Distracted Doctoring: Returning to Patient-Centered Care in the Digital Age. Do We Have Time for This?

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Excerpt

I was glad to read Distracted Doctoring: Returning to Patient-Centered Care in the Digital Age, and I believe other readers of this venerable journal will be, too. The book is engaging, mercifully free of psychobabble, and eminently quotable. It is comprised of 17 chapters spanning 260 pages, and, ironically, is the size of an iPad mini. It was published by Springer in 2017 and coedited by the clinician Peter Papadakos and the social scientist Stephen Bertman. It includes a foreword warning us about digital harm and an afterword imploring us to slow down. The authors deserve full credit for highlighting an issue that deserves undistracted attention. Unfortunately, they were less successful in prescribing what health care workers need most: practical solutions to future-proof the doctor–patient relationship. It is unclear to me whether anyone has those answers.
To use a medical analogy, the authors fully outline etiology and pathophysiology but are unable to offer bromides. It is often easier to diagnose than cure, but this is what many modern readers will demand. While the book is certainly worth $50.00 ($40.00 for the eBook version), many of us are more time- rather than money-poor. The authors adroitly describe how we live in an “attention economy,” so perhaps my experience is informative. It took me 4 frequently interrupted days to read this cover to cover, during which I was “distracted” by 60 hours of clinical work, 70 electronic pages, and over 200 emails. This is before factoring in paperwork, manuscripts, engaging with colleagues, muttering to family, exercise, and sleep … perchance to dream. Time spent with Distracted Doctoring was definitely not worthless. It was, however, worth less than it could have been. A second edition should prioritize solutions for us sufferers and sinners.
I will recommend this book widely, especially to those fascinated by human factors or “cursed” with medical administration. I benefited from reading about medicine’s metamorphosis from the flesh-and-blood patient to the iPatient. I relished the discussion of how our brains are seduced by the immediate, and how we are naïve if we believe more is necessarily better. I better understand how the term “digital addiction” is not hyperbolic, how mindfulness could help, and how the comparison with distracted drivers is apropos. The book also explores the differences between data, information, and meaning, and the myth of multitasking. It additionally outlines the dangers of outsourcing deep thought and diluting face-to-face contact. Unfortunately, there is excessive repetition. Ideas that were initially illuminating become hackneyed after multiple reiterations. Regardless, the message is clear: if doctors were patients, then we would be told to stop such risky behavior immediately.
A more geographically diverse authorship might increase the book’s generalizability; all but 1 is American, with a sole Canadian, Dr Bertman, living a few miles from Detroit. Additionally, the subtitle “returning to patient-centered care” may be specious. There is little objective evidence of a halcyon age in which acute care doctors worked in a distraction-free environment. Before computers, we rushed to the library, to radiology, and to medical records, and after hours, it was worse because we had to waylay a security guard. However, the authors are entirely right that we must reemphasize the primacy of the history, then physical, and only then should we perform targeted investigations. On the other hand, modern acute care means no clinician knows everything, and few things are as helpful as legible, accessible records. The challenge is to make the computer the servant, not the master.
The word “vigilance” is so important that it permeates the mottos of anesthesiology societies.
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