Issue 47 / 9 December 2013

WE humans are quite good at convincing ourselves that rules are for other people.

The less nimble or less skilled might need to comply for their own safety but we can safely cross against the red light or send a quick text while driving to meet friends.

I don’t know how scientifically based it is, but this New York Times interactive game designed to highlight the effect of texting on driving certainly makes you question your ability to multitask at that level.

A paper published in the Annals of Internal Medicine last week argues the use of electronic health records may pose a similar challenge for doctors.

“As when driving, physicians… need to be alert to environmental cues and unexpected turns. Multitasking can undermine the core activities of observation, communication, problem solving, and developing trusting relationships”, US general internist Dr Christine Sinsky and family physician Dr John Beasley write in an opinion piece provocatively titled ‘Texting while doctoring: a patient safety hazard’.

Medical encounters are particularly unsuited to multitasking, they argue, because they already exhibit the characteristics of “information chaos” — “various combinations of information overload, information underload, information scatter, information conflict, and erroneous information”.

“Although there is a relative lack of observational data, in clinics across the country, we have observed patients send signals of depression, disagreement, and lack of understanding and have witnessed kind, compassionate, and well-intended physicians missing these signals while they multitask”, they write.

But does computer use have to undermine communication during a medical consultation?

As a patient, I’ve certainly come across doctors who seemed more focused on the computer screen than the consult, but I’ve probably seen more who integrate their computer use seamlessly into the encounter, in some cases using it as a tool to improve communication.

In fact, an Australian study of GPs suggested inclusion of the computer as a third party in the encounter could actually empower patients, by helping them to ask questions of the doctor, for example.

An American Medical Association report earlier this year also suggested computers could help rather than hinder the consultation — as long as they were used well.

The position of the screen — allowing the patient to see it and the doctor to maintain eye contact while using it — was considered crucial as was individual doctors’ level of skill and comfort with the technology.

“The accumulating evidence suggests that whether exam room computing has a positive or negative effect depends in significant measure on the perspective and skills physicians bring to using computers in encounters with patients”, the report said.

So texting while doctoring might not be such a hazard after all.

Like many of our interactions with technology, the really important question may not be whether, but how.

Jane McCredie is a Sydney-based science and medicine writer.


Does using a computer in clinical encounters inhibit communication between doctor and patient?
  • Yes - sometimes (54%, 54 Votes)
  • Yes - always (24%, 24 Votes)
  • No - improves communication (22%, 22 Votes)

Total Voters: 100

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6 thoughts on “Jane McCredie: Texting hazards

  1. Genevieve Freer says:

    I do work as you describe in a public hospital, where hand-writing everything takes as long  seeing the patients, but at least is not constrained by any idiotic computer programme . The point I  am trying to make is that the computer programmes , not the computers, are pitiful. Perhaps a new specialty is needed, medical computer programming by doctors. This might suit some  of  our profession who are sick of treating patients with our hands tied by sicker  programmes.

  2. Donald A. Gullickson, MD says:

    I suggest you follow for 24hrs a busy hospitalist attempting to provide good patient care while coping with the idiotic, labor intensive, non intuitive EMRs, attempting to meet the documentation of the government, insurance companies, billing departments, lawyers, medical records dept. etc.  Every week someone comes up with more.  Who suffers?  The patient and the physician.  Check on the dissatisfaction rate and burn out that is occurring among physicians.  In 40+ years as a busy internist/hospitalist, I have always said if a computer makes us more efficient, doctors will take to it like “ducks to water.”  But every time a new computer program comes on line, it results in more work -that takes away from doctor patient interaction. Some things on computers are good – information availability as an example, but most applications are labor intensive and a disaster for patient care.  And this is from someone who is very adept at using computers, but I also remember how efficient I was with a hand held Dictaphone and medical assistants to do the “busy work” while I went on care for patients.


  3. Genevieve Freer says:

    Inclusive use of the computer to improve the consultation is a skill which reportedly may be learned and taught by those of us who choose to do so.

    The biggest problem I see is not the computer, but rather the programmes, which could be greatly improved by our input, starting with demographic data, (10 year-old girl), the presenting complaint, (cough for 2 days), followed by the history of the presenting illness ( worse  today, friend with cough   tested positve  last week  for whooping cough) , systems review, allergies, past history, immunisations, medications, physical examination,  leading to a differential diagnosis, relevant investigations suggested by the differential diagnosis, (PCR)  and treatment.(current guidelines for Pertussus contacts) . Instead of this logical guide to a consultation, we are bombarded with endless irrelevant  options whether we want them or not, which waste our time to get past,  detracting  from the interaction with the patient..

  4. Tom Gavranic says:

    In my practising days I was always able to interact seamlessly and productively with my patients by having one whole wall of the consulting room painted with blackboard paint and using coloured chalks as communication tools. Any children were reguarly kept occupied during the consultation without resort to sweets, by having them draw on the board. As a bonus, this often provided insights into the family dynamics.All this was at a fraction of the cost of  a computer. But, geewhizz , computers are so modern! 






  5. Glen Smith says:

    The article raises a number of issues.


    From “personal experience”  I have run a number of experiments while attending GPS

    1) Do they take relevant notes= from my experience 66% of GPs notes do not tell the GP why I previously attended.

    2) 66% have not included the medical condition I have attended previously for

    3) One of the GPs asked me the same question twice in a row, not because they did not understand but because they “appeared” to be in another place

    4) One of the three GPs clearly had “poor” computer skills and was trying to type and as a consequences took “poor’ notes of imited value

    5) the latest research  on multitasking says that there are some people who multitask very well. The outcomes were not related to gender and the main charecteristic of this group was that they already had  high taks performance and were a sub-set of the high performance group.

    6) the rest of us suffer considerable task performance degradation as a result of multitasking. Some may view multitasking in a consult as negligence, I certainly would and have not returned to 66% of the above GPs more than twice.

    The astonishing result you provide out of this that “texting may not be such a hazard after all” defies descritption.

    From my small survey

    1) the majority of GPs currently do not have  skill to accurately record accurae medical records

    2) GPs arent coping with the current technology (which is about 40 years old now)

    3) This is not a group that is high functioning in this area and to say multitasking is not such a hazrard is totatlly lacking in evidened based practice

    Please be more responsible in you editorials

  6. Ray Taylor says:

    In Psychiatry I have found that typing notes takes my attention away from watching the patients’ non-verbal communication as well as I can when recording by pen. Perhaps it would be different if I had been trained as a touch typist. Patients notice the reduced attention too. However, in recent years I have found myself forced into eletronic record keeping by the demands of agencies like WorkCover and courts. They will not pay adequately for the time required to draft and supply a report from writtenrecords and in some states resort to attempting the subpoena of the entire record as a short cut. Some lawyers acting for such agencies even try to misuse the provisions for patients to access their own health records . This type of intrusion becomes more manageble once you have an electronic record and can paste from the file to a report.

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