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Editor's Page: Deadly Case of Distracted Doctoring
Don't let technology come between you and your patients.
Dan O'Connor
Publish Date: March 3, 2015   |  Tags:   Editors Page
OR Excellence

Marriott Rivercenter San Antonio, Texas Oct. 13-16
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The cell phone he carried into the oral surgery suite turned out be a smoking gun. Anesthesiologist Barry Friedberg, MD, claims he made a 30-second call to check his voicemail, never once leaving the patient's side — "My left hip was in constant contact with her left hip," he says — and maintaining constant visual contact with her chest excursions and constant auditory contact with the pulse oximeter. A technician from the procedure tells quite a different story. She testified that Dr. Friedberg refused to end his call when she tried to warn him of a problem with the patient.

It really doesn't matter if Dr. Friedberg made a 30-second call by the patient's bedside or was on a 30-minute call out in the hallway. Or that he never stopped watching her chest excursions or listening to the pulse oximeter.

The headline in the Orange County Register late last month says it all: "Doctor accused of talking on cell during surgery gets probation."

All people will remember about the case more than 5 years ago at the now-closed Smile Implant Center in Newport Beach, Calif., was that the patient suffered a heart attack and died during an operation to replace her dental implants, and that the anesthesiologist responsible for keeping her alive held his cell phone to his ear during the surgery.

End of story.

There's more to the story, of course. There always is. "Google air embolus dental death," says Dr. Friedberg. "The case involved 7 open mandibular sockets."

But with distracted doctoring as much of a societal scourge as texting and driving, no explanation can drown out the fact that the state medical board ruled that Dr. Friedberg was talking on his cell phone instead of monitoring his patient. He has been placed on probation for 3 years, a punishment he calls "tepid." While on probation, Dr. Friedberg is barred from supervising physician assistants and his work must be monitored by another anesthesiologist. He's also required to take ethics and extra CE courses. But for Dr. Friedberg, 66, who has devoted much of his 37-year career to safe anesthesia and making sure patients don't "hear, feel or remember their surgery," this incident stings. "They tried to portray me as failing to pay attention to the patient," he says. "I had a death on my watch, and I still feel badly."

Dr. Friedberg isn't convinced, however, that this is a case of distracted doctoring.

"It's not below the standard of care to take a cell phone call during surgery," he says. "I was listening to the tone of the pulse oximeter with my other ear. That tone is like gold. If you hear that beep-beep-beep ..."

Dr. Friedberg says an old ("but still true") definition of anesthesia is 99% boredom, 1% sheer terror. "Distraction may be a form of coping with boredom," he says. "What some call distraction, others might call multi-tasking. Chasing EMG spikes back down to baseline is a novel virtual video game for the anesthesia professional that also fights boredom."

Why not steal a page from the It Can Wait texting and driving campaign? The text, the phone call, Facebook: They can wait until after surgery.

"Nothing angers me more than seeing a staff member with his feet propped up in a clinical location, texting on his cell phone," says Mary Ann Kelly, RN, administrator of the Madison (Ala.) Surgery Center. "Who wants to be anesthetized and monitored by someone who is checking his e-mail?"

But it's an epidemic. Everybody's addicted to their gadgets nowadays, says anesthesologist Peter J. Papadakos, MD, the director of critical care at the University of Rochester (N.Y.) Medical Center. "When you come onto the surgical wing, you pass the unit secretary who is texting on her smartphone, then the nurse, who is surfing the Web, then the resident, who is gaming on his tablet," he says.

This is harsh, but think of holding a cell phone to your ear like holding a gun to your patient's head.

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