In one ongoing malpractice case in Texas over the death of a 61-year-old woman following a low-risk cardiac procedure, attorneys for her family discovered that the anesthesiologist charged with administering anesthesia and monitoring the patient’s vital signs had been on his iPad throughout the operation. In his deposition, the surgeon testified that the anesthesiologist didn’t even notice the patient’s dangerously low blood-oxygen levels until “15 or 20 minutes” after she “turned blue.”
The anesthesiologist admitted to texting, accessing websites, and reading ebooks during procedures. He claimed, though, that “even when I'm doing so, I'm always listening to the pulse ox, always checking the blood pressure, always—you know, at least every five minutes.” It seemed lost on him that five minutes is an eternity in medicine: The brain begins to die after just a few minutes without oxygen.
The normalization of social media may have dulled our ability to correctly measure our usage habits. In the United States 73 percent of online adults are active on social media sites—90 percent of those aged 18-29, and 78 percent of adults 30-49. On average, social media users aged 18-34 spend nearly four hours each day on sites like Facebook, Twitter, and LinkedIn; those aged 35-49 spend three hours daily on social media.
On other occasions, the attorneys found, the anesthesiologist had posted about a patient on Facebook—"After enduring the shittiest Friday I've had in a while, I just found out my next patient has lice. Freakin lice”—and even published a photo of a patient’s vital signs during surgery, captioned, “Just sittin here watching the tube on Christmas morning. Ho ho ho.” The physician admitted in his deposition he knew he shouldn’t have been doing any of these things.
A medical malpractice attorney in Colorado relayed the case of a neurosurgeon settling with a patient he paralyzed during a surgery after it came out that the surgeon had made no fewer than 10 phone calls while operating.
“Airline pilots don't allow themselves to be distracted by social media, because they themselves do not want to die,” argued Dr. Peter Papadakos. But the only way to ensure health care providers follow suit, he claimed, would be to say, “If there's a wrong-site surgery or other error, we will shoot everybody in the OR.” It’s a problem in operating rooms and emergency rooms alike: Nurses, technicians, and physicians glued to smartphones, tablets, and even laptops instead of patients.
Papadakos, an anesthesiologist affiliated with the University of Rochester, is a leading expert on “distracted doctoring,” the deceptively mild term used to describe physician negligence involving electronic devices. While throughout the 1980s, most programs banned residents from so much as studying in operating rooms or on the ward, doctors now routinely do far more distracting things in these same settings, with no possible medical justification—from tweeting to texting to posting on Facebook. How did this happen?
The oft-given defense, that physicians and nurses use electronic devices to keep medical records or look up relevant information, is more limited than most of us might realize. Because SMS doesn’t meet criteria for protecting privacy under HIPAA, for example, it shouldn’t ever be used for communicating with or about patients. Even if the purpose of the use is valid, the decision to use a device for any reason not immediately relevant to the patient is indefensible.
“To adhere to [the Hippocratic] oath, it is critical to be mentally present during all clinical encounters or you may miss a critical, life-impacting piece of information,” an article by a University of Connecticut physician on doctors’ use of smart devices argued. Put simply, physicians should be attentive: If they’re texting, tweeting, or reading, they’re not paying attention.
But at an annual meeting of the American Society of Anesthesiologists in 2011, one presentation claimed survey data showed “nurse anesthetists and residents were distracted by something other than patient care in 54% of cases—even when they knew they were being watched.” Worse, “[m]ost of what took their time were pleasure cruises on the Internet.”
A survey published by a journal for perfusionists, the technicians who operate bypass machines used in heart surgery, found that 56 percent of respondents admitted to using cell phones during procedures. While 78 percent said that cell phone use posed a risk to patients, only 42 percent of respondents agreed that having a cell phone conversation during surgery was always unsafe and just 52 percent said that texting during surgery was not safe. “This survey suggests that the majority of perfusionists believe cell phones raise significant safety issues while operating the heart-lung machine,” the journal drily notes. “However, the majority also have used a cell phone while performing this activity.”
A medical malpractice attorney in Colorado relayed the case of a neurosurgeon settling with a patient he paralyzed during a surgery after it came out that the surgeon had made no fewer than 10 phone calls while operating. An administrative director at an Oregon hospital, meanwhile, admitted to having to discipline a nurse caught checking airfares on a computer in the operating room.
The term “distracted doctoring” doesn’t seem adequate to describe the phenomenon of health care providers who habitually use electronic devices for non-medical purposes during appointments and procedures. These doctors, nurses, and technicians aren’t momentarily distracted: They’re deciding to interact with Facebook friends or Twitter followers instead of the patient in front of them.
Papadakos and others have warned that smart devices and social media have “an addictive element.” He thinks more studies are needed to understand this form of compulsion, to figure out how it can be eliminated. Even if that’s so, there shouldn’t be any confusion about health care providers and institutions’ obligation to protect patients in the meantime. 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?