Why you can’t use Google Glass when you’re talking to a patient

After using Google Glass for a few months in various medical settings, one of the silliest things I hear and read about is how you can use Glass when you’re talking to patients.

Don’t get me wrong, I think there are plenty of uses for Glass in medicine.

I made this clear last month when I wrote an article titled, How Google Glass will save your life one day.  In that article I highlighted how Glass will be used in medicine, but also touched on how I was perplexed by people who think Glass can be used in patient encounters. I’ll elaborate more.

The typical scenario I hear and read about is the following: How cool would it be if I(physician) was talking to a patient, and I could read about their prior H&Ps and lab and imaging results at the same time. It sounds like a good concept, but you can’t do this without being rude to your patient.

To understand why, you have to understand the facial look someone has when they are actually using Google Glass. If you get any notification or message on Glass, your right upper visual field is immediately taken up, and you can’t help but dart your eyes quickly to read the message or alert. I call it the blank glazed over stare. This stare is what the patient would see when they are talking to you and have their eyes fixed on you — not ideal.

Imagine talking to a patient and looking at your watch in the middle of the conversation — it’s the same loss of eye contact, except at least when you look at your watch your patient knows what you’re reading. With Glass, if you’re talking to someone, it’s immediately noticeable if the person is looking at their Glass screen in their right upper visual field. Even if you’re able to train your eyes to only look straight at the patient and ignore the alerts and messages in your visual field, if you’re in close proximity to the patient, they will be able to see your Glass screen lighting up. Not professional.

The counter I will hear to this is the following: But plenty of physicians use Laptops or tablets when talking to patients! While this is true, when you’re using a laptop or a tablet with a patient, they have a better understanding of what you’re doing. You don’t have a blank glazed over stare on your face as you do with Glass. The look just isn’t as awkward.

As I mentioned in my How Glass will save your life one day article, there are settings where not meeting typical medical professionalism guidelines is trumped by the acuity of the patient — such as a crashing patient or during a procedure.  But for a low acuity setting, such as the clinic where you’re discussing  a patient’s back pain, the use of Glass should be done appropriately.

So how are you supposed to use Glass with patients? I’ll discuss the etiquettes of using Glass for patient care in my next article.

Remember, though, when talking to a patient in a low acuity setting and actively using Glass at the same time, there is a good chance you’re coming off as unprofessional.


Iltifat Husain, MD

Founder, Editor-in-Chief of iMedicalApps.com. Assistant Professor of Emergency Medicine and Director of Mobile App curriculum at Wake Forest University School of Medicine. He is also the founder of iPrescribeApps, a platform for prescribing apps to patients. Dr. Husain has given lectures on digital medicine globally. He went to North Carolina State University for undergrad and went to medical school at Wake Forest School of Medicine.

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19 Responses to Why you can’t use Google Glass when you’re talking to a patient

  1. Stuart Ray January 22, 2014 at 10:04 am #

    This may be the most purely subjective post I’ve seen on imedicalapps. Not a step in the right direction, IMHO, but it’s your site to do with what you wish.

    • Iltifat Husain, MD January 22, 2014 at 1:17 pm #

      What’s wrong with a subjective piece and giving ones opinion?? The piece is a commentary piece. Even journals have opinion pieces? I’d love for you to elaborate how it’s not a step in the right direction?

  2. Jay January 22, 2014 at 2:44 pm #

    I think it is BS that a patient would feel offended by your gaze getting distracted while checking something on Google glass. It is hyped (the physician-patient eye lock, I mean) and so we need to wake up and face reality. After all, the patient will benefit more (always more) if I am processing data for his/her benefit rather than stare emptily into the eyes of a patient without knowing the name of a drug or relevance of a test or whatever. Instead, knowledge can always be brought into a ‘real time’ mode with Google Glass and the interaction for the patient (from a perspective of depth of information for one) with the doctor becomes meaningful. We should stop being such super duper ultra sensitive providers.

    • Iltifat Husain, MD January 22, 2014 at 6:39 pm #

      I think everyone agrees here that glass is useful with patients (look at the article I reference prior), but the physician patient interaction / eye contact isn’t overhyped at all. If anything, a physician staring off into space is going to distract the patient as well and not help with the history. I think we need to be mindful that it’s important we have a good rapport with patients, treat the patient, and not just the numbers we see. The less time we spend actually interacting one on one with the patient in favor of looking at numbers, the more we lose of our physical exam.

  3. Amy Donahue January 22, 2014 at 6:28 pm #

    Hmm, interesting, but I take a little bit of issue with this. I think it’s just a matter of time before something like Google Glass does become commonplace, and just like looking at a watch or laptop, patients (or anyone in any social setting) will understand. It will be become a common pattern of human behavior, as long as it becomes used regularly. The laptop example itself is proof of this – it wasn’t long ago that using a computer during a patient encounter was not understood at all (and I’d argue there are still plenty of places where this is true, but it’s rapidly changing, as it will when Google Glass becomes common place). And people are becoming more and more adept at multitasking, so I think you may be putting limits on human capabilities that we just don’t know are there yet.

