As a practicing otolaryngologist and the chief medical information officer for University of Iowa Health Care in Iowa City, Douglas Van Daele, MD, sees how mobile devices and their associated technology can help transform patient care. But his dual perch means he can see the downsides as well, particularly with smartphones, whose prevalence in the health care setting has skyrocketed in recent years.
“They are great inventions, and they have enormous potential for information, but they do clearly have some risk,” he said. “In a similar way to when you’re being distracted while driving, if you’re actively caring for a patient and you’re getting many different messages about other patients, it can be a tremendous source of risk.”
Therein lies the dilemma for otolaryngologists: Physicians are increasingly incorporating lightweight computers, mobile phones and tablets into the delivery of health care. But that melding of humans and technology comes with the potential for distraction.
Unintended Consequences
A raft of ENT-specific research on the dangers of interruptions due to mobile devices has yet to emerge. But anecdotal evidence and initial studies from other specialties show the potential for distraction—and for medical errors (BMJ Open. 2012;2:e001099).
“I don’t think we fully understand how best to use [mobile devices] in practice,” said Robert Wu, MD, MSc, FRCPC, research director at the Centre for Innovation in Complex Care at Toronto General Hospital. “Just like any technology, we’re learning there are unintended consequences.”
Dr. Van Daele believes there are multiple pitfalls to using mobile technology in a medical setting. While an obvious one is the momentary distraction that comes with the buzz or beep of an incoming phone call, text message or e-mail, a less apparent consequence may be the risk of confusing medical records. Many devices allow you to toggle easily between applications or programs. The risk of distraction can become more dangerous, he said, when an otolaryngologist is reviewing or updating records for a critically ill patient or an airway patient. “Let’s say you’re getting information from the electronic record in one way, and now you get a text about a patient and/or a page about a different patient,” Dr. Van Daele said. “There’s a risk there of pulling together disparate information about different patients into one patient.”
—Ronald Kuppersmith, MD
Prioritize the Situation
Ronald Kuppersmith, MD, of Texas ENT and Allergy in College Station, Texas, said that while mobile devices may have the potential for distraction, they are no more distracting than pagers or other devices that have been standard issue for ENTs for many years. “The issue isn’t necessarily the technology,” added Dr. Kuppersmith. “People using the technology have to use it appropriately. You can use it to your distraction, or you can use it to your advantage. It’s your choice. It’s your choice and your responsibility.”
Dr. Kuppersmith likens the distractions of mobile technology to the earliest training college graduates receive in medical school: Prioritize the situation. “Most of us are trained to triage what the most important thing is,” he said. “The nature of what we do, there are interruptions. What channels they come through, I don’t think it really matters.”
Gregory McNeer, Jr., a principal of Stratford Consulting in Winston-Salem, N.C., who recently helped organize a webcast for physicians on the dangers of technology and privacy laws, agrees that judicious use of available technology can counteract the pitfalls. “I’ve seen some doctors who really seem to be surgically attached to what I call their ‘electronic leash,’” he said. “They respond to every buzz and beep and burp they get. They like that; they like the connectedness of it. But I’ve also seen, from my perspective, [that] it degrades the nature of the doctor-patient relationship if they are not able to limit their jumping back and forth between their electronic device and the issue at hand—the patient in front of them.”
The same can even hold true for otolaryngologists who might check a mobile device during surgery, depending on the circumstances. A study in Perfusion, a journal focused on perfusion, oxygenation and biocompatibility and their uses in modern cardiac surgery, found that 55 percent of technicians who monitor bypass machines had talked on cell phones during heart surgery (Perfusion. 2011;26;375-380). Half of the study participants said they had texted while in surgery. Yet, roughly 40 percent described talking on the phone during surgery as “always an unsafe practice,” while roughly half expressed the same sentiment about texting while in surgery.
While the study results—and the national attention they garnered in an article in The New York Times—paint a picture of a troubled technological tableau, McNeer said nuance makes all the difference. “It’s just a question of, like so many things, degrees,” he said. “Do you have a man or woman in the middle of a sensitive operation who is constantly looking down at his or her iPhone because it keeps buzzing all the time, or do you have someone who is focused on the task at hand and then, at an appropriate time, steps back, takes a breath, checks her phone and goes back to the patient?”
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