.
Although these findings are useful and provide some support for the idea that distractions from mobile devices matter, there is still a need for more research on the various health care settings in which mobile devices are being used and whether they actually contribute to distractions that negatively affect care…or not. Better evidence in this area will be important moving forward as health care systems continue to grapple with the brave new world of mHealth technology.