“Distracted Doctoring” – updating your Facebook status in the O.R.

Do you know what your O.R. team is up to while you’re lying there out cold during surgery? The New York Times has taken a revealing peek at the impact of electronic devices like smartphones on modern medical care – and it’s not a pretty picture.

The troubling issue is that your doctors, nurses and techs can be focused on the screen and not the patient, even during moments of critical care.  This includes the neurosurgeon making personal calls during an operation, a nurse checking airfares in the O.R., and a frightening poll showing that half of technicians running bypass machines during open heart surgery had admitted texting while working on a cardiac procedure

Dr. Peter Papadakos is an anesthesiologist and director of critical care at the University of Rochester Medical Center in upstate New York.  He recently published an article on these “electronic distractions” in the journal Anesthesiology News.

“My gut feeling is lives are in danger. We’re not educating people about the problem, and it’s getting worse.”

The Times article cites the medical malpractice case involving a Denver patient who was left partly paralyzed after surgery. The neurosurgeon was distracted during the operation, using a wireless headset to make personal calls on his cellphone.  At least 10 of them were to family and business associates, according to phone records introduced in the lawsuit,which was settled out of court by the neurosurgeon.

Dr. Stephen Luczycki is an anesthesiologist and medical director in surgical intensive care at Yale-New Haven Hospital. He told The Times that when he was in medical training, he was admonished to not even study a textbook in surgery, so he could “focus on the rhythm and subtleties of the procedures.” 

But in his current O.R. experience, he says he has “seen it all”:

“Amazon, G-mail, I’ve seen all sorts of shopping, I’ve seen eBay. You name it, I’ve seen it.”

Research on the troubling subject of electronic distraction among health care providers is beginning to emerge, according to Matt Richtel’s article in the Times.

For example, Dr. Trevor Smith’s peer-reviewed survey* of 439 medical staff was published this year in Perfusion, a medical journal about cardio-pulmonary bypass surgery.  Dr. Smith’s team found that 55% of staff who monitor heart bypass machines acknowledged to researchers that they had talked on cellphones during heart surgery. Half said they had texted while in surgery.

As a heart patient, here’s where I found the results of this study to be downright creepy. The perfusionists studied reported that, while in the middle of cardio-pulmonary bypass surgery, they had:

  • accessed e-mail (21%)
  • used the internet (15.1%)
  • checked/posted on social networking sites (3.1%)

While all this phoning, surfing and Tweeting are going on in the O.R., safety concerns were expressed by 78.3% of respondents who believe that cell phones can introduce a potentially significant safety risk to patients. Speaking on a cell phone and text messaging during CPB were regarded as “always an unsafe practice” by 42.3% and 51.7% of this study’s respondents, respectively.

Let’s take another hard look at these findings.  Are Dr. Smith et al saying that half of medical personnel actually believe that phoning or texting or updating their Facebook status are NOT unsafe, inappropriate distractions while they’re in the middle of open heart surgery?  Have these people taken multi-tasking to a new and deranged level of acceptance?

Dr. Smith’s study also found that personal distraction by cell phone use that negatively affected performance was admitted by 7.3%, whereas witnessing another perfusionist distracted with phone/text during coronary-pulmonary bypass surgery was acknowledged by 33.7% of respondents.

This study concludes:

“The majority of perfusionists believe cell phones raise significant safety issues while operating the heart-lung machine. However, the majority also have used a cell phone while performing this activity.

“There are clear generational differences in opinions on the role and/or appropriateness of cell phones during bypass surgery. There is a need to further study this issue and, perhaps, to establish consensus on the use of various communication modes within the perfusion community.”

There is “a need for further study”?  How much more “study” might be required before all operating rooms everywhere ban the use of inappropriate distractions like cell phones, Internet browsing and social media updating during coronary bypass surgery?

Call me crazy, but I’d like to believe that the medical staff in the O.R. during my next cardiac event are paying attention to me and not to those irresistibly cute kitty videos on YouTube.

The study’s authors concluded:

“Such distractions have the potential to be disastrous.”

UPDATE June 9, 2014:  A recent KevinMD column about live-broadcasting surgery called “Google Glass Has  a Long Way To Go in the O.R.” reports on surgery performed in London while the surgeon wears Google Glass to film the procedure. The list of distractions is telling. For example:

  • The surgeon talked about how many people in different countries were watching.
  • He said that a number of text messages were coming up on his Google Glass screen.
  • At 21 minutes into the case, he stopped for a 5-minute interview with a TV crew.
  • He chatted with a colleague who came into the room.
  • He asked questions of the audience and answered them himself.
  • Several times, he asked his technical crew how things were going.

See also:


* Smith T, Darling, E, Searles B. Perfusion. 2011 Sep;26(5):375-80. Epub 2011 May 18. 2010 Survey on cell phone use while performing cardiopulmonary bypass.


14 thoughts on ““Distracted Doctoring” – updating your Facebook status in the O.R.

