Imagine, for a moment, an epidemic sweeping the country. No one is immune. Its vague symptoms range from physical to mental, but they appear unrelated. Unlike during COVID, however, there is no outcry from health officials, the government, or the public. The problem is widely felt but rarely confronted; its insidious nature allows it to pass as normal. Therefore, the medical and scientific communities have made no serious effort to diagnose or treat it. Doctors ignore it, failing to recognize the myriad ways it can present in patients and in themselves. The disease spreads unabated, wreaking havoc on society with no end in sight. What I have described is not science fiction, but reality. I am describing the disease of smartphone overuse, and primary care doctors need to start doing something about it.
Americans spend over five hours per day on their smartphones. They look at their phones while eating, waiting in line, going to the bathroom, riding in an elevator, and frighteningly, while driving. Among children, this phenomenon is particularly well documented, and serious public health efforts have been made to address it. As of late 2025, 35 states and Washington, D.C. have signed or enacted laws or policies limiting student cell phone use in K-12 classrooms. These efforts are laudable and critical, but smartphone overuse affects adults just as dramatically, and no similar public health efforts yet exist to address it. Primary care physicians can, and should, step in to fill this void.
As a primary care physician, I see patients every day who present with neck pain, blurry vision, anxiety, insomnia, inattention, and a general sense of unease. Prolonged and frequent smartphone use is often a major contributor, if not the outright cause. Repeated movement of the upper extremities in awkward postures has been shown to be a major contributing factor to musculoskeletal symptoms such as neck, shoulder, and upper back pain. Smartphone overuse is also closely associated with increased stress, decreased focus, anxiety, depression, and sleep disruptions. Despite these well-known, well-documented connections, I hardly ever discuss phone usage with my patients. Why do I, and most of my colleagues, ignore this obvious link?
I see several possible reasons. Primary care physicians are notoriously rushed and overworked. A 2022 study found that a primary care physician would require 26.7 hours per day to see an average panel of patients and follow national recommendation guidelines for preventive, chronic disease, and acute care. While AI, team-based care, and other initiatives have reduced the burden, PCPs are still forced to cover a lot, usually more than is possible, in an average visit. We’re understandably disinclined to add even more to our plates.
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Moreover, for patients, discussing phone use may feel invasive and awkward. Patients come to their primary care physicians expecting guidance on things like diet and exercise, not a lecture about screen time. An element of hypocrisy may exist as well. For a PCP, counseling a patient on phone use may ring hollow when the doctor giving the advice is just as tethered to his or her device. The evidence from obesity management bears this out. A 2002 study found that patients seeking care from nonobese physicians indicated greater confidence in general health counseling and treatment of illness than patients seeing obese physicians. We primary care physicians, then, must disentangle ourselves from our phones, so we can face these challenges with our patients effectively and confidently.
But the stakes are too high to allow time constraints and timidity to impede primary care physicians from addressing this critical topic. The health consequences of phone overuse range from the predictable, psychiatric and orthopedic, to the underappreciated. Take, for example, heart disease, which is the leading cause of death in the United States. One person dies every 34 seconds from cardiovascular disease, accounting for one in every three Americans’ deaths. Smartphone overuse is a clear, new risk factor for cardiovascular disease, one which primary care physicians must get comfortable discussing with patients. Research has shown that high-frequency phone users were more likely to forgo opportunities for physical activity in order to use their phones for sedentary behaviors, and that cell phone use was significantly and negatively related to cardiorespiratory fitness.
Primary care physicians, with their broad scope of training, are perfectly positioned to diagnose and treat the condition of smartphone overuse, which affects nearly every aspect of our health. The appetite is there among patients. Two in three Americans say they want to cut back on phone use, primarily to make better use of their time; physical and mental health concerns are also driving the desire to reduce phone usage.
So how should primary care physicians broach the topic? Simply raising awareness is a start. PCPs can start by lightly probing smartphone use as part of the annual physical. Over time, this discourse should become a critical component of a patient’s social history alongside diet, exercise, sleep, and alcohol use. Ultimately, primary care physicians should examine and monitor phone use as if it were any other vital sign.
Motivational interviewing, a technique originally developed to treat addiction and substance use disorders, can be helpful. Primary care physicians have successfully utilized motivational interviewing to help patients resolve ambivalence and change their behavior. A systematic review and meta-analysis found that motivational interviewing had a significant and clinically relevant effect in approximately three out of four studies, and that physicians obtained a positive effect in approximately 80 percent of studies, including in as little as 15-minute encounters. But like many effective practices in medicine, motivational interviewing requires specialized training and time, both of which many doctors lack. Nevertheless, even a basic foundation in motivational interviewing can be helpful for PCPs to navigate and address patients’ smartphone overuse.
Motivational interviewing relies on open-ended questions, affirmations, reflections, and summary statements to empower patients and guide them toward healthier behaviors. This technique provides space for patients and doctors to acknowledge the benefits of phone use, such as staying in touch with friends and family, navigating a new city, listening to music, and booking an appointment. Motivational interviewing also recognizes that not everyone will be ready to reduce (or even discuss) their phone use, and that is OK. In fact, much like eating healthier, exercising more, or quitting smoking, physicians cannot make these changes for their patients. Our role, rather, is to meet patients with evidence-based counseling techniques and plant a seed. For some patients, and some doctors, that seed may grow into something worth putting the phone down for.
Justin Oldfield is a family physician.
