Doctors Experiences of Interruptions in the Digital Age and the Impact on Clinical Care in England

Objective: Interruptions are frequent in clinical care globally and associated with inefficiency, cognitive burden, and patient safety risks. Existing research into interruptions reflects paper-based workflows, and 'digital distraction' studies often focus on personal device use. There is little research regarding interruptions produced by mandated digital infrastructures such as Electronic Health Records (EHRs) and clinical messaging platforms. This study aims to examine how mandated digital systems shape the form, experience, and meaning of interruptions in English outpatient care, and how doctors attempt to manage these demands. Methods and Analysis: We conducted a qualitative analysis of focus group and interview data from a larger study of interruptions in outpatient care. Participants were 42 UK outpatient care doctors across specialties and experience levels, recruited via a screener survey and stratified into six groups based on experience level and self-reported patient complexity (trainee, 0-19 years, and 20+ years' experience, each divided into high and low complexity). Data were analysed using Reflexive Thematic Analysis, with interpretation informed by the combined lens of Cognitive Load Theory and Social Identity theory; a pairing not previously applied together to interruptions, capturing both the cognitive and social-relational dimensions of digital interruptions. Analysis as structured deductively around these theories while remaining open to inductive, novel insights. Results: Four themes captured digitally mediated interruption. Mandated systems normalised constant availability, making interruption a persistent condition of work. Digital tools acted as cognitive amplifiers, increasing extraneous cognitive load through fragmented interfaces, multi-window navigation, and technical unreliability, with perceived safety risks around patient-context switching. Digital coordination occurred without social cues, weakening visibility and contextual signals that support judgements of relevance, urgency, and responsibility, contributing to interpersonal friction. Doctors sought to reclaim control through individual strategies, including limiting exposure to channels and selectively embracing digital prompts where they supported safety or care quality. Conclusion: Mandated digital infrastructures transform interruption into continuous, cognitively disruptive, and socially ambiguous demands. Mitigation requires system- and organisation-level solutions beyond individual workarounds.