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Tag: Distracted doctoring

An Extremely Teachable Moment

John Mandrola MDIt was a mistake to send the Liberian national Thomas Eric Duncan home from a Dallas emergency room after he presented with fever and pain, which were early signs of Ebola infection.

It would be a larger mistake to miss an important learning opportunity. This case demonstrates what I believe to be a major threat to patient safety—caregiver distraction.

Doctors and nurses are increasingly prevented from giving full attention to the important things in patient care. The degree of value-added nonsense has reached the point where delivering basic care has gown dangerous. This morning, in Canada, news of a case of deadly drug interaction occurred because of alert fatigue—or distraction.

I am a cardiologist; I am also a patient. I want the Duncan case to be a turning point, a wake up call, a never event that serves as a spark to improve the delivery of medical care. Right now, all that this case has changed are tweaks to EHR protocols and checklists. We need more than tweaks; we need big changes.

An uncomfortable truth is that medical mistakes are normal. Errors, like this one in Texas, have occurred since doctors started treating patients. The good news is that technology has made medical care better. No credible person suggests a return to the paper-chart era. Yet, it is still our duty to face mistakes, learn from them, and in so doing, improve future care. Being honest about root causes is necessary.

Another truth about medical mistakes is the ensuing rush to inoculate against blame–which always comes. In the Duncan case, initial blame was assigned to the electronic health record. The computer software failed to flag the travel history in the physician “workflow.” (Just using the word, workflow, hints of the bureaucracy problem.) And you know there is trouble when hospital administrators use the passive voice. “Protocols were followed by both the physician and the nurse…”

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How Healthcare’s Embrace of Mobility has Turned Dangerous


No industry has adopted mobility faster than healthcare.

Doctors love their devices. 81% of physicians have smartphones. They also love their apps. 38% of them use medical apps daily. One-third use smartphones or tablets to access electronic medical records today, with another 20% expecting to start using them this year.

For instance, 200 doctors and nurses at Charite Berlin, one of Europe’s largest hospitals, are piloting SAP’s new Electronic Medical Record app on iPad.

The app allows medical providers to trade their clipboards for (electronic) tablets, which present them a clean dashboard that lets them drill down into data such as medical history, medications (and allergies), X-rays and vital signs. It pulls that data down from a speedy SAP Hana in-memory database.

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