    I think the much bigger issue with using Google Glass in a patient setting is *privacy.* There is no way we could promise our patients that Google isn’t taking their data, associating it with their name, their previous Google searches, and now their physical appearance and even possibly recorded conversation with their doctor. This information would be more than a goldmine for people trying to sell ads, and perhaps much more evil purposes.

    I also somewhat agree with Stuart – opinion pieces certainly have their place, but this article doesn’t add a lot to the conversation. I appreciate what you’re trying to say, but it would have been much more interesting and informative if you had linked to data about patient reactions to different technologies in clinical settings, or had some interviews etc. Even just some specific examples of what you mean by the “blank glazed over stare,” which may mean very different things to different people. As it stands, it’s just kind of a stream of consciousness from a single person. But in general, I love this site, I just thought I’d respond to “elaborate” request. Thanks!

    • W H February 12, 2014 at 2:33 am #

      People do multitask. It is a neurophysiologic impossibility. W switch focus from one task to another, perhaps rapidly, but we do not multitask. And focus does demand that we do this. Observe pilot training. Inability to multitask is ingrained in pilot training, with its emphasis on scanning protocols in order to safely perform a multitude of tasks when multitasking is a known impossibility. Note the remarkable multiple in auto driver reaction time when texting is added to the driving mix.

      Google Glass may become more accepted over time, but it would serve doctors well to keep the patient apprised, keep them “in the loop” if we must use Glass to look up a drug or dosage in real time. Glass, more than any heretofore widely utilized data retrieval system, excludes others from our on-line interactive processes. And doctor-patient interaction is not well served with this distancing phenomenon.

      We constantly advocate that pts be involved in their care decisions. Glass is a measurable step away from that. Unless perhaps, the patient has Glass also, and doctor and patient Glass are networked.

    • @CleverKibitzer April 21, 2014 at 3:28 pm #

      I have to respectfully disagree about the privacy challenge comment by Amy. Secure encryption is no more difficult with Glass than it is with a smart phone. In addition, simply connecting Glass only to a hospital’s intranet is a pretty good security measure in itself. Google can’t access anything there, backups don’t happen from there, and all other patient data is already secure.

      As for the practicality of using Glass in the presence of patients, as a patient I would much rather have my physician taking 5 seconds to glance up at a Glass card (hands-free) rather than wheeling over to the computer to type on a nasty keyboard before wheeling back around to finish my exam. Ick.

  4. Stuart Ray January 22, 2014 at 7:47 pm #

    The major flaw I see in this “article” is illustrated by the belief just repeated – that a provider reading something from Google Glass will seem more distracted/less caring than a provider looking at a laptop/tablet/phone/computer; perhaps the body language of facing the patient (as opposed to a desktop/laptop computer) will offset a distracted look that might become familiar (and therefore less disturbing). Without DATA this is simply speculation, yet it’s the heart of the “article”.

    BTW, I don’t agree with the tone of Jay’s comment – I DO think we need to be abundantly aware of the quality of our interaction with the patient.

    Any claims about impact on care should be backed by evidence. Surely IMA’s editors know this – Evidence Based Medicine is one of the strongest justifications for using IT in the healthcare setting.

  5. Iltifat Husain, MD January 23, 2014 at 11:27 am #

    I think Jay’s comment and your counter show the importance of this dialogue — that with technology and distractions we might have opposing views of how important keeping eye contact with patients can be. I think it highlights the importance of this article as well.

    The main purpose of this article was to stimulate a discussion on how there is a misperception that when you are actively using Google Glass, you can maintain eye contact with a patient, and in someway how that is better that traditional modes of consuming content (this has been perpetuated by various techy blogs). Since most physicians (hardly any) do not have Glass yet, my purpose was to show people through my experiences how this is not the case. So no, there is no “data” to back this, but for there to be “data”, it would take a few months, setting up a trial, and then publishing in a journal, and then having it out in a year when it’s a moot point.

    It always perplexes me how we as physicians are so worried about writing opinion pieces based on our own perceptions with technology. The problem for waiting on evidence in the informatics ecosystem is that by the time we publish material on how information technology should be used in peer reviewed journals, developers have already created the apps / technology. They don’t care about waiting on studies. It’s why I always tell my colleges we have only ourselves to blame for complex / annoying EMR systems. We decided to take the back seat, run clinical trials on information workflows on EMRs, and by the time we published data, the developers had already created the systems and the “data” was essentially worthless.

    I’m most gratified by developers who have emailed me / messaged me on twitter who are creating physician centric apps for Glass and were grateful this article was released so they had a better understanding of the interaction between a physician and patient. They were buying into the hype that somehow having vital signs next to the patient on your Glass screen would enable you to keep eye contact with patients and would produce less distractions.

    That alone was the purpose of the article — glad this article did simulate this discussion. I think it’s essential as physicians we continue to write about our experiences / opinions of new technologies, so it can guide developers and makers of physician centric apps / software in the right direction. Otherwise we only have ourselves to blame when apps / software are created for us to use that don’t make sense.

