The illusion of multitasking

Yesterday I went through the drive-thru of a local fast food chain. The young lady manning the register asked for my order, so I started giving it to her. She asked me to pause for a second, and when she resumed she repeated the first part of my order back to me. She had it completely wrong. This happens to me all the time in the drive-thru, which is why I typically avoid them at all cost. Yesterday I made an exception and instantly regretted it.

People working drive-thru windows at fast food joints typically try to multitask, i.e. take an order from one person while trying to put an order together for another, and so on. In my experience this usually results in what happened to me yesterday. Frequently I have to repeat part, if not all, of my order. I find it quite irritating.

Multitasking is a myth, plain and simple. People do not have the mental capacity to concentrate on more than one thing at a time. Don’t take my word for it. There’s plenty of evidence to back up my claim.

Christopher Chabris, PhD is a professor, research psychologist, and coauthor of the best-selling book The Invisible Gorilla. His research focuses on two main areas: how people differ from one another in mental abilities and patterns of behavior, and how cognitive illusions affect our decisions. He has published papers on a diverse array of topics, including human intelligence, beauty and the brain, face recognition, the Mozart effect, group performance, and visual cognition. He was also the keynote speaker at the unSUMMIT that I attended last week. The presentation was fantastic.

According to Dr. Chabris everyone thinks they can multitask, but very few can. His research estimates that a mere 2.5% of people can “do ok as a multitasker”. Unfortunately his research has demonstrated that everyone thinks they can multitask, and those that consider themselves true multitaskers tend to do the worst in experiments that require one’s attention.

Everything that Dr. Chabris spoke about applies to pharmacy, but I found two things particularly interesting:

  • Post completion errors – this is when someone forgets to complete the last step of a process. Examples include leaving an original paper on a copy machine, or in healthcare, when someone leaves the guide wire from a PICC insertion in place. Even when people are told they forgot the final step they often can’t figure out what went wrong. Dr. Chabris refers to this as “satisfaction of search”, i.e. you see what you expect to see. This type of thing happens all the time in pharmacy practice, especially during the distribution process and the IV room.
  • “Illusion of attention” – this is when people think they can pay attention to multiple things at once. He refers to this as an “everyday illusion”, of which multitasking is a prime example. These misconceptions are hard to overcome and systematically wrong. How many times have you witnessed a pharmacist or pharmacy technician trying to do more than one thing at a time – talk on the phone while filling a script, retrieve tablets from a “Baker cell” while on the phone, etc? Happens all the time.

Overall the presentation was solid and the information valuable. I recommend taking a look at Dr. Chabris’ work. The concepts can be applied both directly and indirectly to errors that occur in the pharmacy.

I used a telemedicine service for the first time and loved it

My daughter woke the other morning with the following complaints:

  • itchy eye
  • watery eye
  • “feels like there’s sand in my eye”
  • and from my observation, redness in the “white” of her eye

Hmm, I’ve seen this before. My initial thought was conjunctivitis, a.k.a. “Pink eye”.  I called our family pediatrician looking for something to hold us over the weekend until we could be seen on Monday. Basically I was saying it looks like Pink eye, so let’s  treat it like Pink eye for the rest of the weekend and I’ll follow up with you on Monday. Unfortunately I got the nurse practitioner on call. She wasn’t very cooperative. She wanted me to take my daughter to the urgent care to rule out periorbital cellulitis. Really? You jump from itchy, red eye with a slight watery discharge to periorbital cellulitis? I thought that was rather ridiculous, so I ignored her and hung up the phone.

Sounded like a good time to try a telemedicine service. My insurance company, Anthem Blue Cross, offers a a service called LiveHealth Online. I followed the link provided by my insurance company, downloaded the app, and by 7:30 am on Sunday morning my daughter and I were sitting on the couch in our living room speaking with a Family Practice physician about her eye.

I let my daughter do all the talking. I was simply there to make sure things went smoothly. The physician asked several questions about how my daughter was feeling, about her eye, who she’d been in contact with, and what she had been doing over the past several days. The physician had my daughter hold her eye up to the front facing camera on her Galaxy S5 from several different angles to better view of the eye. Conclusion? Conjunctivitis, probably viral. The physician decided to treat with some anti-bacterial eye drops “just in case”. A prescription was electronically sent to our pharmacy and that was it. From beginning to end the entire visit took less than 15 minutes.

It’s been about 36 hours since we started treatment and her eye has improved significantly. Overall I have to say that my first experience with telemedicine was fantastic. A trip to the urgent care would have taken several hours and been quite inconvenient. I have to say, I believe now more than ever that telemedicine has a place in healthcare, especially for things like this.

