My Cellular Confession
August 12, 2019
By Geoff Frost, UBC Physiatry Resident
It’s a busy day. I know I’ve got a lot to manage at the clinic. More patients than I can probably see by myself, but that’s medicine right? Time to buckle down and get through it. But before I step into the first exam room, I quickly check my phone. Why? What’s so important on WhatsApp that needs my attention before speaking with the patient who may literally demand my attention with a blood pressure of 220, uncontrolled chest pain, or an active suicide plan?
As a mid-cohort millennial, I can honestly remember what life was like before cell phones. I remember meeting up with people based on plans we made in person. I remember enjoying that. I remember devoting my unmitigated attention to a specific task for hours on end – like that time I spent 12 straight hours programming a solitaire game for my final computer science project in undergrad. How did I become the guy that needs to check my phone before walking into an exam room? But more importantly, how does checking my phone make me a better physician? Or, more worryingly, how does it make me a worse physician?
I’ve thought about this a lot. And like anyone who’s identified an embarrassing behaviour, I’ve found someone else to blame. In the first few years of my residency, everything was organized through WhatsApp. Who was taking the latest ER consult, who was seeing Ms. Q on Ward 8A with chest pain, it all ran through WhatsApp. We all still carried pagers, but they had devolved to an odd status symbol. If we wanted something done, we IM-ed it. And there was no way I could leave the ringer on. Imagine a flurry of WhatsApp pings going off in the middle of a surgery? I have no interest in finding out how the senior staff surgeon would react to that. So I learnt to check my phone. Impulsively. If there was ever a down moment, I would pull out my phone, and check it. I could not possibly miss being delegated an ER consult or a chest pain on the ward. So I had to check it.
But I’m no longer a 1st year resident. I’m no longer tied to those team-based WhatsApp groups. So why am I still checking that 14cm by 7cm glass rectangle? And in the height of irony, why, in the course of writing this, did I check my phone?
I think it’s important to realize one thing: in the entirety of my smartphone using life, only once have I answered an actual emergency on the phone. Once. Yet that compulsive need to check-in every 30 minutes still persists, even after about a decade of evidence suggesting that surely, it can wait.
While it’s certainly du-jour to lambast the cellphone addicted, it’s worth considering how cell phones impact our ability to deliver care. Are they helpful for, or do they hinder, care delivery? Cell phones undoubtedly improve our ability to recall the arcanum of medicine. With UpToDate and a few taps, suddenly even I can remember the phenotype of Spinal Muscle Atrophy Type 1 vs. Type 4. Yet, there’s a raft of studies that show persistent cell phone use erodes our attention span and our ability to focus. As a medical student, perhaps the most important thing I learnt was that a good history often yields the diagnosis. Yet here I stand, addicted cell phone user. There’s no doubt my ability to focus is impaired compared to a decade ago. And, logically, there is no doubt this has impacted my ability to take a good history.
The most obnoxious thing a person can do in an intrapersonal situation is to allow themselves to be distracted. To take themselves out of the moment. It admits, through action, that the intrapersonal situation is secondary, unimportant, and unnecessary. It devalues your conversational partner and the moment itself. Physicians treat people during their worst moments: their suicide crises, their miscarriages, their first day admitting a long-term care facility may be necessary. It seems self-evident that we must remain in the moment for our patients. Yet we find ourselves distracted. We allow ourselves to mentally turn away. As a patient, I would never want that kind of care. I would want a practitioner that stayed in the moment, that focused on my problem, and that helped me find a solution.
And while I enjoy poking fun at myself and my cell phone habit, I can’t help but pause and wonder what the advent of EMRs has done to our ability to be present for our patients. We’ve all heard the benefits of EMRs – and they are legion. The efficiency, the collection of pertinent results into one space. These are real benefits. And I get it, typing out our SOAP note while interviewing a patient is simply efficient. It minimizes time spent documenting, which allows us to see more patients. These are all good things.
But that doesn’t mean the technology comes without a cost. To me, it’s become obvious that we now mediate our patient encounters through a digital chaperone. We see every patient in that fuzzy out of focus space behind the monitor. So impersonal that sometimes it’s hard to make out their features. Did that mother of three just cry as she recounted her marital difficulties and how they are impacting her ability to breast feed? I can’t say I’m certain, I was checking her lytes.
There are many obvious, and impractical, answers to this conundrum. We can throw out the EMRs, but we might as well throw ourselves out in the process. Modern medicine is here to stay.
So that brings me back to the cellphone. I won’t get rid of the EMR, but I can control the cellphone. At the start of every clinic day, I enjoy dropping it off in my locker. Not because I need to, but because I want to. I don’t feel the need to check WhatsApp every moment when the phone isn’t there. And sure, I’ll miss a meme. But, in a small way, I feel I’ve regained some autonomy from the machine. There is no need to multitask both my phone, the EMR, and my patient. It’s time for me to focus on what matters, the patient in front of me.
Geoff is a fourth-year Physiatry resident at UBC. He currently serves as the Director of Communications at the Resident Doctors of BC and is the host of the Pulse Podcast. Geoff is a professional engineer in Ontario, and prior to entering medicine, he worked as a biomedical engineering entrepreneur.