  6. W H February 1, 2014 at 3:26 pm #

    As a physician initially trained in the era even before Bill Gates fiddled with his Altair 8800 and still actively practicing in the EHR environment, I overall agree with Dr. Husain.

    Roughly 85% of human information exchange is nonverbal. And all of that is lost in computer/database information exchange. Patients do not come to you for your ability to browse Google while interviewing them. They come to you for many reasons, not only your supposed expertise, but in search of someone with expertise who will also care about an interact with them as a person, not merely an object for inspection and possible repair. I say this because over reliance on complex information systems for care and treatment continues to move us away from the nonverbal interactions that are personally important to our patients, important to our ability to render care that is diagnostically on point for that person in particular, as well as tuned to the complex needs of that particular patient, and are hard wired into the DNA of our species from millennia of natural selection.

    Simply wearing Glass entering a patient interview conveys copious information about you to the patient, far more likely negative than positive, setting the tone for the entire visit. Initial impression become set in stone within seconds, and are usually only altered over very long and complex interaction. You don’t need that.

    Next; using Glass while interviewing a patient potentially reinforces many negative things to that patient. that first glance into the corner view, conveys a lot of negative sense. You are focused on the data an not the patient. Or you are perhaps unsure or inexperienced. For good or ill, you are reminding them that you care more about the data than about them.

    EMR/EHR/cloud based medical information, (in this case via Glass) while useful, must deal far more with the complexities of what a human being is, before it can substitute for, or even very much assist, assets that are more important: knowledge you personally possess, experience and compassion.

    Excellent point, Dr. Husain.

    • Iltifat Husain, MD February 9, 2014 at 2:33 am #

      Great thoughts put together nicely. Completely agree w/ the nonverbal aspect — so key.

  7. Jim Hutchinson MD February 8, 2014 at 1:39 pm #

    Patients love it when new technology is used, especially if their physician explains how it will help them. You might even give them a quick look at the “glass.” Explain that I may seem like I’m distracted when your information comes to me in my glasses, but believe me this brings me the information I need right while I’m here to care for so that I can act on it immediately.

    The art of today’s medical practice is the blending of our most valuable technology while retaining the human factors that at one time was such a large portion of what we had to offer. Best we use it in the best interest of the patient/practitioner team that is engaging the health challenge opponent.

    And yes, there will always be a learning curve with the rapidly evolving technologies; it’s a portion of our 21st century CME.

    • Iltifat Husain, MD February 9, 2014 at 2:34 am #

      I think instead we’ll have a system where when you’re talking to a patient you’re not wearing glass, but it’s hanging around your neck. when you ARE using it, you place it then.

  8. Peter Jones February 8, 2014 at 4:44 pm #

    It’s a sad commentary on what has happened to our profession that folk would need this pointing out. It’s mind-bendingly rude (and risky) not to give the patient (or anyone else for that matter) your full attention when you’re listening to them. Never mind where your eyes are, it’s where your brain is that matters. People pick this up in an instant. Laptops and computers are not much different btw

    • Iltifat Husain, MD February 9, 2014 at 2:35 am #

      Agree — thats why these types of discussions are so key. Right now there isn’t much of a “standard” w/ this.

  9. Jennifer Joe, MD February 20, 2014 at 5:17 pm #

    I think these are great points. It will be interesting to see how patients react to a physician wearing Google Glass. I definitely think it will be tricky, and down right inappropriate at times.

    For example, doctors notoriously don’t have time to eat. We compensate by always having a power bar in our coats, and eat bites of it in between patients. Have you ever tried eating in front of a patient? They are 100% upset every time you do it, even if you’re just chewing the end of a few bites that you took in the hall.

  10. Rafael Grossmann April 21, 2014 at 10:06 am #

    Iltifat, great points and nice summary.
    I really believe that it is all about a change of culture, good communication and education.
    Things that are new and today appear ackward, will be common behaviors tomorrow ( just as now it is for texting, looking at the smartphone screen intermittently during a face to face interaction, signing on a screen, dictating on a computer, drawing on an electronic board, etc.)
    We will all adapt to technology, as long as it makes processes better; forums like this one, lots of ” preaching” by innovation evangelists like us, and wise writing like yours, will certainly guide the change.

  11. Angus Matheson May 3, 2014 at 3:14 am #

    I have never used glass in a clinical setting. However I do use a phone and computer regularly. What I think patients hate, and my experience with glass makes me think it will be more of a problem, is when I’m dealing with something other then them during their visit. I think glass lends itself to the “you just got a text message from your wife” not “oh thank god he is looking up a medicine that will save my life” when you are looking at it. There is something that people, in San Francisco at least where they have had the most exposure, really dont like. Re/code had a funny, insightful column about a night with glass. I find in this modern age I am so much more distracted in life and in the exam room which is a bad thing. I think glass, as it is currently imagined, increases distraction in the exam room. I am confident there will be a time when our technology helps us focus on the patient. I just don’t know what that would look like.

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