We all have nightmares about what could go wrong in a hospital setting. Now we can add distracted doctors to the list.
In one case widely cited by experts in hospital care, a resident recently used her smartphone to begin entering an attending physician's order to cease a patient's anticoagulation therapy in the facility's tracking system. But in the middle of the task, the resident received and responded to a personal text message and never finished entering the doctor's instructions. Because of her slip, the patient eventually needed emergency open-heart surgery. In other cases, a nurse was caught checking airfares during surgery and a neurosurgeon used a wireless headset to make personal calls during a procedure in which the patient emerged partly paralyzed.
Smartphones are increasingly being used for various aspects of patient care across the country and are valuable, efficient tools for tracking medical histories. But institutions are also beginning to realize that the devices often distract health care workers, and this can have life-threatening consequences.
Caregiver distraction from mobile devices was listed No. 9 in a recent report on the "Top 10 Health Technology Hazards for 2013" by the ECRI Institute, an independent, nonprofit group that applies scientific research to the cause of improving patient care. Doctor distraction was included in the report to call attention to "a topic that really isn't being talked about as much as it should be," says Rob Schluth, ECRI senior project officer.
A Widespread and Growing Concern
Generally, the debate about smartphone use in clinical settings has focused on concerns over privacy and the potential for security breaches that could allow patient information to be accessed by unauthorized parties. Those concerns are real, ECRI says, but doctor distraction could more directly impact patient care.
In a 2012 survey of operating-room administrators cited by ECRI, more than half of all respondents said they had received reports or witnessed incidents in which OR doctors were distracted by their mobile devices during procedures — and several said that distraction could be linked to "adverse events," including at least one "wrong-site surgery."
ECRI believes incidents of distracted caregiving are even more prevalent than studies have found. "Someone may catch themselves before a problem occurs," Schluth says, and not report it. "That doesn't mean it's not something people shouldn't be paying attention to."
Even if they're using a device to record or access patient data, practitioners may miss crucial nonverbal signals. "They should be making eye contact with the patient," Schluth says. "It's a good way to pick up valuable clues and keep the patient engaged."
How You Can Keep the Focus on You
It's long been shown by studies of patient-doctor interaction that people tend to be overly deferential to their physicians and shy about questioning a provider's actions or decisions. The smartphone can add an additional layer between patient and doctor. "Caregivers should be aware that they are creating that situation," Schluth says, "and keep those walls down for more effective interaction with their patients."
Justly or not, when patients see a doctor focusing on a screen, they may question the quality of their care. If you have your doubts about how much attention your doctor is paying to you, Schluth says, speak up. If you feel a provider has missed potentially important information while using his or her smartphone, repeat your questions or concerns until you're confident the doctor has heard and addressed them.
Crucial Next Steps
Until patients understand how smartphones are being used in their care, and until hospitals put safeguards in place to avoid the risks of distracted doctors, questions — and fears — will persist. "The hospital environment is a really tricky place to try out new things," Schluth says. "You can see the consequences if things go wrong. These devices burst onto the scene in health care with functionality we wouldn't have been able to predict a handful of years ago, but without the infrastructure for dealing with them."
To minimize the risks, ECRI predicts that hospital administrators will prioritize setting policies for how providers can use smartphones in the year ahead. "Everyone has the same goal in mind: to care for patients," he says. "You don't want to overreact. The fact that someone is using a smartphone doesn't mean they're ignoring patient care. Blanket bans may not allow for circumstances in which smart phones could provide clinically useful information."
In the meantime, with different facilities employing smartphones in a variety of ways, patients may face distinct risks from site to site. "It's brand new and people are trying things out," Schluth says. "It's got the feel of the Wild West right now."
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