Digital Addictions
2020; Lippincott Williams & Wilkins; Volume: 96; Issue: 2 Linguagem: Inglês
10.1097/acm.0000000000003831
ISSN1938-808X
Autores Tópico(s)Social Media in Health Education
ResumoI am addicted. My drug of choice is Haiku, the smartphone app for the EPIC electronic medical record (EMR) that imports patients’ information into my pocket with the touch of a button. When I open the app, an abbreviated version of the chart appears, anchored by a circular photo of the patient that mirrors a profile picture. Physicians can order medications and lab tests for patients on Haiku like I can summon Pad See Ew from my favorite Thai restaurant on Postmates. The app unearths a little digital window into my patients’ lives—their heartbeats and breaths, chemical imbalances in their blood, infections brewing inside their bodies, and current statuses at the hospital. As a millennial and a medical student, I pick up my phone an average of 149 times per day. I check Haiku at all hours. After reflexively scrolling through Instagram to see what countries my friends are traveling through, I will open up Haiku to review my patients’ vitals, scour the latest subspecialty recommendations, and analyze medication changes. On the couch watching TV, I will scroll through my email and then switch to Haiku. My habit of clicking through my apps just to check—even if there is no reason—has not changed. Haiku is just a new digital addiction. My obsession is unhealthy, but I cannot stop in the way I cannot stop checking Instagram. Watching lab values populate or vitals stabilize makes me feel an odd technological closeness to my digital patients. I am carrying them around with me in my pocket. The first time I found out that one of my patients died was through Haiku. I was slouched on my bed, nearly asleep. Scrolling through Haiku, I froze when I saw “Deceased” written in small letters under my former patient’s name. He was my first hospitalized patient. I spent hours at his bedside, updated family members, and tracked down his prized belongings from the local rehab facility. I stared at the little blue screen; this was all the closure I would have. I slowly read the emergency department note about how he decompensated in minutes. I scrutinized his labs trying to recreate his final moments. A sky-high potassium level led his heart into unstable rhythms. Signs of raging infection precipitated the failure of his organs. I closed the app, took a shower, and cried. This was weeks after I finished my rotation and I never talked to anyone about it. I am glad I found out that my patient passed away. It made me wonder what else we could have done. But I wish I had heard the news in person, with my team there to help me process what happened. I wish it did not feel like scrolling through my Facebook feed and accidentally discovering that an old friend had gotten married. The information was important. But the process unsettled me. It felt empty, and I wondered what I was doing spending my free time scrolling through a patient list. As a trainee, my addiction to Haiku is complicated. Many physicians now spend the majority of their day interacting with the EMR. 1 At my institution, medical students averaged more than 6 hours of EMR time every day during some rotations. 2 What would these studies show now with the creeping of the EMR—not only into our computers, but into our phones and our smart watches? I wonder how much time I spend on it at home, on my walks to the cafeteria, or on the way back to my car. Many have argued that the EMR and apps like Haiku have distanced us from our patients. I think it makes us too close. A resident mentioned they checked on a patient on Haiku while hiking on vacation. An attending admitted they tracked their patient’s hourly drain outputs from home after surgery. Portable versions of the EMR like Haiku erode into the few sanctuaries we have from the often all-consuming nature of our work. Yet, Haiku is functionally useful for patient care and a comfortingly familiar way of interacting with technology. From now on, I am going to try to create boundaries and stop checking Haiku as soon as I leave the hospital. Really, I cannot make any promises. But the first step is admitting there is a problem.
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