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Authors Institution
David Ferguson
Nader Hanna
Abdul Hassan
University of Leicester
The Alexandra Hospital, Redditch
Theme
eLearning
Smartphones in Western medicine - is our use eroding core ethical principals? A review of clinical cases compromising medical ethics
Background

Ladies and gentlemen, we stand on the brink of history. By the end of this year the number of smartphones will exceed the number of people on this planet.Integration of this technology into the clinical care of our patients in western medicine is rapidly increasing, with research finding 75%3 of junior doctors own a smartphone and  57% admitting to using a smartphone during ward rounds.2 Through observation of clinical practice we discovered numerous situations where the use of smartphones has potentially compromised patient safety and eroded medical ethics. By focussing on real life scenarios we hope to draw your attention to this rapidly developing situation and begin to discuss options for a solution.

 

 

Summary of Work

Fruit Ninja in theatre 

Non-Maleficence

Dr H was observed to be playing the blockbuster game Fruit Ninja intraoperatively. This level of interaction with an electronic device increases the risk of distraction on the part of the anaesthetist. Research indicates it may take over 23 minutes for concentration levels and cognitive function to reach baseline level after interruption of a computer based task e.g. responding to an SMS message.4

 

“Text me the results”

 Beneficence

It is often simpler for doctors to communicate information to each other via smartphone messages rather than more traditional methods. In one notable example a consultant surgeon asked a junior member to SMS them a patient's blood results prior to listing for an operation. These methods of communication have inadequate levels of security - both in terms of remote data interception and in terms of physical access to message data on the handset in the absence of security code implementations.5-7

 

“Have you got iTranslate on that?”

Justice

The doctor/patient language barrier is increasingly becoming an issue. Expansion of the European Union8 and the relaxation of cross border travel is an example of  this. In our observed example, Dr T was unable to communicate with a patient and resorted to translation software on their smartphone in an attempt to expedite the consultation. The potential for miscommunication is vast owing to user input errors and software which is not accredited for use in the healthcare setting.

 

Face value 

Autonomy

Certain products on the Appstore demonstrate how patient autonomy is being eroded. The CALPOL® application9 attempts to diagnose childhood illnesses utilising a ‘symptom sorter’ algorithm. User inputted data feeds software which then exclusively recommends a formulation of CALPOL® and pharmacies from which it may be obtained. The popularity of this app increases the risk that further apps are in development, resulting in the potential for further erosion of patient autonomy.

Conclusion

Examination of these cases evidences the threat to patient safety and medical ethics that use of smartphones in western medicine poses. The rapid expansion in the number of handsets1 and their use means the current situation is set to escalate. We believe one solution is to integrate education on correct smartphone use into the curriculum for medical students and junior doctors.

 

 

Take-home Messages

Through current methods of smartphone usage in western medicine, patient safety and core medical ethics are becoming increasingly at risk.  As this is the year in which the number of smartphones overtakes the number of humans on the planet, it is time for us to address this issue as a collective body to ensure smartphone technology is utilised correctly, in our patients' best interests.

 

If you have any ideas on how we could move forwards and improve the situation please contact us on twitter @ferg1986 for a discussion in an open environment.

References

1. "Visual Networking Index (VNI)." Cisco. http://www.cisco.com/en/US/solutions/collateral/ns341/ns525/ns537/ns705/ns827/white_paper_c11-520862.html (Accessed 15th July 2013).

2. Katz-Sidlow RJ, Ludwig A, Miller S, Sidlow R. Smartphone use during inpatient attending rounds: Prevalence, patterns and potential for distraction. Journal of Hospital Medicine 2012;7 (8), 595-9.

3. Payne KF, Wharrad H, Watts K.  Smartphone and medical related App use among medical students and junior doctors in the United Kingdom (UK): a regional survey. BMC Medical Informatics and Decision Making 2012, 12:121

4. FastcompanyWorker. Interrupted: The Cost of Task Switching.www.fastcompany.com/944128/worker-interrupted-cost-task-switching (Accessed 14th July 2013)

5. National IT Industry Promotion Agency.  IT planning series: the trend of mobile computing security technology. Seoul, Korea; 2011. Department of Health. Choosing Health: making healthier choices easier, CM6374. London: Stationery Office; 2001.

6. Ho AJ. Security of smartphone pouring. Inf Secur 21C. 2010; 114; 54.

7. Schrittwieser S, Fruhwirt P, Kieseberg P, Leithner M, Mulazzani M, Huber M, Weippl E. Guess Who’s Texting You? Evaluating the Security of Smartphone Messaging Applications. SBA Research. Vienna. 2011, http://www.internetsociety.org/sites/default/files/07_1.pdf (Accessed 15th July 2013).

8 "Stay Connected." European Commission. http://ec.europa.eu/enlargement/countries/strategy-and-progress-report/index_en.htm. (Accessed 15th July 2013).

9. McNeil Healthcare (UK) Limited. Calpol. (Version1.1) [Software] Apple Appstore. Available from: https://itunes.apple.com/gb/app/calpol/id519071291?mt=8.

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Background
Summary of Work
Conclusion
Take-home Messages
References
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