Ring-xiety and how to unplug

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Ever felt your phone buzz in your pocket, only to find it hadn’t? Do you have #FOMO when it comes to the latest @ketaminh tweet, an @EMTogether podcast, or even the latest DFTB post in your inbox (yep, you can subscribe)?

I bought my first smart-phone two days before I graduated Med School (and certainly my patients are almost exclusively younger than the iPod (15 years!)), and the device has been omniscient throughout my clinical practice. Unsurprisingly, I have at times become overly attached to my ‘screens’, be they phone, tablet, laptop or desktop. (I ditched my pager long ago.)

This post confronts some of the challenges of how to ameliorate or obliterate your technophilia and how to combat the distraction of hyper-connectivity. It offers some pragmatic ways to reduce the influence of the devices, social media and the internet intruding into your thought space.

Firstly, I challenge you to think about the relationship you have with your device. Where is it now? Are you using it to read this?  Perhaps as you stroll down one of Antwerp’s mobile phone lanes ? (Perhaps you’re doing an ‘internet poo’!)  Is it your pocket? Out in your eyeline? Chances are if you’re not using it, it’s within reach.

I would speculate that in the medical profession, we succumb to the idea of keeping our phones close as part of the ‘emergency delusion’. In truth, MET buzzers, Cat 1 Caesarian pages, Bat-phone calls and their ilk are NOT coming through on our mobile. And, unless you are on call for a resus area, or retrieval service, it is entirely possible to discount the notion that the buzz in your pocket is a life-threatening medical emergency.

Other reasons we are so attached to our phones might include ringxiety, FOMO or as a nervous habit, perhaps it’s just something to do with your hands. We might even postulate that many people use their phones as what our psychiatric colleagues call a “transitional object”; much like a toddler’s thumb, teddy or blanket. Consider Winnicott’s seminal 1953 summary of the special relationship of the “transitional object” 

Summary of Special Qualities in the Relationship

  • The infant assumes rights over the object, and we agree to this assumption. Nevertheless some abrogation of omnipotence is a feature from the start.
  • The object is affectionately cuddled as well as excitedly loved and mutilated.
  • It must never change, unless changed by the infant.
  • It must survive instinctual loving, and also hating, and, if it be a feature, pure aggression.
  • Yet it must seem to the infant to give warmth, or to move, or to have texture, or to do something that seems to show it has vitality or reality of its own.
  • Its fate is to be gradually allowed to be decathected, so that in the course of years it becomes not so much forgotten as relegated to limbo. By this I mean that in health the transitional object does not ‘go inside’ nor does the feeling about it necessarily undergo repression. It is not forgotten and it is not mourned. It loses meaning, and this is because the transitional phenomena have become diffused, have become spread out over the whole intermediate territory between ‘inner psychic reality’ and ‘the external world as perceived by two persons in common’, that is to say, over the whole cultural field.

If you’ve made it this far, I suspect you’re somewhere at or beyond the contemplation phase of behaviour change (turns out it’s not just for quitting cigarettes!)

stages-of-change

At work,

Mobiles can really muck with our work; they divert our attention from the patient in front of us with a mere (and often phantom) vibration, they cause awkward pauses as we “just finish the text” before talking to a colleague and occupy our wandering minds in a packed clinical handover room. Not to mention distracting us on the drive home or during another death by powerpoint teaching session.

A common rebuttal to the use of smartphones in the medical setting is that they have a wealth of information at your fingertips. I have no dispute with this fact; but other than a calculator, a stopwatch and Shann’s Drug dosing, I’m yet to come across an app that has genuinely, in the moment, augmented my clinical practice.

If you do the kind of work which involves serious conversations or giving bad news to people on what could be the worst day of their life, practice turning your phone off or giving it to a colleague.

Mobile phones are sometimes prohibited in the NICU environment for their hypothesised risk as a bacterial vector, however, a 2014 study by Mark et al identified no pathogenic bacteria in swabs from 50 phones from the members of a surgical unit in Belfast. 

