Smartphones in the clinical environment: a help or hindrance?
Friday, August 23rd, 2013
It’s not an uncommon scenario: The medical team arrives at the patient’s bedside for the daily round. A phone rings and the registrar excuses herself from the bedside to answer it. Meanwhile, the intern checks the dosage of the medication being prescribed online. One of the medical students is looking up one of the patient’s diagnosis whilst the other replies to a personal text. During the time spent with the patient, most of the team has used their smartphone.
The use of smartphones by medical staff and students in the clinical environment has increased dramatically in recent years. Purported advantages include ease of access to information, use as clinical learning tools and improved communication with other medical staff. [1-3]
Smartphone use amongst medical students is already high, with a recent Australian study showing that the majority of medical students own a smartphone and 72% of these use their phones to access medical apps.  Given this, medical schools in Australia are investigating the role that formalised introduction of mobile phone technology into curricula could play in medical education. [4,5] In the United States, some medical schools already require that students have access to a smartphone or other handheld device during their clinical years. [6,7]
The implications of increased smartphone use in the clinical environment may not be entirely positive. Medical students and staff report potential disadvantages of smartphone use to include spending less time with patients,  challenges navigating personal/professional boundaries  and potential for distraction from clinical tasks. [2,8] The risk of distraction from clinical tasks is not insubstantial. In a recent study performed in the United States, 57% of junior medical staff self-reported using smartphones during rounds, with 37% admitting to using them to access personal texts or emails.  As a consequence of smartphone use, 19% further reported that they had missed important patient information during rounds. 
The use of smartphones in clinical settings, whether for personal or professional purposes, may also have implications for doctor-patient communication. One report has suggested that junior medical staff frequently interrupt clinical encounters to answer phone calls and that this behaviour was sometimes perceived as unprofessional by other staff.  The impact of the digital device on non-verbal aspects of communication  and patients understanding of the doctors’ reasons to use a smartphone  are other potential ways that this communication could be negatively affected. There is, however, little research that directly examines patients’ perceptions of smartphone use by clinicians.
Smartphones are undoubtedly useful clinical tools and uptake by clinicians and medical students reflects this. As smartphones become a permanent fixture on the ward round, we need to think about how our use of smartphones affects communication and care of patients.
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3. Wu RC, Morra D, Quan S, Lai S, Zanjani S, Abrams H, et al. The use of smartphones for clinical communication on internal medicine wards. Journal of Hospital Medicine 2010;5(9):553-9.
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6. Stanford School of Medicine: eStudent [cited 2013 April 30]; Available from: http://med.stanford.edu/estudent/.
7. Georgetown University School of Medicine: Handheld computing requirement [cited 2013 April 30]; Available from: http://som.georgetown.edu/studentservices/informatics/about/HandheldComputing/.
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