New York
Times | Matt Richtel
Hospitals and doctors’
offices, hoping to curb medical error, have invested heavily to put computers,
smartphones and other devices into the hands of medical staff for instant
access to patient data, drug information and case studies.
But like many cures, this
solution has come with an unintended side effect: doctors and nurses can be
focused on the screen and not the patient, even during moments of critical
care. And they are 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
admitted texting during a procedure.
This phenomenon has set off an
intensifying discussion at hospitals and medical schools about a problem perhaps best described as “distracted doctoring.” In
response, some hospitals have begun limiting the use of devices in critical
settings, while schools have started reminding medical students to focus on
patients instead of gadgets, even as the students are being given more devices.
“You walk around the hospital,
and what you see is not funny,” said Dr. Peter J. Papadakos, an
anesthesiologist and director of critical care at the University of Rochester
Medical Center in upstate New York, who added that he had seen nurses, doctors
and other staff members glued to their phones, computers and iPads.
“You justify carrying devices
around the hospital to do medical records,” he said. “But you can surf the
Internet or do Facebook, and sometimes, for whatever reason, Facebook is more
tempting.”
“My gut feeling is lives are
in danger,” said Dr. Papadakos, who recently published an article on
“electronic distraction” in Anesthesiology News, a journal. “We’re not
educating people about the problem, and it’s getting worse.”
Research on the subject is
beginning to emerge. A peer-reviewed survey of 439 medical technicians
published this year in Perfusion, a journal
about cardio-pulmonary bypass surgery, found that 55 percent of technicians who
monitor bypass machines acknowledged to researchers that they had talked on
cellphones during heart surgery. Half said they had texted while in surgery. About 40 percent said they
believed talking on the phone during surgery to be “always an unsafe practice.”
About half said the same about texting. The study’s authors concluded, “Such
distractions have the potential to be disastrous.”
Doctors and medical
professionals have always faced interruptions from beepers and phones, and
multitasking is simply a fact of life for many medical jobs. What has changed,
doctors say, especially younger ones, is that they face increasing pressure to
interact with their devices.
The pressure stems from a
mantra of modern medicine that patient care must be “data driven,” and informed
by the latest, instantly accessible information. Annual investment in gadgets
and other technology by hospitals and doctors has soared into the billions of
dollars. By many accounts, the
technology has helped reduce medical error by, for example, providing instant
access to patient data or prescription details.
Dr. Peter W. Carmel, president
of the American Medical Association, a physicians group, said technology
“offers great potential in health care,” but he added that doctors’ first
priority should be with the patient. Indeed, doctors and nurses
face growing pressures to listen carefully to patients, provide customer
service and show empathy as they look for subtle cues that might explain an
illness.
“The computer has become a
good place to get a result, communicate with other people,” said Abraham Verghese,
a doctor and professor at the Stanford University Medical Center and a
best-selling medical writer. “In the interest of preventing medical error, it’s
a good friend.”
At the same time, he said, the
wealth of data on the screen — what he frequently refers to as the “iPatient” —
gets all the attention.
“The iPatient is getting
wonderful care across America,” Dr. Verghese said. “The real patient wonders,
‘Where is everybody?’ ”
It is hard to know the precise
impact that distracted doctoring has on patient care, because it is hard to
measure. But at least one example puts the risks in sharp relief.
Scott J. Eldredge, a medical malpractice lawyer in Denver, recently represented a patient who was left partly
paralyzed after surgery. The neurosurgeon was distracted during the operation,
using a wireless headset to talk on his cellphone, Mr. Eldredge said. “He was making personal calls,” Mr. Eldredge
said, at least 10 of them to family and business associates, according to phone
records. His client’s case was settled before a lawsuit was filed so there are
no court records, like the name of the patient, doctor or hospital involved.
Mr. Eldredge, citing the agreement, declined to provide further details.
Others describe multitasking
as relatively commonplace. “I’ve seen texting among
people I’m supervising in the O.R.,” said Dr. Stephen Luczycki, an
anesthesiologist and medical director in one of the surgical intensive care
units at Yale-New Haven Hospital. He said he had also seen young
anesthesiologists using the operating room computer during surgery.
“It is not, unfortunately,
uncommon to see them doing any number of things with that computer beyond
patient care,” Dr. Luczycki said, including checking e-mail and studying or
entering logs on a separate case. He said that when he was in training, he was
admonished to not even study a textbook in surgery, so he could focus on the
rhythm and subtleties of the procedures.
When he uses computers in the
intensive care unit, he regularly sees what his colleagues were doing before
him.
“Amazon, Gmail, I’ve seen all
sorts of shopping, I’ve seen eBay,” he said. “You name it, I’ve seen it.”
Dr. Luczycki is also a huge
fan of technology’s positive impact on medicine. So, too, is Dio Sumagaysay,
administrative director of 24 operating rooms at Oregon Health and Science
University hospitals, even though he has heard about or witnessed instances of
people using devices during critical moments. In early 2010, he heard
several complaints that doctors or nurses were using their phones to check or
send e-mails even though they were part of a team intubating a patient before
surgery.
Mr. Sumagaysay established a
policy to make operating rooms “quiet zones,” banning any activity that was not
focused on patient care. He later had to reprimand a nurse he saw checking
airline prices using an operating room computer during a spinal operation.
Medical professionals say
young doctors can be particularly susceptible to distraction because they have
grown up being constantly connected.
At Stanford Medical School,
for example, all students now get iPads, which they use to read medical texts
and carry with them in hospitals but are also admonished not let get in the way
of their work.
“Devices have a great capacity
to reduce risk,” Dr. Charles G. Prober, senior associate dean for medical
education at the school, said. “But the last thing we want to see, and what is
happening in some cases now, is the computer coming between the patient and his
doctor.”
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