Curbside Consult with Dr. Jayne 6/3/13

A recently posted Commentary in the Journal of Graduate Medical Education reflects on a study looking at resident physician use of iPads. The study itself only looked at 12 young physicians and their self-reported behavior. The commentary, however, provides food for thought about the risk of “distracted doctoring.”

There have been plenty of stories about badly-behaved physicians: surgeons making personal phone calls via Bluetooth in the operating room, physicians posting patient-specific comments on Facebook, and others ranting on Twitter. More insidious and possibly more dangerous is the negative impact that being constantly connected can have on concentration and attention. The commentary mentions residents responding immediately to requests from remote nursing staff while potentially ignoring the patient physically present.

We’ve all experienced this in customer service situations when we’re standing at a checkout line or customer service counter and are functionally “put on hold” while staff answers the phone rather than attending to the customer in front of him or her. I see this in physician offices all the time, especially as incentives are put in place to reduce hold times or voice mail queues. While increasing satisfaction for remote patients, it does little to contribute to the satisfaction of the patient standing at the desk or sitting in the exam room.

The commentary mentions a medical student using Facebook while rounding on patients, particularly when an attending physician was discussing a cancer diagnosis with a patient. There is no excuse for this kind of behavior, but unfortunately I don’t think everyone agrees with me. Social media can be incredibly enticing and it takes a lot of self-control to be able to put down the phone and be present.

We’ve all seen media articles wondering if smart phones are making all of us dumber. One could argue this is just an extension of the anti-technology rants of the 1960s and 1970s (remember when television was referred to as the “boob tube?”) but I think we could all use a little reflection about the amount of time we spend interacting with technology instead of people, especially when it’s not required.

I can’t count the number of times I’ve watched physicians who complain about having to use computers for patient care sit in the work area surfing the Internet. I once shadowed a physician who said she had to spend hours after work documenting, and during the course of the shift, she bought multiple pairs of shoes from three Internet sites. Although I have to admire her sense of style, it completely undermined any points she was trying to make about the computer slowing her down.

Although it’s frustrating, I guess I should be grateful that there’s virtually no cell signal in my ER. We’re located in the bowels of the hospital between radiology and the morgue. I usually end up turning my phone off to avoid battery drain. I guess I should also be thankful that we don’t have computers in the exam rooms because it really does force you to pay attention to the patient in front of you (although I think there’s a patient safety problem with not having the chart, but my Department Chair doesn’t agree).

I had the privilege of doing a rotation in the UK while I was a resident. I quickly learned that the easy availability of echocardiograms in the US made my ability to diagnose heart murmurs pale in comparison to my British colleagues. I’m sure there are other ways that technology is eroding our skills. What do you think? E-mail me.

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