Not the type of tablet I had in mind, doctor

MEDICAL MATTERS:IMAGINE a surgeon making personal calls on a mobile phone during an operation. Or a theatre nurse surfing a travel website on her tablet.

Despite the old joke about anaesthetists checking stock prices in the newspaper during an uneventful period in a lengthy operation, has the ready availability of hand-held technology made it easier for healthcare professionals to be distracted from their work?

Hospitals and medical schools are supplying devices such as iPads and smartphones to encourage more efficient working by offering instant access to patient data and drug information. But it seems an unintended side effect is emerging: doctors and nurses are focusing on the screen – and not the patient.

While this is bad enough if they are focused on work-related issues, research is emerging of electronic distraction being driven by personal rather than professional needs.

One survey of cardio-pulmonary bypass surgery technicians in the US found 55 per cent acknowledged they had talked on mobile phones during heart surgery. Half said they had texted while in theatre. Some 40 per cent said they believed talking on the phone during surgery was “always an unsafe practice”. About half said the same about texting.

It’s not that medical professionals have never experienced distractions. Multitasking is part of the job, and bleeps and phones have long been a source of frustration. It seems, however, that the interactivity of the new devices is acting as an irresistible siren call for health workers. Younger professionals, in particular, seem especially prone to inappropriate distraction.

Some hospitals have reacted by making operating theatres “quiet zones”, where any activity not focused on patient care is banned. But there is a dilemma; the new devices have helped reduce errors, while, at the same time, patients risk feeling marginalised as computers end up coming between patients and their doctors. It’s hard to listen attentively if you are grappling with a new computerised record system. You can end up treating the numbers and not the patient in front of you.

One possible solution may be to limit access to apps on devices supplied by hospitals and clinics. This kind of restriction has been introduced for pilots, who can only use applications linked to flight safety on tablet devices.

Not all technology has undesirable side effects. Telehealth, a growing area, involves use of equipment to monitor a patient’s vital signs from a remote location. Telecare uses alarms and sensors in a person’s home to send information to medics.

In one study of 6,000 patients funded by the department of health in England, remote technology helped reduce emergency admissions due to chronic conditions such as heart failure. Curiously, the study detected some resistance to the initiative from doctors. It would be interesting to know whether this was predominantly among older practitioners.

The electronic revolution enthusiasts want online booking to become the default option for making appointments in primary and secondary care; they would like to see patients manage their treatment in systems linked to their electronic medical records. Meanwhile, public health authorities could detect potential outbreaks of illness by monitoring online behaviour, such as a surge of people looking up the same symptoms on the internet.

Apparently the National Health Service lags behind the public sector as a whole in its use of electronic systems, with just 7 per cent of contacts between clinicians and patients taking place online. I suspect this is the result of a combination of reluctance to move from face-to-face consultations and a lack of a system for paying doctors a fee for online interactions.

In the meantime, make sure to ask any iPad-wielding doctor to put it to one side while you tell your story of why you think you need medical care. Tell them it’s far more interesting than Facebook, and that putting the thing away is less likely to lead to mistakes.