In 1986, the United States and Canada mandated the adoption of a center brake light on all new cars. Studies had shown that this was better at getting attention than the two side lights alone, and reduced collisions.
Of course, as the years went by the safety benefit gradually faded. It never returned to the previous level, but clearly, as people got used to it, the new light faded into the background of their attention.
Dr. Allan M. Block
Today, we have electronic health record (EHR) systems that use all kinds of pop-up warnings to check INRs, to give flu shots, to consider COPD in the differential ... a million things. I’m sure the attorneys love them. (“Doctor, since the computer clearly warned you about this, why did you click ‘ignore’ and move on?”)
I don’t use one of those systems, but I talk to plenty of doctors who do. Initially, it was interesting and got their attention, then became annoying. Each pop-up window interrupted the chain of thought, distracting them from the task at hand: patient care. As time went on, they just began ignoring them. It’s easier to click “cancel” than it is have to think through something you’ve probably already considered.
So, like the center brake light, the well-intentioned pop-up window is ignored and pushed to the far side of your attention span.
Do these things improve quality of care? Probably no more than the center brake light reduces car accidents these days. They’re likely useful in training, to remind medical students and residents of things that are important, but beyond that would be a tough case to make.
I’m not saying attending physicians are infallible. We all make our share of mistakes in this world. But medicine is not a one-size-fits-all field. The EHRs, at least at present, can’t take into account as we do all the variables of each patient’s personality, social situation, compliance history, medication tolerance issues, and other factors.
Not only that, but the pop-up window saying, “Have you considered this?” is no less distracting than having to take a phone call during a visit. It’s intrusive, throws your train of thought temporarily onto another track, and requires a minute to refocus on the task at hand. In that time, you may have forgotten something equally, if not more important. Or missed some critical piece of information the patient mentioned.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.