Is that a smartphone in your pocket?

Smartphones are almost ubiquitous on the wards nowadays.  In a departmental meeting the other day a question popped up about the commonest reason for admission to hospital acute medical services.

Out came my smartphone, and after a search, and a tweet – almost instantly (and quickly enough to furnish an answer by the end of the session) answers came flying at me through the ether. (It depends on how you cut the numbers, but chest pain is the winner.)

Indeed, twitter is not the only useful educational tool I keep on my smartphone.  I have a number of apps (26 in fact) which can only be used for work purposes.

This paper ( epub ahead of print) looks at the proportion of Interns using smartphones in the Republic of Ireland.  Unsuprisingly the vast majority of interns use smartphones on a daily basis, and the most popular app was the BNF (which is free to NHS employees)

The questionnaire formalises what is common sense in terms of the utility of smartphones for communication within teams – with 87.3% reporting receipt or broadcast of a work related SMS message and 83.3% having made or received a call about work.

More important issues raised in the paper include the use of other smartphone functions – for example cameras, with 52% of those surveyed having taken a picture at work, and 22.% reporting taking a picture for work related reasons once a week.  This use and storage of sensitive information on a personal device is of concern, and that such proportion of doctors use these functions shows just how useful they can be.

What is not examined in this paper is the impact of increasing use of technology – and smartphones in particular on the clinical relationship between doctor and patient.

Many medical students now take notes on their mobile device – often sitting in a clinic room tap tapping away at a screen.  I am sure that most are being diligent and using technology to enhance their learning, but I have no guarantee.  I wonder how I would feel as a patient if a student in my consultation seemed to be organising a night out, or looking up the latest football results?

Indeed – I use a smartphone in consultations with my patients on a regular basis – I have predicted spirometry calculators, risk scores, and the very useful BNF app to turn to when required.  I always tell the patient what I am doing, but I am concerned that this intrusion of technology might put some patients off, or somehow leave them with questions about my bedside manner.

There has been some research into the use of electronic health records in primary care consultations – here looking at the new triumvirate in consultations, and here  how software design can influence how the computer develops a ‘face’ in the consultation.

Some advice on the use of computers in consultations – and how to use them to enhance rather than detract from a consultation has been offered here.

So – I think we have to accept that smartphones are here to stay – and that their utility in clinical practice means that they are going to be more and more prominent on our wards and in our consulting rooms as time goes on.  The rules of engagement when introducing smartphones into routine clinical practice are yet to be defined, but you can be certain that basic manners will be a good place to start.

However, two key points for clinicians will remain:

Listen to your patient – he is telling you the diagnosis.

and

The art of medicine consists in amusing the patient while nature cures the disease.

 

  • Umang Patel

    I agree, smartphones/tablets are here to stay. As more tech becomes available, we will need to adapt to use it in the best ways.

    I’m going to start asking the students that come to my clinics with ipads – how they might use them to enhance my patients experience.

    Good reminder to:
    1. Be polite
    2. Listen
    3. Amuse!

    • tobyhillman

      Thanks Umang – I think that quite a lot about this is to do with perception. When I explain that I am using my phone for an up to date guideline on management, or the latest version of the drugs reference, I think that patients feel somewhat reassured that they are getting a ‘cutting edge’ opinion. However, if I or my students just whip out a phone and start tapping away without explanation, or involvement of the patient – this can only result in a negative perception, and I am sure a less beneficial relationship next time we meet.

      As you say – newer tech will be available soon, and adaptation of a centuries old model of medical care is inevitable. What is great is that we can apply some of the lessons of engagement with technology over an even wider plane – http://pmj.bmj.com/content/early/2013/07/09/postgradmedj-2012-131519.full this paper explores a slightly less hi-tech solution – the use of SMS to assist in sexual health campaigns in adolescents.