How the Communication Revolution in Healthcare is Hampering More Than Just Communication

It happened again. Yesterday, I was charting on the recently launched streamlined version of our electronic health records and a new note popped up in the right lower corner of the screen:

Welcome to athenaText. Now you can instantly and securely text about patient care with all of your colleagues…

A few seconds later, a message popped up. “You have one unread message.”  As with most other communication systems, this new option promises to be collaborative, convenient, and secure.  But as with all other options, it leaves out a few other important words:  considerate, patient, and conscientious.

You see, there is something that I and so many others are noticing these days, both in and out of healthcare, when each new system of instantaneous communication is unveiled. Other systems not only remain, they often lack coordination with the new system, and coordination with my brain, which can only handle so many places (on and off the screen) to check for a new message before I just become scattered and inefficient.

I am fortunate to be part of the roughly 2% of individuals in my age group to not have a mobile device, and to work for a company that supports this choice. This in effect has limited the number of ways in which I can be reached, and has allowed me to centralize and coordinate my communications in a way that I feel is protective for my attention, decision-making, efficiency, and overall psychological health.

But for many healthcare professionals today, the options for being messaged have reached almost epic proportions. Conventional routes of years past, such as office phone calls, faxes, and delivered letters, are still utilized, even if perhaps less and less.  Meanwhile, most professionals (both clinical and administrative) now have mobile devices, which means that they can be reached via a phone call (yeah, it still happens occasionally), text, or emails routed directly to their phone.  Now with the proliferation of electronic health records (EHR), all kinds of communication systems (e.g., portal communication, texts, instant messaging) are being adapted through the EHR system.  As if this wasn’t enough, most of us have a desktop computer, where we can still receive emails (which may or may not end up on the mobile device, or be appropriate to respond to there).  At the end of the day, it is safe to say that healthcare professionals can be reached in a double digit number of ways, and may have half as many systems that these messages can be routed through.  For better or worse, long gone are the days when practically all messages came through the front office or one mobile device (e.g., pager).

A couple of years ago, I had a conversation with a former administrator, who admitted that she was overwhelmed by all the ways in which she could be reached. She acknowledged that her attention and communication had suffered because of it, and that it left her more anxious and scattered.  Unfortunately, those who were sending her messages were usually more focused on reaching her quickly than being considerate of her state of mind and competing demands.  It was not uncommon for a physician to send an email only to follow up on it a couple of minutes later with a text, just to “make sure” she got the message.  I know she is not alone, and I must admit that as I saw that text pop up the other day, I had this sinking feeling that once again, we are sacrificing sanity for convenience and consumerism.  It would be one thing if each system was part of a larger command center.  But as each of these systems are used in different ways by different individuals, it is the “I” who is threatened to be left behind.

A few months ago, I gave my annual talk to a group of high-achieving 8th graders interested in being in the medical field one day.  As I have done before, I acknowledged that I don’t have a mobile device, and I also bike to work most days.  As so often happens, their jaws hit the floor and their hands hit the sky.  They were flabbergasted.  “How does your wife get ahold of you?” (Answer:  by office phone or email).  “How do your kids get to soccer practice?” (Answer:  one of us drives them).  “How do you get work done?”  (Answer:  many different ways).  The questions could have gone on for an hour.  It was as if my family and I were living in a hut with no running water and no rights to speak of, certainly not the “inalienable right [necessity]” of instantaneous, mobile communication of all kinds.

In some ways, it was another hilarious conversation. In some ways, it was really sad.  These future medical professionals were largely convinced that success and progress in this world meant being slaves to their devices and screens.  Even as they acknowledged all the ways the “communication revolution” could, and was, causing significant harm to their well-being, they simply saw no other option.  I think many healthcare professionals today feel the same way.  They must do what they are told, and just accept one more means of communication even if it seems far from the best practice of preserving their own health & well-being so that they can model and instill this in others.

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