It’s clear that smartphones have much to offer doctors. Up-to-date information on best management practices; help with dosing calculations; access to recent journal articles; and even communicating with doctors in other specialities or other hospitals for patient care.
In most cases, smartphones are essential, because hospitals simply do not provide adequate internet access for staff. In Australia and the UK, it is commonplace for hospital computers to be outdated, slow, running an extremely old operating system and with heavy censoring of web access.
For example, in my experience, trying to access the National Library of Medicine frequently leads to the message ‘This website has been blocked under the category HEALTH”. It’s like banging your head against a brick wall. As a result, smartphones are often the only connection between health professionals and the internet.
But they also come with their own set of problems.
A recent case report on the AHRQ website highlights a potential problem with smartphone use in hospitals.
In the case discussed, the hospital used smartphones for electronic prescribing for patients. During a ward round, the resident was asked to cease the warfarin (a blood-thinning drug) prescribed for a patient, as it was no longer needed. The resident started to do this on her smartphone. In the middle of this task, she received a text message inviting her to party. She replied to the text message, and forgot about ceasing the warfarin. The rest of the team assumed it had been stopped.
48 hours later, the patient developed cardiac tamponade due to blood filling the sack around the heart.
This case is peculiar on many levels: including the details of the text message in a case report like this seems odd. Why wasn’t the initial error picked up for 48 hours? Does nobody check the medication charts each day on the rounds? Did the patient’s nurse on the round not remember that it should have been ceased?
Last year, Jacobi Medical Center conducted a survey to identify smartphone use, by doctors, during ward rounds.
The majority of those surveyed used their mobiles during rounds and 37% of residents used them for personal messages and emails. 19% of residents felt they’d missed clinical information due to being distracted by their mobiles.
Consequently, Jacobi now regulates smartphone use – doctors have to state why they are using their phones and now they pretty much have to ask permission before looking something up.
Is this really the best solution?
As a patient, would we really expect (or want) our doctors not to access information on their phones?
These problems are not unique to hospitals – smartphones are an intrinsic part of the modern world. Distraction due to smartphones is a problem for us all, not just doctors. As a society, we are grappling with how to integrate smartphones into driving; into courtrooms; and into lecture halls.
The response to the motorcar in the 19th century was to get a man to walk in front of cars waving a red flag. Similarly, responding to the problems of smartphones by getting junior doctors to walk around waving red flags every time they use them is ludicrous.
We need to create an adequate regulatory framework suitable for their use, so we can benefit from all they have to offer for improving patient care.
But just because smartphones are there does not mean that good medical practice can be ignored. The team (not the phone), still has responsibility for optimal patient care. If medications should have been stopped, then it’s the team’s responsibility to ensure that it actually has been. If a dose has been calculated using an app, then it’s the prescribing doctor’s responsibility to make sure that it is appropriate for the patient.
In the 1950s, the registrar in the AHRQ case report might have made an error because she had a personal problem; because her training was outdated and she had no way of keeping up to date with best practice; or because her mental arithmetic was poor. Distraction has always been, and will always be, an issue for doctors.
We all need to learn how to reap the benefits of smartphones without them consuming us and distracting us from our ‘real’ lives. Doctors too need to learn how to use smartphones well. It’s not appropriate to check personal emails during the ward round, but it might be appropriate to look up a journal article on a treatment plan that’s being discussed.
Removing smartphones, or censoring access isn’t the answer. Doctors are human beings and need to learn how to moderate their smartphone use like everyone else.