Hi everyone, I just finished listening to Sapiens: A Brief History of Humankind by Yuval Noah Harari. One of Harari’s most provocative assertions is that historical breakthroughs, like learning to farm, were also calamities. While it’s easy to appreciate the value of agriculture, it’s even easier to overlook what we lose with progress.
As hunter-gatherers, early humans consumed diets rich in fruits, nuts, fish, and game. They developed advanced survival skills and could easily distinguish edible from poisonous plants. They ran enormous distances, climbed trees, traversed impossible terrains, and cooperated in groups to bring down elusive game. Hunter-gatherers overcame challenges that would destroy modern humans.
But when people started farming, they harvested vast quantities of food while becoming prisoners of the land. They became relatively isolated and forgot their survival skills. They slaved over crops- digging ditches, spreading dung, and pulling weeds. They consumed monotonous grain-based meals. They faced an ever-present risk of famine from pestilence and drought. They replaced the euphoria of hunting a mammoth with the tedium of milling barley.
So too the computer age, which brought both progress and calamity. Nowadays, we can google instantly, discover secrets in gargantuan data sets, and communicate instantly across thousands of miles. But we’ve also become slaves to social media and email. We’ve surrendered our privacy to Facebook. Instead of talking, we text, relinquishing the warmth, rhythm and nuance of voice. Like uninvited dinner guests, our smartphones sit on our dinner tables, intruding on our intimate conversations.
Is modern medicine following the same pattern? EMRs have made charts legible and accessible- but often redundant and meaningless. Digital radiography allows us to view x-rays and CTs anywhere and everywhere, but we’re less likely now to visit our radiologists to work through cases together. We pore through test results on the computer, seeking elusive clues, while overlooking more accessible and valuable clues embedded in patients’ stories. As we become increasingly proud of our mastery of technology, we marginalize the satisfaction available to us at the bedside, the magnet that pulled us into medicine in the first place.
It doesn’t have to be this way. We can commit ourselves to harnessing progress while acknowledging its risks. It would be ridiculous to deny the value of science and technology but just as ridiculous to ignore the fallout that occurs when we neglect our mission. What good is curing without healing? What’s the point of mastering sophisticated skills if we’re left feeling discouraged and burned out?
We don’t have to be Luddites or technophobes to recognize that progress has a down side. We can acknowledge the value of progress while cherishing and preserving what we value most. We won’t return to being hunter-gatherers, but we can put down the car keys and exercise. We can’t live off the grid, but we can look up from our screens and really talk to each other. And we can refuse to be slaves to the EMR and resolve instead to use the computer as a tool. And when we’re done with EPIC, we can log off, stand up, and enter the patient’s room, remembering that it’s our work at the bedside that heals our patients and, in the end, gives meaning and sustenance to our lives.
Have a lovely Sunday, everyone,
Mark
PS in honor of Residency Appreciation week, thanks again for the incredible work you do. I thought you’d particularly appreciate this piece just published in JAMA: https://jamanetwork.com/journals/jama/fullarticle/2677479?widget=personalizedcontent&previousarticle=2677478