[Air-L] Fwd: [ciresearchers] Doctors, [ICTs] and potential distractions / today's NYT

gene loeb geneloeb at gmail.com
Thu Dec 15 15:39:33 PST 2011

This is very interesting and useful to my colleagues here.

---------- Forwarded message ----------
From: David Sadoway <bigbluearth at gmail.com>
Date: Thu, Dec 15, 2011 at 6:38 AM
Subject: [ciresearchers] Doctors, [ICTs] and potential distractions /
today's NYT
To: ciresearchers at vancouvercommunity.net
Cc: michael gurstein <gurstein at gmail.com>

An article which may be of interest from today's NYTimes.

December 14, 2011


As Doctors Use More Devices, Potential for Distraction Grows


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

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

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

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

“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

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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