It was 9 am at the VA hospital, and twenty of us sat in morning report exercising our diagnostic minds. A patient case was presented. We heard the presenting symptoms, the relevant history, the physical exam, and the laboratory values. We discussed how each new finding changed the probability of each potential diagnosis. In the same way that a professional golfer trains his golf swing or a swimmer perfects her stroke, here we were exercising the muscle memory of diagnostic thinking.
With each new fact, I felt my brain burn extra calories to compute the updated disease probabilities. I couldn’t keep all of the diagnoses in my head at once, and I couldn’t of course calculate an exact probability adjustment; all my figures were ballpark estimates. Diagnosis A, probably 50% chance, Diagnosis B, probably a 5% chance.
A resident physician in the back of the room raised his hand and offered a new possible etiology of the patient’s disease. Thirty seconds later as I looked back to see his reaction, I noticed he was back on his smartphone scrolling through Facebook.
I wondered if my current training is the contemporary equivalent of learning how to do math on a slide ruler. Everything we were doing in that morning report could be done better by a computer, and not in 20 years. It could be done better today. The thought made me sad, because the art and practice of diagnosis is one of my most sentimental ties to our profession.
But in addition to changing practice, I also wonder how the role of technology is changing us, both as care providers and as patients. As providers, we page, get paged, and return phone calls. We sit in team rooms all day, virtual islands in the hospital, communicating to nurses and pharmacists through electronic health systems. In many ways, the computer has become the new stethoscope. My most meaningful experiences in the hospital have come from interacting with patients, and much of physician burnout can be tied to being trapped in this digital-medical purgatory.
Our hospital can no longer function without an EMR. Our pharmacists can no longer compute doses without calculators and smartphone apps. But our society has to be attuned to when machines are distracting us from our purposeful lives. This is not exclusive to medicine, but the changes we see in medicine, this most intimate of professions, are canaries in the coal mine for a coming digital tsunami. As scientists, care providers, and community leaders, physicians need to be responsible for molding a strategy to brace for the impact of digital on our health and well-being.
Psychiatry’s DSM-V has already begun to recognize dangers of digital addiction with new diagnoses, but further research is needed to understand how digital is changing our well-being and our behaviors.
Are attention spans shorter? Is our creativity impaired? Are we more prone to aggression? And are we happier? Medical science needs to study these question and inform the public on the risks and benefits of digital engagement.