What about away from work? It’s important to consider the influence of shift work and the sleep-wake cycle; we live on a 25-hour planet when you consider New Zealand (GMT -11) vs American Samoa (GMT+13)!

As the sun rises and sets in different parts of the world, different sectors of the social media landscape ebb and hum. When it comes to devices, and mobiles phones in particular, consider the negative aspects of device usage at particular times of the day.

During the daytime, our phones can distract us from the task at hand, including real-time person to person communication and being present in the world around us. At night, devices can stop us from sleeping.

On the run,

Exercising without your device can sometimes be a challenge, particularly if you like music or run/ride/?ski more than five minutes from home. The tradeoff can be listening to birdsong, traffic noises or the gym’s choice of playlist. Besides, would you answer your mobile phone on a bicycle? Listening to a plain-old music player allows space from the threatened buzz of the cell phone whilst working out.

At night,

Sleep hygiene is essential in the medical profession. There are many components of this including having a dark room, minimal caffeine in the six hours before bedtime, a sleep routine et cetera. Some of the device related parts of this are to keep (charge) your phone away from the bedside, preferably out of the bedroom. This distance also slows the instinctive email-check as a soon as your eyes open. Remember, you can always buy an alarm clock!

Many of the tips offered to teenagers can help too, such as no phones at the dinner table. Some households have a Wifi bed time and a mobile phone bowl. That means there’s no chance of pottering around on Reddit after the appointed “electronic lights out”.

Productivity,

Use the right screen for the right task, and get rid of the others; if you’re trying to dictate a letter, write a paper or plan a talk, your mobile phone probably isn’t the ideal instrument for this. Make the most of ‘clean screen’ apps, such as good-old word processors, Grammarly, or Drafts, and if you’re really trying to unplug, you can always use pen and paper!

 

The overall message for this part is to eliminate the unnecessary & non-beneficial intrusions of your mobile into your life. In particular, I’d say this applies to holidays and night time. In his book “The 4-hour Work Week”, Tim Ferris dedicates a large component to the ‘elimination phase’ of information overload. Sometimes, one of the best things we can do is take an actual, wifi-less, internet-free holiday without any phone service.

Device tips

 If you must have your device in your pocket or nearby, try some of the following;

Do Not Disturb – most smartphones can be set to “Do not disturb” mode, which automatically silences all calls, messages & notifications between the prescribed hours. If you’re worried about emergencies, two calls from the same number within a few minutes will override the silence function. I only turn this off when I’m on call.

Night Mode – is another form of blue-blocker, which reportedly helps you regulate your circadian rhythms; this can be set as automatic on the iPhone. Kristin Boyle via Life in the Fast Lane reviews some other methods for this in the shift work environment here.

Notifications can be turned off on an individual app basis. From a stimulus – response point of view, less is likely more. That is, only calls and messages elicit any sounds. You can also reduce banner-style interruptions to zero both locked and unlocked, as well as stopping individual apps from showing the number of badges/notifications awaiting your limited attention.

The challenge here is to make the phone a thoroughly uninteresting proposition for procrastination / distraction. Consequently, if one gets to the stage of dragging the phone out of the pocket, it’s on your chosen schedule, not exclusively as a reaction to ongoing noises or buzzing.

Next, aim for no banners/notifications on your lock screen (these can be turned off, as above), so once you look, you know the time, date and perhaps glance at that photo of your loved ones or favourite motivational quote, before returning the phone to pocket, bag or table.

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After an accidental but compulsive unlocking of the phone in a weaker moment, aim to see no badges ( “Ooh, shiny!”) or things to attend to. Continue to open your particular app of choice, until…

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Freedom is an app that blocks part or all of the internet. You can set particular periods, and with a subscription, you can schedule repeating blocks. Currently, I have the first four hours of my work day set to block “all social media” and a few sites I visit out of habit (think ABC news, sports apps and Notemaker.com.au) to waste brain space. When the block is on, they just won’t load. Thwarted, I return to the present!

