Computers, smartphones, Ipads and other
electronic devices can aid doctors and other health care providers with
immediate access to patient records and medical data. They can also
cause serious distraction when personal text messages, email, shopping
and games interrupt care.
A New York Times story by Matt Richtel
describes the unintended side effects of electronic gadgets. "Doctors
and nurses can be focused on the screen and not the patient, even during
moments of critical care," he writes. "And they re not always doing
work; examples include a neurosurgeon making personal calls during an
operation, a nurse checking airfares during surgery, and a poll showing
that half of technicians running bypass machines had admitting texting
during a procedure."
The Times story reports a
malpractice practice case filed by a patient who was partially paralyzed
after surgery. Records showed the neurosurgeon, who was wearing a
wireless headset to talk on the phone, made at least 10 calls to family
and business associates while operating on the patient.
A peer-reviewed survey of 439 medical technicians reported in Perfusion, a journal about cardio pulmonary bypass surgery, found 55 percent of
technicians admitted having cell phone conversation while monitoring the
machines, and half said they had texted during surgery. More than 78
percent said they thought cell phones introduce a risk to patient
Dr. Stephen Luczycki, anesthesiologist at Yale-New Haven Hospital, is enthusiastic about how technology can improve medical care, according to the Times story, but
he has also seen colleagues checking email and shopping on Amazon, eBay
and other commercial sites during patient procedures.
Dr. Peter J. Papadakos, anesthesiologist and critical care director at the University of Rochester Medical Center, writing in the journal Anesthesiology News, describes a "digital nightmare" in which a supervising attending enters
a ward where the unit secretary is texting on her smartphone, a nurse
is surfing the web and a resident is gaming on his electronic tablet.
He writes that direct communication with
patients and colleagues is no longer the norm. "The new health care
model is one of electronic records and patient care data downloaded from
a distant server," he writes. "Generational changes mandate that we
educate 20 and 30 year-olds how to speak to patients-but these
individuals have grown up communicating through secondhand electronic
media without direct contact." From the patient's viewpoint, he writes,
they are no longer the center of care-their data are.
Papadakos adds that considerable evidence
shows social media has an addictive element, and that the psychology of
the constant need to get information and be entertained has not been
fully studied. His article is followed by interesting commentary, in
which colleagues agree and dissent.
Dr. John Halamka wrote a thoughtful piece on electronic multitasking
at the request of the AHRQ. He describes a case in which a resident, on
orders of an attending physician, was starting to enter an order to
stop an anticoagulant medication for a post-surgical patient when she
was interrupted by a text message from a friend about an upcoming party.
She confirmed her party attendance, but never finished the order to
stop the medication. As a result, the patient later needed emergency
open heart surgery and a three week hospital stay. Halamka discusses the
ways mobile devices aid clinical care, some of the problems they cause,
and some steps that can be taken to limit distracting personal usage.
Physician blogger Dr. Kevin Cho suggests
courses in online professionalism need to be part of medical school
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," he writes.