Continuous Partial Attention

Continuous Partial Attention–while reading a blog post this morning that term jumped out at me. The last few weeks of juggling a laptop while talking with patients have made it obvious how easily distraction can take away from the doctor-patient interaction. Right now the computer interferes with my ability to give complete attention to my patients’ stories. Did I have the same problem way back in third year medical school when my first ? I don’t recall taking pen and paper in patient rooms back then, but do remember trying to juggle all the things I needed to ask–chief complaint, history of the present illness, past medical history, family history, medications. Then there were things that needed to be looked at–vital signs, physical exam, nurses notes, ER notes–followed by the assessment and plan. These were all foreign terms and workflows to me. Was I intensely listening to the patient then or more likely, worrying about what I’d forgotten to ask, or do, or write down or study? My earliest instance of Continuous Partial Attention (let’s call it CPA so I don’t have to keep writing that term) with patient care must have begun then.

Early in practice I found ways to control the CPA triggers–a snack of nuts or fruit around 10 am to keep my sugar from dropping out; keeping the phone on silent (there are medical programs on it that I use routinely so I can’t leave it on my desk); using meditation techniques to bring me back to the patient if I find my brain wondering off; exercising and sleeping routinely so I have enough energy for my day.

It’s not just doctors who have the CPA issue. Many times I recognize the same thing going on with the patient–the gentleman this morning who needed to be at work and was only half-listening to my advice regarding his medication and exercise compliance, the woman who thought bringing three kids to her physical was a good idea, the patient who was recently diagnosed with cancer and nearly oblivious to any other health concerns, or the husband with a terminally-ill wife paying little attention to his own health (or me).

Surely the CPA will fade away as I find a path to making the electronic record become as unobtrusive as the paper one once was (hint to IT dept–smaller tablets would help with this…just sayin’). In the meantime, one of the more important lessons on the EHR learning curve is finding a way to move the laptop out of the center of the conversation–figuratively and literally.

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