I’ve been thinking a lot about smart phones as distractions. It’s a combination of a few things. One is that I have a problem distancing myself from my phone. In my quest to document what’s happening around me and keep up with the never-ending deluge of news I track, my phone is often in my hand. To remedy some of the problem, I’ve taken to physical separation from my phone at certain times of day, including both work and personal time.
There have been other things that motivated me to write this post:
- A recent family trip in which family members played Words with Friends almost nonstop.
- This recent HBR blog post asking why not just experience life, not document it.
- The comment on one of my posts about pagers being less of an interruption to clinical workflow than smart phones.
- The AHRQ Web Morbidity and Mortality Rounds from December about the resident being distracted while entering a patient order and then never completing the order.
- An article from about a month ago about smart phones and iPads being potential distractions. Side note: I like how iPads now represent the category of tablets, with the inference being that iPads are the genuine article and all other tablets are just imitators trying to be the real thing, a hard and expensive mountain to climb (just ask Pepsi).
I’ve seen other stories recently about how younger people are losing social skills they once had because they choose virtual interactions over face to face ones. And then there are all the stories of the loss of interactions at work (no more water cooler talk).
Being distracted by your phone in a social setting – say, at dinner with friends — is annoying and might not bode well for your likability. But the problem becomes more significant in a healthcare setting. In healthcare, our goals should be — and are in rhetoric — to deliver better care, lower costs, and improve the experience of care for patients, family, and provider. Mobile devices have great potential in all of these areas, including the experience of receiving and giving care, but they also present a significant risk of distancing provider and patient.
The problems with distraction from mobile are similar but different from distractions from computers. Both mobile and PC can absorb clinicians and make the patient feel left out. The major difference, though, is that computers in patient rooms are not personal devices — they are professional devices. Smart phones — and I’d say iPads as well — are seen as personal devices. When people use personal mobile devices in front of me, I assume they are doing a mix of both personal and professional work, and I assume it doesn’t all pertain to the current conversation or meeting. I think patients have this same perception, and it isn’t completely inaccurate. As the AHRQ post above highlights, a resident was simultaneously putting in a patient order and responding to a personal text message. In that particular case, an adverse event occurred.
Mobile devices are powerful and have improved many aspects of patient care. Phones are often used to access UpToDate, Epocrates, and PubMed to pull evidence and treatment guidelines. This is powerful stuff. They are also used to document and capture billing info, reducing the extra time needed between patients and at the end of the day. But, people don’t turn off SMS or personal e-mail or any number of other personal apps so the professional power of mobile is muddled by distraction. To quote John Halamka from the article above, "I think all of us who use mobile devices have what I will call continuous partial attention."
I think back to an article in the New England Journal from several years ago titled “Culture Shock – Patient as Icon, Icon as Patients.” It’s in regards to computers, not mobile devices. The author presents the problem of treating the patient’s chart and not the patient. It speaks to the erosion of the bedside interaction and its replacement with test results. "For the clinician, the bedside is hallowed ground, the place where fellow human beings allow us the privilege of looking at, touching, and listening to their bodies. Our skills and discernment must be worthy of such trust."
Proper mobile etiquette needs to be learned and enforced. One of the challenges I see is that medical students and residents are often leaned on to enter orders, look for articles, or pull other information the medical team wants. This increasingly means residents and students check out of the bedside interaction to look something up on their phones, creating what likely will become a bad habit down the road. Before phones, the expectation was for residents and students to either step out of the room or wait until after the encounter to find a computer.
I’m not even addressing the issue of mobile distractions leading to adverse events, like the AHRQ article above talks about. I’m only talking about provider-patient interactions. What do you think? Does the value of mobile in documenting, looking up, and capturing at the point of care, in a very time-restricted encounter, become eroded by making the interaction less personal and connected?