  1. Horrifying. I’m scheduled for a surgery in about 3 weeks!

    I think I’ll lobby hard for a friend or family member to be with me during surgery. I’ll dream up some kind of reason I need that – maybe for my emotional sense of safety or something. If there’s an outside person in the OR who might see this outrageous behavior, I’d hope staff would be too afraid of a lawsuit or at the very least, a report to their bosses.

    Does anyone have any other ideas?

    • Hello Bev – why not print off this article (or the original New York Times piece) and hand it to the O.R. staff when you arrive and ask them to read it before your procedure? Good luck with your surgery!

  2. Australian hospitals have signs everywhere requesting we the public turn our phones OFF, as they assert that cell phones may interfere with certain medical equipment. Bizarrely, I now wish I was an RN in the cardio-thoracic unit all over again, just so I could take a peek and see what’s going on in Aussie ORs.

    I am – sadly- no longer surprised or startled by the hubris and nonsense which passes for diligent health care in many settings.

  3. I have always been under the impression that using mobile phones around monitors etc was a risky practice as there might be feedback issues, or at least that was what I was told when I was working in a high intensity Critical Care Unit… 🙂 The problem does not seem to be THAT bad in the set up where I have been working!

    • But why do you think patients are restricted in their use of mobile devices (as Margi points out in her Australian experience) but hospital staff can bring (unsterilized) mobile devices into the O.R. with impunity? Yikes.

  4. As a participant in Smith’s study, I feel that it is taken a bit out of context. For instance, there are times during an operation when one must contact another member of your staff for an emergency that occurs in your OR or department. At times it could be deemed safer and quicker to shoot off a quick text or call from behind the bypass machine then perhaps turn your back on your equipment and the patient to use a wall-mounted phone as opposed to a hand-held device. It is also not uncommon to have to call for additional equipment, supplies, bio-medical engineering, etc during a proceedure. Would you rather the tech that needs to contact someone outside of the OR for a legitimate reason pertaining to the proceedure walk away from the pump to use a wall mounted phone as has been the practice in the past or use a handheld device?

    Also, a quick text can be less distracting to the rest of the OR team than a voice phone call that everyone probably is trying to listen to instead of focusing on their individual part of the proceedure.

    • Thanks for sharing your personal perspective, KC. I have trouble, however, buying the premise that, of the perfusionists surveyed who admitted to using their smartphones during open heart procedures (over 50%), they were somehow all doing so because of an emergency that came up. If this were true, why do you think physicians in the O.R. are decrying this practice because of “significant safety issues” or “the potential to be disastrous” or because “lives are in danger”?

      Also, can you clarify the questions here about those public signs restricting cellphone use by patients in hospital because they might interfere with certain medical equipment?

  5. The AMA found this subject worthy of comment:

    “Doctors have to manage smartphone distractions
    As the use of mobile devices grows among physicians, so does concern about how to minimize interruptions that could endanger patients.”

    “A case described in the December 2011 issue of the online patient safety journal AHRQ WebM&M highlights the concern. While rounding on a 56-year-old man hospitalized to have his percutaneous endoscopic gastrostomy tube replaced, the attending physician at an unidentified academic medical center said the patient’s Warfarin should be stopped.

    “A resident rounding with the attending physician started entering the drug stop order using her smartphone, which could access the hospital’s computerized physician order entry system. She was interrupted by an incoming text message from a friend asking about an upcoming party. The resident answered the text message — yes, she would attend the party — but forgot to complete the stop order.

    The patient continued receiving Warfarin and two days later developed shortness of breath, a rapid heart rate and low blood pressure. He ultimately required open-heart surgery to remove blood that was filling the sac around his heart. The spontaneous bleeding, the medical team believed, was due to the extra doses of Warfarin the patient got because the drug order was not stopped.”

    There are many journal articles addressing this growing problem. Just one more is: “Association of Interruptions With an Increased Risk and Severity of Medication Administration Errors”

    • Thanks for sharing these two links, Cave. The Australian study was particularly telling:
      “Each interruption was associated with a 12.1% increase in procedural failures and a 12.7% increase in clinical errors…”

  6. I’m trying to figure out a way to express my concerns to my orthopedist prior to my upcoming surgery without putting him on the defensive (for the OR staff). It’s not his own staff, though; it’s the staff of the institution, so maybe it wouldn’t offend him.

    Still, anyone have non-threatening words to express to him how nervous I am that anyone, (including him, though I wouldn’t tell him that), might be “distracted” by answering a phone call or text from a someone? I’ve thought of saying something like “I’m really glad I have you for a surgeon. You strike me as the kind of person who wouldn’t be afraid to tell anyone in the room to put their phone down. Maybe you could say something before the surgery. What do you think?” But I can just hear him saying, “Oh, that’s nothing to worry about. It’s a great place and you’ll be just fine.” Actually, even if he laid down the law, how can he keep track of what everyone else is doing and focus on my surgery at the same time?


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