Forest is another app, more the carrot than the stick kind. Forest allows you to set a timer, during which time a digital tree or bush grows. When the timer finishes, the plant is added to your forest. But, if you change apps or switch to the home screen, your plant dies immediately, and the dead tree sullies the landscape.

One last app that can be an interesting and objective way to become aware of excessive phone usage is to us the IFTTT ‘Do Button’ feature. You can create a ‘recipe’ which collects a time stamp every time you press the button. Leave the app open and each time you unlock the phone, the button says “Unnecessary phone use.”; you are are obliged to press it before continuing; usage is collected in a google sheet for you read at a later time.

Both Forest & Freedom are about “blocking” the internet or phone usage. But what about positive internet time? I mean, it’s good to have some connection to the hive mind. Ferris describes setting time aside to screen emails and respond. Pragmatically, rather than withdrawing entirely, you can set aside an hour or two a day of dedicated social media time to “get your fix” whilst fostering connections and even schedule tweets.

Another way to make the most of short periods of connected time is to set emails to ‘snooze’; Google’s inbox offers this feature, as does the Boomerang app. This kind of technique also works well with the philosophies of David Allen’s Getting Things Done.

The Apple ecosystem has a habit of installing apps on all your devices. Critically and selectively deleting apps that you don’t want on a particular device allows you to discriminate what will buzz when. For example, I have twitter on my iPad but not my mobile phone.

To help with this ‘feature creep’, some folks use particular private message apps for set groups. For example, family on viber, work on WhatsApp, sports team on FB messenger and so on. In concert with the use of selective notifications, you can filter the distractions to a manageable amount.

If you’re really struggling to unplug from social media, but can’t be rid of your phone, you can just uninstall it all. Sounds dramatic? Try limiting your device to a set number of social media apps. Which five do you want the most? Which three? Which one? The same goes for all kinds of network; which of twitter, Instagram, snapchat, facebook, Reddit, LinkedIn and the rest can you divest yourself from without feeling isolated or lonely?

Password managers can also be useful; sometimes the temptation to “just to see what’s happening” on a particular social network leads to the actual website (in lieu of the app). If you can’t remember the inordinately long password, it’s another cognitive block to log in.

Lastly, consider do you need a smartphone? In the USA, about 1 in 7 people still use a “feature” or dumbphone . The phones can send messages and make phone calls; what else do you need? A handful of my colleagues have tried the two-phone option – one number for work calls, one for the rest of the world. It allows discrimination between the two and, I’m told, helps people to stop hating & fearing their phone.

In summary, mobile phones and devices are omnipotent in clinical and personal life for most people. Many people feel that their devices intrude into their lives. Although a bit preachy, this post has considered some of the challenges attendant with being constantly connected, as well as some pragmatic ways to free our minds from our screens. We’d love to hear your suggestions in the comments below!

Disclosure:

I’ve tried almost everything mentioned in this post, some successfully. I paid for any of the apps or actions in this post by myself. I also killed at least 4 trees in the Forest app, glanced at my phone six times whilst driving home, browsed twitter for thirty-nine minutes, read extraneous PubMed (and DSM-V) material for twenty-eight minutes, glanced at my iPhone (it’s in reach) at least twelve times and looked at expensive fountain pens whilst researching & compiling this post. Uploading was also delayed because I stayed up too late at night and thus my internet was blocked.

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About 

A Paediatric Trainee based in Queensland, Australia, Henry is passionate about Adolescent Medicine & General Paediatrics, with a strong interest in Medical Education & Clinical Teaching. An admitted nerd & ironman with a penchant for Rubik’s Cubes & ‘Dad jokes’.

@henrygoldstein | + Henry Goldstein | Henry’s DFTB posts

Author: Henry Goldstein

A Paediatric Trainee based in Queensland, Australia, Henry is passionate about Adolescent Medicine & General Paediatrics, with a strong interest in Medical Education & Clinical Teaching. An admitted nerd & ironman with a penchant for Rubik’s Cubes & ‘Dad jokes’.

@henrygoldstein | + Henry Goldstein | Henry’s DFTB posts