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Emergency Medicine News:
doi: 10.1097/01.EEM.0000450851.62228.29
Second Opinion

Second Opinion: Distracted Doctoring

Leap, Edwin MD

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Dr. Leapis an emergency physician currently working locum tenens throughout the United States. He is a member of the board of directors for the South Carolina College of Emergency Physicians and an op-ed columnist for the Greenville News. He is also the author of three books, Working Knights, Cats Don't Hike, and The Practice Test, all available atwww.booklocker.com, and of a blog, www.edwinleap.com/blog. Follow him @edwinleap, and read his past columns athttp://bit.ly/LeapCollection.

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I have a shiny new Bluetooth. I can speak without my hands touching my phone as I zip around town, which is a good thing because our county is passing a ban on cell phone use unless it is hands-free, and as we all know, distracted driving is bad. I'm told that it's even more dangerous than drunk driving. That it may, in fact, be the cause of global warming! (I made that one up.)

Anyone who has ever driven down the highway to the awesome sounds of Radar Love by Golden Earring fully understands the intensely distracting value of rock and roll. The most distracted I've ever been in a vehicle was when my girlfriend, now wife, Jan was behind the wheel. We were in college, and her black hair was blowing in the breeze. Then she did that magical trick that gets the lifelong attention of every young man. She took off her bra while driving. Through her sleeve. I'd have rolled the car for sure if I had been driving.

So I get the distracted thing. It's tragic for any life to be lost over something as trivial as a driver looking at a text. It occurs to me, though, that we practice distracted medicine every day. I can't imagine that we could make medicine much more perilous than we do now. The opportunity to focus on a patient, complete a thought, or finish a task is vanishingly rare.

You're up to your passwords in EMR, charting some complex interaction involving an angry mother, a drunk father, a sick child, and a dog that apparently ate everyone's narcotics. As you decide how to describe the situation, a nurse thrusts an EKG in your face. “Chest pain in 12. Don't forget to sign and time it.” You run off, knowing that it isn't a STEMI. But there are risk factors. “Nurse, I need you to give three nitro and four baby aspirin, and get a chest x-ray.”

“Fine. Put it in the computer.” The same interaction is repeated every day with lab techs, EKG techs, x-ray techs, and almost everyone because nothing can happen until it is on a hard drive. Otherwise, it's a lawsuit waiting to happen!

So you were distracted by the EKG, and then your thinking was interrupted by the insistence that you document the things you want done. You're back at the computer, thinking about something else when Joe Dirt says, “Hey, how long it's gonna be? ’Cause this is ridiculous. And can I get a cup of ice?” Your badge that says “Dr.” might as well say “Dr. Pepper” because he has no sense that interrupting you is inappropriate. But neither does anyone else.

On the way to another patient, the secretary says that urgent care has a transfer, and you're the only doctor there. Thought process interrupted as you field a call from across town to accept the patient. What was it you saw in the triage note that concerned you?

You need to refer a patient to a specialist. Easy? Hardly. You have another form thrust in front of you that you are supposed to fill out to make things easier on the specialist. Almost without fail, large hospital or small, transfer forms, ambulance certifications, and medication orders for EMS will all be in front of you, electronically or in print, or both. Those are forms for doctors to fill out, not anyone else.

Considering the nuances of abdominal pain becomes problematic in the midst of this, and trying to use your years of insight to decide if that college student is suicidal or that roofer is having a TIA is all but impossible. Every thought is interrupted by another request, another need, another demand, another form.

You go back to your computer, and you realize it timed out. You have to re-enter the password, then another password for radiology viewing. You spend as much time entering passwords as you do listening with your stethoscope. It's hard to think about drug doses when you have to juggle the passwords of your life. But don't worry about interactions or allergies because every order is stopped by a pre-programmed warning. “Warning! Tylenol may cause liver disease with prolonged use!” “Warning! Without adequate airway management, succinylcholine may be fatal!” “Warning! Phenergan may interact with Lortab to cause sedation!” One ceases to process them. Or anything else.

It goes on and on. Another call, another form, another field to fill. More data to enter, more orders to enter, and the patient may be very sick or very complicated, but that matters little in the world of distracted medicine. And at the end of the day, there are more charts to fill out and more data to enter to complete the record, but you've forgotten half of them because you were never allowed to complete a thought.

This doesn't count the distracted practice that occurs from patients who have difficulty describing symptoms or those who outright deceive us with discombobulated stories and misinformation that lies on our cerebral hard drives like spam.

With every new rule, form, or computer field, with every new dropdown menu that requires five minutes to find “fever” among choices like Lassa fever and metal fever, we are distracted. With every electronic prescription that takes five minutes to every 30-second handwritten prescription, we are distracted. With every demand that we treat every ridiculous complaint as a thing of inestimable value, we are distracted.

What we do is important. It's too important for us to spend our shifts struggling through the brambles of endless, unnecessary distraction. We need to push back. This is horrible; it is devastating. It shortens careers and endangers lives. Just as the driver's main focus should be driving, ours must be the timely, efficient care of patients.

If our directors and administrators want us to continue to save life and limb, they need to realize that distracted practice is at least as dangerous, maybe more so, than distracted driving.

Access the linksin EMN by reading this on our website or in our free iPad app, both available atwww.EM-News.com. Comments?Write to us atemn@lww.com.

Wolters Kluwer Health | Lippincott Williams & Wilkins

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