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Distracted Doctoring?

Posted by Dr. Suzanne Koven  December 20, 2011 08:26 PM

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9542402-mature-male-doctor-busy-working-at-his-desk-speaking-on-mobile-phone.jpgSometimes, as I walk around the hospital, I find myself wondering what a time traveler, one of those 18th and 19th century physicians whose names grace the plaques along the corridor walls, would think about the electronic gadgets attached to all the humans. Would we look like pod (?ipod) people? A futuristic nightmare? I notice that the medical staff, particularly, are rarely unplugged. It's not unusual for me to be standing in an elevator with 5 or 6 doctors and nurses, eyes all glued to our smart phones. Now, some worry that our addiction may affect patient care.

A recent article in the New York Times highlights the growing problem of what's been called "distracted doctoring." The problem is that while computers, smart phones, and other devices can enhance communication among medical professionals, improve accuracy of medical records, and help avoid errors, they divert clinicians' eyes and minds from the patient.

Such devices also have high potential for abuse, as this article emphasizes. It cites scary incidents such as a surgeon using a headset to make personal calls during an operation (that left the patient partially paralyzed), a nurse checking airline fares during surgery, and a study that revealed that a majority of technicians running cardiac bypass machines during heart surgery are texting on the job.

While I am horrified by these examples, I am actually much more concerned about the growing tendency of even the most conscientious doctors (in fact, often the most conscientious ones) to type while talking with a patient.

When I've mentioned this concern to my colleagues they nod sympathetically but counter that, with pressure to see so many patients per day and to keep medical records up to date, it's nearly impossible not to type (or dictate into a recorder) as a patient is speaking. Plus, they say, there are ways to type that make it more collaborative and inclusive; turning the screen so that the patient can see his or her record, for example.

I don't buy it.

Eye contact is one of the most basic ways in which human beings communicate, pick up on social cues, feel and express empathy. Many studies have shown that infants learn social skills as their ability to maintain eye contact develops and one study showed that when adults decrease eye contact with babies, the babies smile less often. Lack of or decreased eye contact is one of the cardinal signs of autism and Asperger's syndrome, conditions in which ability to read and react to social cues is impaired.

Not long ago, I went to a physician for a relatively minor, not anxiety-inducing problem. The doctor had just started using a voice recognition system, and wore a headset as we spoke, repeating each sentence after I'd uttered it, and then typing in corrections to the automatically-generated text. "I gotta tell you," I said, "This is making me kind of anxious." He seemed surprised. "Between the headset and the screen," I said, "I feel like you're not really listening to what I'm saying." He said that once he'd taken care of the medical record, then the real doctoring would begin. But, I thought to myself, by then the "real doctoring" will have been compromised by my impression that he cares more about the medical record than about me.

Does your doctor type while you talk? How do you feel about that?

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

Suzanne Koven, M.D. practices internal medicine at Massachusetts General Hospital in Boston. She writes a monthly column for the Globe's G Health section and her essays have appeared in the More »


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