Gupta A, Chennatt JJ, Singla T, Barabari GS. The Surgeon and the Smartphone – is the Association Really Smart? Hellenike cheirourgike. Acta Chirurgica Hellenica. 2020 ;92(5):177-181. DOI: 10.1007/s13126-020-0571-6.
Abstract
The aim of this literature review is to encompass the importance of integrating smartphones in the life of a surgeon especially in the era of the COVID-19 pandemic. With the progression of technology, telesurgery, remote pre and postoperative care, smartphone-assisted intraoperative navigation and transcontinental education can be made a reality. Nonetheless, rates of nosocomial infections have been raised and the increased use of a smartphone can compound this issue. Similarly, there is a greater potential for operator distraction, medical equipment interference and increased radiation exposure for the user. All the above create a new set of problems for the surgeon. We hereby attempt a review of the advantages and harmful effects from the usage of smartphones.
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Concerns with use of smartphones
1. Health care associated infections
Multiple studies have been done to demonstrate the association between use of white coats and incidence of hospital acquired infections. However, smartphones and mobile phones are used extensively by health care professions and are arguably a more common source of infection as compared to white coats in the current era.
2. Distraction
Smartphones are a huge distraction, especially in the operating theatre, not only for the operating team but for the anaesthesia team and circulatory staff as well. Studies have shown that the self-reported use of mobile phones among health workers ranges from once every 15 minutes to once every 2 hours [21]. Nomophobia, refers to discomfort, anxiety, nervousness or anguish caused by being out of contact with a mobile phone or computer [22]. This has become a significant problem even amongst medical field personnel and significantly increasing the level of distraction.
3. Interference with medical equipment
At present, there are no fixed guidelines or regulations on the use of smartphones near medical equipment in operating theatres or in the wards. The safest option is Irnich and Tobisch “one meter rule” which entails restriction of the use of phones less than 1 meter from medical equipment [26]. Most interference is in relation to the disturbance of the cardiac monitor signals [27]. However, with technological advancement, studies haveshown that newer equipment has become less sensitive to interference from external sources [25].
4. Radiation exposure
Multiple studies have been done to ascertain the risk of radiation exposure associated with the use of mobile phones. One such study showed that the use of cell phones for more than 50 minutes a day could be associated with early dementia [28]. In 2011, the International Agency for Research on Cancer (IARC) determined that Radio Frequency Radiation (RFR) emitted by cell phones belongs to Group 2B (“possible”) human carcinogen [29]. Current knowledge shows that there is ample justification to warn the general public that having a cell phone in close proximity is harmful [30]. Thus, surgeons are no exception to the same recommendations and should try to minimize unnecessary use.
5. Effect on body
Users of smartphones commonly maintain their necks at approximately 45 degrees of flexion. This causes an alarming level of strain on the cervical spine. In the neutral position, the head weighs a relative 10-12 lbs as compared to 27lbs, 40lbs, 49lbs and 60 lbs at 15 degrees,30 degrees, 45 degrees and 60 degrees respectively [31].This causes serious musculoskeletal consequences. Longitudinal studies have also shown that there is a relation with time spent texting and persistent neck and upper back pain. Thus, physicians and the general public should be aware of the potential strain on the spine by the use of smartphones and take appropriate measures such as posture adjustment to avoid ‘text neck’ and other detrimental effects [32].
6. Loss of personal touch
In spite of all the advantages of using a smartphone, there is definitely a lack of personal touch when using a smartphone for communication, especially with regards to patient care. The general lack of eye contact and face to face communication all adds to the perception of detachment. One possible way to mitigate this is to use video calls more often and be more expressive while texting.
7. Compromise to patient’s privacy
One of the major concerns with the use of smartphones in relation to patient care is protection of the patient’s health information. Prior to giving permission of the use of smartphones for storage of personal healthcare information, security threats must be thoroughly assessed.