More than a decade into America’s love affair with ubiquitous smartphones and tablets, the evidence is mounting that these addictive distractions can lead to deaths, depression in teens, and mistakes by doctors and other healthcare professionals.
“Many times, that distraction takes away from the task at hand, especially in the operating room,” says Peter Papadakos, MD, FCCP, FCCM, FAARC, director of critical care medicine and professor of anesthesiology, surgery, neurosurgery, and neurology at the University of Rochester Medical Center in Rochester, NY.
In 2017, Papadakos published a book titled, Distracted Doctoring: Returning to Patient-Centered Care in the Digital Age, with co-author Stephen Bertman, PhD. Papadakos also is scheduled to speak on this topic at the OR Excellence Conference, which is set to take place Oct. 3-5, 2018, in Ft. Lauderdale, FL.
An example of an extreme case of distracted doctoring involves a 2011 case in which a Dallas anesthesiologist was looking at his iPad and failed to notice his patient’s low blood oxygen levels. The patient died, and a subsequent malpractice lawsuit alleged the anesthesiologist’s electronic distractions led to the patient’s death. ()
“There have been a number of distracted incidences occurring, and my main point is we need to educate people on distracted doctoring and electronic etiquette,” Papadakos says.
Healthcare providers also must learn appropriate ways to interact with patients when electronic charts are present. “You go into the doctor’s office, and he’s crazily typing on the computer console with his back to you because he needs to fill out federally required nonsense,” Papadakos says.
Healthcare professionals can be more fixated on the electronic chart than on the patient, he adds. “Unfortunately, with the electronic medical record, medical errors have increased, physician burnout has increased, and costs have gone up,” Papadakos laments.
Four problems caused by electronic distractions in healthcare include worsening patient care and vigilance, a breakdown in the bonds between providers and patients, creation of medical legal liability, and higher healthcare costs. Medical liability results from the recent discovery that plaintiff lawyers can investigate a provider’s electronic footprint and use whatever the provider did online during that day as evidence for a malpractice suit, Papadakos explains.
“To be exact, they look into your pattern of use: how many hours you are online during the day and even at night because they can add that you were fatigued and addicted,” he says. “Your posts and emails are not private.”
If healthcare professionals exhibit a strange electronic presence that includes racist, hateful, or other negative comments about patients or families, that will come back to haunt them, Papadakos adds.
For instance, in the case of the Dallas anesthesiologist whose patient died, a deposition showed that a lawyer asked him about two Facebook posts from previous cases. In one post, the physician mentioned a patient’s lice. In the second post, the doctor had photographed the patient’s monitor.
Electronic distractions can increase healthcare costs when employees are slower in OR turnovers because those employees constantly check their phones. Or, these distractions might affect housekeeping and the flow of patients in a facility, Papadakos offers.
“In a hospital, you walk around and see staff buried in their gizmos,” he observes. “We’ve become addicted to these devices through dopamine from the bings, pop-up stimulation, and alerts.”
Smartphone and social media addictions are nationwide issues that affect all areas of life. But the problem in healthcare is that distracted doctoring affects and includes everyone in the organization — not just doctors, Papadakos says.
Additionally, there’s the overwhelming, lingering threat that lawyers will gain access to cellphone records. For example, a lawyer in a malpractice case could easily discover what a physician was doing on the morning of a surgery and use this in court: “Dr. Smith, according to your phone records, you sent 5,000 texts while in the OR, and you weren’t paying attention to the patient,” or “Dr. Smith, you were watching Netflix on your phone,” or “You texted that the patient who had a massive heart attack under your care was a jerk.”
If ASC leaders educate physicians and staff about this risk, it might result in better outcomes. “This is much more threatening than having a supervisor take your phone away, and that’s how we educate people,” Papadakos explains. The solution from an ASC perspective is to restrict Wi-Fi, perhaps allowing connections in certain areas. Or, ASCs could prohibit staff from using their phones or tablets. Administrators could mandate that family members who need to contact a staffer regarding an emergency could call the operating room or main phone. Most of the time, staff will miss trivial things.
“I work with younger staff, and they have day care and nannies, and the texts they receive continuously are: ‘Baby had a bottle,’ ‘just changed the diaper,’” Papadakos reports.
The chief obstacle to prohibiting cellphones is staff backlash. “People have a fear of not being connected,” Papadakos notes. Another solution is to educate employees about the legal and medical risks they incur when they’re addicted to electronic devices and cannot put those away while at work.
Organizations can mandate classes in electronic etiquette, which might include teaching staff how to approach a physician or colleague to say, “I’m supposed to warn you that you’re on your phone, and it will disrupt patient care. Please put your phone away,” Papadakos offers.
ASCs can develop their own multidisciplinary guidelines on how to curb electronic distractions. For example, Beth Israel Deaconess Medical Center’s department of anesthesia, critical care, and pain medicine created guidelines for electronic device use, which include: placing electronic devices (other than hospital pagers) on silent or vibrate to minimize interruptions of patient care; limiting electronic device use to when patients are stable; prohibiting participation in electronic games, social media, videos, online shopping, magazines, and non-medical books during OR time; postponing private phone conversations; and minimizing hospital-related internet usage.
However an ASC handles electronic distractions, Papadakos stresses that the important thing is to begin this conversation.