The clicking doctors: how the mouse restructures clinical attention.

Abstract

The attention of office-based physicians is increasingly structured less by the patients in front of them than by the screen beside them - by the clicks, notifications, system lags, and task-switching that the practice information system demands. Research on cognitive load and burnout documents the demands of screen work, but commonly used outcome measures do not directly assess whether repeated fragmentation changes habitual patterns of clinical attention. This article pursues exactly that question: what screen work may change is less the amount of attention than its disposition. Drawing on research into attention residue, system response times, and time-and-motion evidence from ambulatory care, it identifies three mechanisms through which screen work restructures clinical attention: attention residue, response-time fragmentation, and interface-induced switching. Unlike cognitive load, these mechanisms may reshape the disposition of clinical attention itself - the way a physician attends to the patient, which may become shallower, more reactive, and more externally driven. The claim is marked throughout as a research-guiding hypothesis: the three mechanisms are measurable, their cumulative dispositional effect is not yet. It then shows why automation does not dissolve the problem, and why the growing evidence on ambient-AI documentation neither confirms nor refutes it. Because every finding cited remains compatible with simple time scarcity, the article specifies the design that would begin to discriminate between the two: a carry-over design presenting the same unhurried clinical task to the same physicians at the end of a high-switch and a low-switch day, scaled to a cohort with repeated measurement. It closes with three design requirements: switch ceilings, context preservation after interruptions, and protected attentional time.