Medical knowledge is continually expanding and changing. So it is impossible for individual doctors to remember all that they need to practise safe care. As a result, doctors need access to evidence-based and continually updated resources that will help them make decisions at the point of care. Many such clinical decision support resources are now available on smartphones and some have an app—enabling offline access. Having reliable knowledge continually available on smartphones seems like a great idea. It can’t have any downsides—can it?
Pinar et al have conducted an interesting study to explore one potential downside. They looked at smartphone use of anaesthesia providers during anesthetised patient care. They found that many anaesthetists used their smartphone during anesthetized patient care. They used their phones to call or text message or surf the net. The vast majority said they never used their phone during critical stages of anaesthesia. Most said that they were never distracted by their smartphone, but many had witnessed their colleagues being distracted.
When I read the study, the first question that I asked myself was whether or not I believed the respondents about being distracted. It is interesting that they thought that they were never distracted even though they thought that their colleagues were. There are a number of potential reasons for this. It may be that the respondents lacked insight into the fact that they were distracted. It may be that they didn’t answer the question about being distracted honestly. It may be that they misjudged the distraction of their colleagues. Perhaps least likely, it may be that they had fantastic ability to multitask that their colleagues did not. On balance, I would go for the first option—that they lacked insight into the fact that they were distracted.
Today we live in an age of distraction. Even as you are reading this personal view, you may be tempted to look at a cute panda bear meme or a video of Ed Sheeran and Saoirse Ronan waving from the top of a house on Long Walk in Galway. My advice is to stick with the article—the really insightful bits are still to come. In giving this advice, I am contributing to the phenomenon the attention economy—where all the emphasis is placed on getting people’s attention for your website and keeping them on it.
But what if you are grabbing the attention of a doctor who should be looking after their patient? What can we do to prevent that? It is difficult to think of solutions. Should we block doctors’ phones from looking at non-clinical sites? That probably wouldn’t work—people are far too good at finding ways around blocks. Should we ban mobile phones? That definitely wouldn’t work. Should we try to automate certain repetitive tasks that render healthcare professionals prone to distraction? That may be the most realistic option. Clinical decision support resources could be developed so that they could make certain clinical decisions autonomously—according to set algorithms. The healthcare professional would not then be involved in repetitive and predictable tasks.
What would patients think of their doctor being distracted when they are supposed to be looking after them? I think that they would take a dim view. Most would probably agree with George Kaufman when he said: “The kind of doctor that I want is one who, when he’s not examining me, is at home studying medicine.”
Kieran Walsh is clinical director of BMJ Learning and BMJ Best Practice. He is responsible for the editorial quality of both products. He has worked in the past as a hospital doctor—specialising in care of the elderly medicine and neurology.
Kieran Walsh works for The BMJ—which provides the clinical decision support tool BMJ Best Practice.