Saturday, July 13, 2013

The Clash of Cultures

"It looks like you've done very well, Mr. Smith..."

"Thank you, doctor."

He left the patient's room and ambled back to the nurses station, legs tired and ankles somewhat swollen.  It had been a long case and now he just had to type his note, send an email message, and review his schedule for the following day.  He sat down at the computer and logged in.  That's when he looked up briefly and saw them.

They looked so young.  Their newly-pressed white coats accentuated the faint glow of the computer screens on their perfect skin.  They looked like thoroughbreds, while he the old horse put to pasture, if they had noticed.  But they were each staring intently at the electronic screen arranged along the desk countertops, one with his back to the other two.  Occasionally the one would turn to ask the other two a question, then return with a blank stare to the screen before him.  The new residents had arrived.

"So different," he thought.  There they are, seated before a computer looking more like telephone operators rather than doctors.  "What were they thinking?" he wondered silently, then pondered how things had changed.

For now he realized that they didn't have to know where the blood or microbiology laboratories were.  They didn't have to search for an x-ray.  Instead, they had to find which button to click.  This day, this moment, was probably their dream come true.  For it was the day they had waited and worked so hard for, the day they became a working doctor.  Underneath the electronic facade, they were probably excited, eager, wanting to do a good job: excitement and anxiety, all rolled up into one.

But somehow, it was different.  The new doctors rarely looked at each other as they stared vacantly into their computer screens.  It was as though they were transfixed by medical porn.  It looked as though they were being bred into an interchangeable electronic medical documentation team, not a cohesive, personal one equipped with interpersonal skills.  After all, they really didn't have to see or listen to each other any more. They could send each other an e-mail, text messages, or chose to stay isolated, listening to the rapid-fire clicking taking place next to them.  Emotionally and physically, they could be miles apart or seated together, it really didn't matter any more.    It was so efficient, so neat, that their organized orientation to electronic dehumanization required very little movement, very little patient contact.

But young doctors, he realized, were meeting their patients like they've always met new friends on Facebook: electronically first.  Was this better?  He wasn't sure.  Would the initial impressions garnered from the chart skew their ability to look independently and objectively at their patient?  Will they be capable of accurate empathy?  Will a patient's undocumented concerns be missed?  Will new doctors forget to use the subtle signs and symptoms brought forth by the physical exam to head off disaster or just wait for the test results to return before reacting instead?  Will they see enough, smell enough, do enough, sweat enough, to learn enough?

He wondered.

But they were young.  They could learn.  They would learn.  They'd adapt.

And they could type faster.

Perhaps.  Maybe.  We'll see.  "I can only hope," he thought, realizing he wasn't getting any younger.

He turned his gaze back to his own screen and clicked the icons slowly, the way he had done hundred of times before, filling his note with voluminous immaterial drivel the government required, then added a single line: "Doing well.  Home today."  So meaningful, he silently quipped, meaningful indeed.

He rose to say goodbye to the unit clerk, who smiled as she peeled her eyes from her iPhone, "Goodnight, doctor."

"Take care of the new guys, okay?" as he pointed to the people behind her with the new white coats.

"You bet," she said, not turning to see them.  Her eyes reset to to her iPhone screen instead.



Anonymous said...

Went to see my niece and a football game last fall - same college I went to for my first degree. Not a soul on The Quad. Very odd, it was always full of kids studying in groups or taking a break when I was there. Heck, nobody en masse walking to the stadium for the football game either. What the Hell?! They were all alone in their rooms, I know. I think the football stadium was full of alumni for the most part.

They don't have any idea how this lack of socialization in learning/life will affect them, and us.


Anonymous said...

a. friends my age bemoan big family gatherings, which include relatives from distant cities.. all sit around glued to ipod or some kind of hand held device.. nobody talks to each other.. they are all plugged in.
b.according to social worker still in education field, a dramatic increase has been noted in the need for SPEECH therapy for elementary kids because they are unable to pronounce/articulate their language..
c. not one doctor has noted that a family member of mine has difficulty walking.. They don't view her entering exam room and once in they are so involved with the laptop, they barely acknowledge her. As she is content with her care, my hands are tied.
d.lack of socialization leads to aberrant behavior in the population btw

Anonymous said...

Welcome to the Matrix, Doc!

Anonymous said...

Great post, Doc Wes! This is a topic that I have often thought about. In particular, this paragraph:
But young doctors, he realized, were meeting their patients like they've always met new friends on Facebook: electronically first. Was this better? He wasn't sure. Would the initial impressions garnered from the chart skew their ability to look independently and objectively at their patient?
Unfortunately, some doctors and nurses in the past labeled me after reading that I had psych history in my profile. In one instance, a nurse actually gave the doctor report on me by making a crucifix with her hands, as if I was an evil thing. It hurt. I was on medication and getting treatment but someone years ago had entered my psych history prior to getting treatment. In my opinion, nothing beats face-to-face doctor and patient. The electronic age is a great advance to medicine--and a bad one.

Anonymous said...

Had minor exposure to EMR (nurses and lab only using, docs still on paper)
since Sept '12. Recently exposed to nearly full EMR at another facility and with no training, I found it took 30 to 60 minutes per pt to "complete"
the chart. Had 28 pts over 18 hours,
so non computer time was 2-3 hours.
After two more shifts I am down to 20-40 min/pt and doubt it will get
much better.