Welcome to the Ethics Forum! The optometric profession has long recognized its ethical responsibilities to patients, colleagues, other health care professionals and the public. This forum provides an opportunity to review a hypothetical case study containing potential ethical challenges and includes suggestions on how one might handle the situation based upon the American Optometric Association Standards of Professional Conduct and Code of Ethics.

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Cell Phone Interruptions

By Morris S. Berman, O.D.

Case Study #5

During an examination, your patient receives a cell phone call and says "Excuse me just a minute, doc."

You sit there wondering what to do next.

DISCUSSION:

Many factors contribute to the development of the doctor-patient relationship. At the outset, patients have an expectation of how they want to be treated and use this gauge to assess the outcome of their visit to the office. Other factors contribute to the patient's experience including the courtesy and efficiency of the office staff, the office ambience, waiting time in the reception area and ultimately, the interaction with the doctor in the exam room. Patients expect to have the doctor's full attention on them in order to receive the appropriate health care. Distractions occur, however, with some regularity during the examination. Examples include an office staff member entering the room with a note or verbal message for the doctor; an examination instrument might not be in working order; the EMR system is not functioning normally; or the doctor might receive a phone call from one of the staff members or a professional colleague.

Other interruptions may be forthcoming from patients themselves. Examples include a patient becoming ill or having an allergic reaction to diagnostic drops or medications applied during the examination. In these situations the doctor has to decide how to best assist the patient and this may also result in also having to reschedule the visit to complete the eye health examination.

A more recent intrusion in the business world has been the widespread use of mobile digital technology, specifically cell phone and smartphone usage. According to a 2014 study by the Pew Research Center1 90 percent of American adults own a cell phone; 64 percent of American adults now own a smartphone of some kind, up from 35 percent in the spring of 2011. Smartphone ownership is especially high among younger Americans, as well as those with relatively high education and income levels. Sixty-two percent of smartphone owners have used their phone in the past year for information related to a health condition. In addition 7 percent of Americans rely heavily on a smartphone for online access.

The interruptions caused by cell phone usage by patients have become more common in the examination room and this impacts the rapport between the doctor and patient. The examination is automatically placed "on-hold" and the patient is now dictating the progress of the office visit. The doctor can respond to the interruption in one of several ways:

  • Be patient and understanding by waiting for the call to end. This is a passive response and gives the benefit of the doubt to the patient who may not be aware of the lack of courtesy extended to the doctor. On occasion this response by the doctor may be justified to spend this "time out" by completing the patient examination information in the chart.
  • Tell the patient that they cannot use the cell phone except in an emergency. This is a firmer, more assertive approach to remind the patient that the priority in the exam room is always focused on patient care.
  • Leave the exam room telling the patient, "I will be back." This enables the doctor to take care of other patients and office responsibilities. This is efficient use of the doctor's time and also sends a message to the patient that answering personal phone calls during an office examination is disrespectful and has consequences.

Interruptions of this nature are becoming far more frequent as the population adapts to the access of social media and the reliance people now place on their mobile devices for instant communication. The challenge for the doctor is to respond in a professional manner that clarifies how the phone call has disrupted the examination. The habit of constantly accessing the internet/phone calls, etc. is distracting to others whether it takes place in an examination room, a classroom, a movie theater or a business meeting. A helpful way to minimize these disruptions would be to post a sign in the reception room that reads, "Cell phones should be turned off in the examination room" or alternatively, "Cell phones should be turned off in the office." This message would be consistent with announcements to audience members that often precede public events including movies, theatre, etc. Assuming that doctors expect their patients to respect "cell phone etiquette" in the office and during the examination visit, the behavior should be reciprocated by the doctor. Personal phone calls should never be accepted by the doctor when caring for patients. Exceptions would be appropriate for any family emergency and for calls within the office related to a pressing patient matter. In a study of interruptions during general medical practice, most patients did not believe the interruption affected the consultation2 . However, a minority of the patients (18 percent) reported experiencing a strong emotional response to the interruption.

The AOA Standards of Professional Conduct says doctors of optometry should conduct themselves with good character in all of their actions to build trust and respect with patients, the public and colleagues. Good character includes but is not limited to honesty, integrity, fairness, kindness and compassion.

Whatever approaches doctors take, they and their staffs need to be as fair and consistent as possible to foster and further the doctor-patient relationship.

References:

1. A. Smith, U.S. Smartphone Use in 2015, Pew Research Center. April 1, 2015

2. Dearden, A., Sanders M., and Thaper, A. Interruptions during general practice consultations - the patients' view. Fam. Prac. April 13 (2), 166-9, 1996

3. Davidson, J. Five Ways Physicians Can Minimize Interruptions. Retrieved January 16, 2016, from http://www.physicianspractice.com/blog/five-ways-physicians-can-minimize-interruptions