NEEDED RESPITE? Non-patient-related activities such as reading and conversation have been going on in the OR for decades, with no discernible pattern of negative effects. Studies suggest occasional "distractions" keep providers sharp.

There's a great deal of hand wringing these days about "distracted doctoring" — the idea that computers and cell phones may be dividing the attention of providers and endangering the lives of patients. But are we in danger of oversimplifying the issue?

An ongoing malpractice suit in Dallas, Texas, is front and center. Anesthesiologist Christopher Spillers, MD, is accused of failing to respond to a patient's clear signs of desaturation because he was too distracted by social media (osmag.net/epm9ht). Surgeon Robert Rinkenberger, MD, also named in the suit, testified in a deposition that Dr. Spillers didn't notice that the patient had critically low blood oxygenation until "15 or 20 minutes" after she turned blue.

"He was doing something either [with] his cell phone or pad or something," says Dr. Rinkenberger. Dr. Spillers initially denied in his deposition that he ever surfed the Internet or posted on Facebook while managing cases. But when confronted with a post from his Facebook account of a picture of an anesthesia monitor displaying a patient's vitals — "Just sittin here watching the tube on Christmas morning. Ho ho ho," reads the caption — Dr. Spillers admitted to sometimes texting and reading his iPad during procedures. The patient, 61-year-old Roseann Milne, had undergone an AV node ablation, a relatively routine heart procedure. She died 10 hours later.

Lesson learned. Social media distractions in the OR are bad and must always be prohibited, right?

Maybe not so fast.

Let's consider a couple of points. One is that non-patient-related activities in the OR are nothing new. Some define anesthesia as 99% boredom, 1% sheer terror. Anesthesia professionals have been reading, doing crossword puzzles and playing Sudoku in the OR for decades, without creating any obvious pattern of negative outcomes.

More to the point, can we assume that any distraction during any part of any case is always a bad thing?

A 2013 MIT study (osmag.net/dawx9u) concluded that military drone operators, who are often fighter pilots, actually tend to be more effective if they're distracted from time to time. They spend the vast majority of their time waiting for something to happen, watching video screens while drones hover over targets. The study found that occasional distractions help alleviate their boredom, which keeps them sharper and more alert when they need to jump into action — when, for example, a hostile target appears.

Anesthesia providers don't fly drones, but they have something in common with pilots. For both, "takeoff" and "landing" are virtually always the most stressful and demanding times. And in between, there's usually relatively little action.

DISTRACTED DOCTORING? An anesthesiologist named in a medical malpractice suit in the case of a woman who died during a routine heart procedure allegedly posted this photo of an anesthesia monitor to his Facebook.

Sterile cockpit rule
Acknowledging that, in 1981, the Federal Aviation Administration enacted what's commonly known as the "sterile cockpit rule." The rule basically forbids crew members from performing any non-essential activities during taxi, takeoff, landing and all other operations conducted below 10,000 feet. In so doing, the FAA recognized that there's a key difference between times that demand full attention and times when crewmembers need to be able to do something other than just stare at the controls.

The same can be said of anesthesia providers. A 2009 study concluded that reading and non-patient-related conversation during the low-workload portions of the maintenance phase of anesthesia don't negatively impact vigilance. Similar to the drone-pilot study, the researchers suggested that reading during non-critical periods can actually improve vigilance by keeping providers intellectually occupied and clinically stimulated.

Still, we need to recognize that despite the lack of any clear scientific data suggesting that personal electronic devices negatively affect patient care, we have to be concerned with certain significant medicolegal implications. Preferred Physicians Medical, a medical liability firm that has defended multiple lawsuits involving allegations related to distractions, says the mere suggestion that an anesthesia provider was distracted makes the case harder to win, regardless of the evidence.

In cases where something goes wrong, plaintiff attorneys can subpoena cell phone records and retain information technology experts to try to cement the idea that distractions are to blame. Metadata experts can determine the exact time a webpage was visited, a text message was sent or a phone call was made.

Be present, be professional
So is the hand wringing warranted, or are a few extreme cases — like the Dallas case — causing knee-jerk reactions?

Based on everything we know, including evidence that properly managed distractions can actually enhance vigilance, I believe the key is to exercise good judgment and common sense, something that was lacking in the Dallas case.

Yes, we absolutely must avoid all distractions during induction, emergence or stressful/intense times during cases. But at other times, we simply need to be present and professional. How can we ensure we don't fall below that standard? The If-this-were-my-mother-on-the-table litmus test should provide an excellent guide. OSM