Periorbital cellulitis my rear.

Keeping up with the Joneses, or how pharmacies choose technology

Recently a colleague sent me a link to the FierceHealthIT article below. Much of what the article had to say rang true for me.

Hospitals covet neighboring facilities’ technology: “Facilities were more likely to acquire a new surgical robot if neighboring hospitals had done so, according to a study from a group of private and government researchers published in this month’s Healthcare journal… The authors found that a hospital whose neighbor had acquired a surgical robot was more likely to also get one….According to the authors, the results suggest that tech adoption may be driven “in part by competition among neighboring hospitals rather than solely by the mission to provide optimal patient care.”

This is consistent with what I’ve witnessed in pharmacy technology over the past several years. In my experience pharmacies rarely choose the technology that’s right for them. It’s much more likely that pharmacies will make decisions based on usage patterns of other local hospitals, i.e. word of mouth. That’s why it’s so important for companies in the pharmacy technology sector to get people using their products. It’s not like the consumer market where new technology can often unseat an incumbent with a whiz-bang feature or some clever marketing. No, in pharmacy it’s likely that once a decision is made that decision will stick for many years.

It’s also important for pharmacies to ensure that they’re making a wise decision when it comes to implementing new technology. They should ask themselves two questions: 1) what do I need it to do, and 2) will it fit my workflow. Answer those two questions and you’ll know if it’s right for you.

Saturday morning coffee [August 2 2014]

“A journey of a thousand miles begins with a single step.” – Lao-tzu, Chinese philosopher (604 BC – 531 BC)

So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

The coffee mug below is relatively new. I picked it up in Las Vegas at M&M World during one of my daughter’s volleyball tournaments earlier this year.

Yellow M&M Mug
Continue reading Saturday morning coffee [August 2 2014]

Desire to see more collaboration between pharmacies and local universities

Bitwise Industries in Fresno is an interesting place. It’s basically a tech hub pulled together by some great local minds. Located in a nice little area in downtown Fresno, BitWise has tasked itself with taking “a burgeoning tech industry that was growing in silos in California’s heartland, add places that inspire community, collaboration, and growth, create accessible education that equips and empowers a homegrown army of technologists, deploy talent to execute technology success stories”. I visited the facility with my brother, Robert when it first opened. Impressive and inspiring.

But this post is not about BitWise. It’s about something I’ve been thinking about for a couple of years. BitWise was simply a catalyst to remind me to revisit my idea.
Continue reading Desire to see more collaboration between pharmacies and local universities

Moving from the Motorola Moto X to the Samsung Galaxy S5

s5_blackA short time ago I was an unwilling participant in my Moto X being dropped on a concrete floor.

Over the past year or so I’ve been working with a colleague on a book about the state of automation and technology in pharmacy IV rooms. During this time I’ve made several site visits to acute care pharmacies to look at the technology, workflow, etc in their IV rooms. As part of the data collection process I not only take a lot of notes, but snap lots of photos and record video of technicians working with the technology. I find the photos and video invaluable when reviewing my notes.

Prior to entering the cleanroom at one large hospital back east, the pharmacist in charge insisted that he wipe down my Moto X with alcohol. I wasn’t thrilled with the idea, but it was either let him do it or not take it in. I opted to let him wipe it down. During the process he dropped my Moto X. It hit the concrete floor pretty hard and bounced. The back popped halfway off. Not good. Since that time my Moto X has been acting weird, freezing up, not taking voice commands, and so on. I finally decided to replace it through the insurance I carry on the device.
Continue reading Moving from the Motorola Moto X to the Samsung Galaxy S5

New Questions for Pharmacists in the Health Care System [article]

Am J Pharm Educ. 2014;78(2)1: “The pharmacy profession is determining how it will become a vital part of new health care models such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs). Pharmacists must be prepared to demonstrate their value in these emerging health care models by improving the quality of care, reducing health care costs, and enhancing patient access and satisfaction. The health care decision makers will require demonstration of value, framed in business language, using new measures of outcomes quite different from what have been used in the past for pharmacy services. Colleges and schools of pharmacy should take on the task of developing these new measures demonstrating pharmacist value in collaborative care delivery, and instruct students in how they will need to demonstrate their value in new health care models.”

Interesting view from the authors. I’m not opposed to calling for colleges of pharmacy to develop measures to determine the value of pharmacists, but I would caution those developing these measures to learn from others. Physicians defined their measures and outcomes long ago and are paying for it dearly now. Pharmacists should not seek to mimic such a model, i.e. valued on the number of interactions, patients seen, and billable events.

