“Distracted Doctoring” Puts Patients at Risk and Practitioners in Trouble

When you’re anesthetized and under the knife in an operating room, you assume your surgical team is concentrating on you, not texting on an iPad. For one heart patient, however, that assumption was wrong.

Pacific Standard Magazine’s unsettling review of distractions during medical procedures described the circumstances of a malpractice case in Texas when a 61-year-old woman died after a relatively low-risk cardiac procedure to correct her irregular heartbeat.

Dr. Christopher Spillers, the anesthesiologist, had been using his iPad throughout the operation. In his deposition in a subsequent malpractice lawsuit, the surgeon testified that the anesthesiologist hadn’t noticed the patient’s dangerously low blood-oxygen levels until “15 or 20 minutes” after she “turned blue.”

Spillers had been known to text, read ebooks and post on Facebook during other procedures. He excused himself by saying that he monitors blood oxygen and blood pressure at least every five minutes.

Did he go to med school? The brain begins to die after just a few minutes without oxygen.

The Texas case isn’t unique. A neurosurgeon in Colorado settled a medical malpractice case with a patient he paralyzed during a surgery in which he had made no fewer than 10 phone calls. A nurse at an Oregon hospital was caught checking airfares on a computer in the operating room.

Dr. Peter Papadakos, an anesthesiologist with the University of Rochester and an expert on the fascination with electronics that leads to “distracted doctoring,” told the magazine, “Airline pilots don’t allow themselves to be distracted by social media, because they themselves do not want to die.” To ensure health-care providers also spurn these distractions, he said, would be to say, “If there’s a wrong-site surgery or other error, we will shoot everybody in the OR.”

Digitally connected practitioners often say that they use electronic devices to keep medical records or research medical information. But when interfacing with patients, such uses should be fairly limited. The Health Insurance and Portability and Accountability Act (HIPAA), the federal regulation that protects the privacy of an individual’s health information, makes the use of these devices for most kinds of communicating with or about patients illegal. “Even if the purpose of the use is valid,” the magazine says, “the decision to use a device for any reason not immediately relevant to the patient is indefensible.”

Even worse, the culprits know they’re wrong. In 2011, a presentation at an American Society of Anesthesiologists conference offered survey data showing that “nurse anesthetists and residents were distracted by something other than patient care in 54% of cases – even when they knew they were being watched. … [M]ost of what took their time were pleasure cruises on the Internet.”

A 2010 survey published by Perfusion, a journal for the technicians who operate bypass machines used in heart surgery, found that:

• 56 in 100 respondents admitted to using cellphones during procedures;
• 78 in 100 said that cellphone use posed a risk to patients;
• 42 in 100 said that having a cellphone conversation during surgery was always unsafe;
• 52 in 100 said that texting during surgery was not safe.

So most perfusionists believe that using a cellphone while operating the heart-lung machine is unsafe, but most do it.

As the magazine suggests, this behavior isn’t about “distracted doctoring,” it’s about addiction. The term “distracted” isn’t “adequate to describe the phenomenon of health-care providers who habitually use electronic devices for nonmedical purposes during appointments and procedures,” it says. These practitioners “aren’t momentarily distracted: They’re deciding to interact with Facebook friends or Twitter followers instead of the patient in front of them.”

Papadakos is in favor of studies to understand this form of compulsion and to eliminate it. Well, maybe, but what’s wrong with a common-sense solution? Personal electronic use should not be allowed during any patient interaction, period. Personal cellphones should not be allowed in an operating room.

As the magazine asks, “A surgeon addicted to alcohol or an illegal drug wouldn’t be allowed to operate while drunk or drinking – so why are physicians addicted to their iPhones and technicians given to texting still allowed in the operating room?”