SINGAPORE — Patients may not think too much of a phone call interrupting a medical consultation, or a nurse knocking on the door midway — but these disruptions could potentially cause stress in healthcare workers, and increase the risk of them making medical errors, cautioned researchers behind a small-scale study by SingHealth Polyclinics (SHP).

Dr Agnes Koong, clinic director of SHP’s polyclinic at Marine Parade, had decided to conduct the study three years ago, after hearing feedback that some doctors found it challenging to juggle the interruptions that happen often in practice.

From September 2012 to June 2013, Dr Koong led seven other healthcare professionals to conduct a small study to examine the impact of phone calls during consultations in polyclinics. Fifteen patients and 16 healthcare workers took part in focus group discussions.

An article on the findings of the study was published on Sept 2 in BMC Family Practice, a medical journal on primary health care.

A concern that emerged was patient safety, as incoming phone calls could distract healthcare workers from the patient they were serving.

Explained Dr Koong: “When an interruption occurs, your thoughts get derailed, and your mind has to switch over to the new task ... it’s hard to get back to where you left off. If it’s not managed well, there’s the potential for errors. And if it happens multiple times a day, it can get a bit tough.”

The high volume of patients and service providers housed under one polyclinic also means that such interruptions mainly occur through the landline phones, the main mode of communication.

Consultations are interrupted at least once, based on their experience, added Dr Tan Ngiap Chuan, SHP’s director of research.

During the focus group sessions, one doctor shared how a pharmacist had called during a consultation to inquire about a patient’s prescription. He amended the patient’s electronic medical record, before turning his attention back to the patient in front of him. “If you are not absolutely conscious about this switch, you could end up prescribing under the wrong identity … these are near misses that have happened before,” the doctor said.

Other near misses reported happened when prescribing and dispensing medicine and immunisation, but Dr Koong noted that at polyclinics, there are checks in place to prevent mistakes from happening.

Patients, on the other hand were less aware of the risks of such disruptions, and simply viewed such calls as part of the healthcare workers’ job. Explained Dr Koong: “They just think it’s important for the doctor to take the call, but they’re not aware of what’s happening inside the doctor’s head … where there’s the challenge in getting the task right, and managing the anxieties they feel.”

But patients expected healthcare workers to exercise professionalism by not answering personal calls, and likewise patients showed respect by turning their handphones to silent mode or apologising and keeping calls short when they come in.

However, the study acknowledged that some phone calls may alert healthcare workers of errors, giving them a chance to rectify them.

Since last year, Dr Koong and her team have put up posters reminding patients in line to enter only after another patient has left the room, and educated staff to minimise interruptions. They also suggest finding alternative modes of communication like text messaging via computers or smart phones to alert healthcare workers on less urgent matters.

Said Dr Koong: “Basically, the bottom line is — can it wait? And if it’s a ‘it can wait kind’ of call, then (bring it up afterward).”

Dr Tan also raised concerns about a higher risk of errors occurring in the general practitioner setting, as medicine is dispensed at one go, but says that more quantitative studies need to be done to explore the impact.

He added: “There’s no one-size-fits-all approach to this issue — it’s a matter of being considerate, respect, and professionalism, (taking note) of all these values and doing what is necessary to minimise disruptions.”

The study was also presented at the Asia Pacific Regional Conference of the World Organization of Family Doctors in May last year.