The time for proving that pharmacists can actively participate in patient care is past. The data is there, but the profession continues to think that providing even more data will flip a switch that will instantly make pharmacists a valued member of the healthcare team. That’s not likely to happen, even in the data-driven healthcare environment of today. Pharmacists are viewed quite differently from physicians and other direct patient care providers like nurse practitioners, and rightly so. As pharmacists continue to fight for “provider status” they should consider carefully the end goal of such a fight.

Let’s not forget what pharmacy is all about. Pharmacy is about providing the safest, most effective, cost conscious therapy possible. That doesn’t necessarily equate to “provider status”.  What happens when the primary concern of our profession is no longer pharmaceutical care? Who will provide such expertise when pharmacists no longer concern themselves with such things? I do not recommend living in the past, but I do recommend thinking long and hard about the future of the profession.

Go read the entire article, it’s only a few paragraphs long. I’d love to hear your thoughts.

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  1. Joseph T. DiPiro and Robert E. Davis (2014). New Questions for Pharmacists in the Health Care System. American Journal of Pharmaceutical Education: Volume 78, Issue 2, Article 26. doi: 10.5688/ajpe78226

Is pharmacy informatics defined well enough to be a specialty?

Pharmacy informatics remains in its infancy as a profession. What started out as a job for tech-savvy pharmacists with working knowledge of pharmacy has turned into an ever expanding career field.

I’m looking through the ASHP Summer Meeting Informatics Institute schedule and the topics are varied. I see something on human factors, information management, clinical decision support, and e-prescribing. And that’s only on first glance.

If you look at job descriptions for healthcare systems seeking informatics pharmacists you’ll see everything from involvement in strategic development of services to data entry by monkeys, and everything in between. There’s little consistency in what one facility is looking for versus another. That point alone is telling.

This reminds me of pharmacy practice in acute care facilities 20 years ago. Outside of academic medical centers pharmacists were largely involved in operations, and only slightly involved in other care activities. That’s all changed as pharmacists practice in many different areas today and can specialize in a variety of disciplines, i.e. infectious disease, cardiology, etc.

I think we’re heading in that direction with informatics as well. The field is so vast that being a informatics generalist will soon be impossible because the information will be more than one person can reasonably be expected to handle. The influx of consumer technology and the need for better interoperability between systems will ultimately drive informatics pharmacists to specialize in one, or perhaps a few, specialized areas.

I consider myself an informatics generalist, but wonder how long before I won’t be able to keep up with new developments in the field. I’m already seeing signs of specialties within pharmacy automation and technology, it won’t be long now until we see it in other informatics areas.

Ultimately pharmacy informatics cannot be a specialty as the subject area by definition requires generalist knowledge. Eventually I think we’ll see practice specialties like we do in pharmacy practice today. Until then creating a pharmacy informatics specialty makes little sense.

5 Shady Ways Big Pharma May Be Influencing Your Doctor

AlterNet: “When it comes to acknowledging the influence of gifts and money on behavior, doctors, like everyone else, suffer from self-delusion. Most say they believe it affects the other guy, not them, and many become offended at the idea that they are “for sale.”

Trips to resorts and strip clubs will likely continue to diminish under the Physician Payments Sunshine Act, but there are many other ways, often sneaky, that Pharma can entice doctors to prescribe its expensive, patent drugs.”

Physicians, just like everyone else, are subject to bias. I rarely come across a physician that’s been practicing for more than 10 years that relies on up to date scientific data and/or guidelines to drive their prescribing habits. I can’t tell you the number of times I’ve had a physician say “because the drug rep told me” in response to my question regarding their use of a specific drug over another. That answer doesn’t instill confidence. 

Here are the 5 methods of influencing prescribing habits as listed in the article:

  1. Spying on Prescribing – “By selling the names, office addresses and practice types of almost every doctor in the US to marketing firms the AMA netted almost $50 million a year
  2. Continuing Medical Education Courses“…these classes are often “taught” for free by Pharma-funded specialists, sparing doctors from having to pay for them but providing the objectivity of a time-share presentation.
  3. Ghostwriting – “Being published in medical journals is essential to academic doctors but researching, writing and reworking papers is a formidable job. Luckily for doctors, Pharma is willing to help—as long as they write what Pharma wants.”
  4. Speakers Bureaus – “Few things combine the ego stroking and fast cash of being paid to speak—and Pharma has no trouble finding takers at $750, $1000 and more per pop.”
  5. Clinical Trials – “Pharma-funded clinical trials can be paydirt to doctors, yielding as much as $10,000 per patient in some cases.”