By Peter Papadakos, MD

imageDr. Papadakos is professor of anesthesiology, neurology, neurosurgery and surgery at the University of Rochester Medical Center in New York. He is a member of the editorial board of Anesthesiology News, a sister publication to 
Pharmacy Practice News.

In the November 2011 issue of Anesthesiology News, I wrote an article outlining my observations of the growing addiction of hospital staff to their smartphones. Not long after the piece, “Electronic Distraction: An Unmeasured Variable in Modern Medicine” (page 8) appeared, I received a call from a reporter for The New York Times, which ran its own article about digital distractions—what the paper dubbed “digital doctoring”—on the front page some weeks later.

The Times story, and subsequent media coverage, served as a call to action in the fields of professionalism and patient safety. Professional societies in the United States and beyond began to address the issue through their annual meetings, safety committees, guidelines and studies. The issue was widely addressed in the newsletters of many health care groups including the ECRI Institute, the Association of periOperative Registered Nurses (AORN), the American Academy of Orthopaedic Surgeons (AAOS), Canadian and American respiratory therapists and the Congress of Neurological Surgeons.

So, where do we stand? The signs are encouraging. Medical centers throughout the country have started to develop guidelines and recommendations on the use of electronic devices and professional behavior. Hospitals, medical schools and clinical departments have addressed the issue thorough grand rounds and staff education. It is being addressed in operating rooms throughout the United States through the recommendations of AORN. ECRI even listed electronic distraction as one of the top 10 technology hazards for 2013.

We have made strides to at least address this issue of addiction with health care workers. One of the tools that has become popular during these educational programs is the University of Rochester Modified CAGE Questions (Table). CAGE is a highly validated survey of alcohol addiction, which has been modified and replaces drinks with personal electronic devices (PEDs). This survey self-validates to the participant his or her own shortcomings with PEDs and is a springboard to starting a dialogue and correction of behavior in the professional environment. Organized medicine has thus started to self-correct and educate its practitioners at all levels of technical staff.

Table. University of Rochester Modified CAGE Questions
Have you ever felt you needed to cut down on the use of your PED?
Have people annoyed you by criticizing your use of your PED?
Have you felt guilty about your overuse of your PED at work?
Do you reach for your PED first thing in the morning?
PED, personal electronic device (includes smartphone, tablet and mini-computer).

But as we train ourselves in electronic etiquette and the proper way to interact with technology in both our personal and professional lives, we must look at society as a whole. Health professionals should be at the forefront of educating the general public in the many dangers of electronic intrusion. These devices are rapidly changing how humans interact with and behave toward each other.

The ever-rising figures of mortality and morbidity by texting while driving—a reporter earlier this year said texting at the wheel now kills 3,000 American teens per year, making it the leading cause of death in this age group—and the tens of thousands of brain-injured survivors and the millions of dollars required for their care will, of course, increase costs and burden the already strained rehabilitation system.

New mental illnesses identified as an addiction to PEDs and to the Internet are reshaping our understanding of how the human brain functions. And virtual relationships like cyber-bullying, pornography and online gaming are altering our society in ways we have not yet begun to fully comprehend. Medicine also is identifying physical conditions that can cause lifelong disabilities such as injury due to repetitive use of the thumbs and back deformities such as “Game Boy back” from prolonged hours of texting.

As health professionals, we already have become leaders in self-correction of this behavior and developing ways of addressing these technology issues. I call on each of us to begin educating both our families and communities. Hospitals and health professionals should educate young people in the schools of the dangers of overuse of this technology. We should pressure our elected officials on the dangers of not only texting and driving, but on distracted pedestrians and their other psychological and physical problems. Through education, we can effect great, positive change in how we interact with these new technologies.