PRESCRIBING LESS SCREEN TIME
As a pediatrician my wife upholds a fiduciary responsibility to the wellbeing of children. She advocates for the safety of neonates by ensuring proper car seat installation. She promotes the effective and timely vaccination of infants against communicable illness. And, addressing another aspect of modern child-rearing, she counsels parents on the appropriate amount of screen time to which the young should be exposed while growing up in environments saturated with electronic media.
This worry about early overuse of technology arises partly from concern that the passivity of consuming content deprives children the physical benefits of active play, prefiguring sedentary lifestyles that will only cause our societal epidemic of obesity to worsen. Less tangibly, the plasticity of developing brains may also make them more vulnerable to delayed socialization in the absence of a hands-on upbringing; the artificial, unilateral stimulation of nascent attention spans by TVs and smartphones can never fully replace nurturing interactions with real-world caregivers.
All of these anxieties about weaning the next generation off an unnourishing stream of digital content are well-founded. But I would issue the same prescription for limited screen time to fully-fledged physicians, lest their own computer-enhanced caregiving fall into the uncanny valley between genuine contact and the inauthentic mimicry of connection with a fellow creature.
Screens are now ubiquitous in clinics and hospitals, to the point they are literally & figuratively coming between us and the individuals we treat. Medicine’s core encounter between two humans — one seeking help, the other offering it — is increasingly seeming to the former like a depersonalized exchange, inflected more by checklists than compassion. There has been an appreciable shift in emphasis during in-person visits from their needs to those of our electronic medical records. As we pivot from portraiture to pointillism, their unique details are being elided for the sake of expedient keystrokes; social histories have morphed from explorations of their identities to reductive inventories of their vices; billing and compliance have taken precedence over sympathetic listening and earnest problem-solving. The EMRs’ hunger for information is insatiable, and, for some healthcare administrators, our discrete value as revenue-generating clinicians lies in how many quanta of patient-derived data we can feed into these systems’ gluttonous cores.
The more monitors have diverted our focus during “face-to-face” encounters, the more patients have used their own virtual tools to recapture our attention, using extreme measures when necessary (look no further than the vitriolic outrage fueling the #doctorsaredickheads hashtag that trended worryingly on Twitter). The correct course of action in response to this recent unpleasantness is not to retaliate or retreat but to reassert our own identity as healers.
Yes, we will still have to click the mouse and match misfortunes to the arrestingly comprehensive list of vicissitudes encoded by ICD-10 (the elementally improbable ‘V91.07: burn due to water skis on fire’, anyone?). The contemporary clinician may indeed remain under tremendous pressure to maximize efficiency, tempted to spend their precious minutes with each patient engaged simultaneously in data entry. But our gaze is too easily diverted from the person in need to the documentation of their problem. Furthermore, it has long been known that spending a mere forty seconds on purposeful kindness can effectively comfort those under our care, and if we cannot spare a minute for such solace then perhaps we are in the wrong profession.
I do not condone the trolling tactic of puerile insults; in the case of #doctorsaredickheads, though, the coarse, chorused language of the otherwise-unheard signifies a cry for recognition that I believe should be heeded. There is value in feedback, no matter how caustic or unsolicited, because it gives us insight into our patients’ interiority, otherwise unknowable, far beyond the discernment of labs and scans.
In acknowledging our Tweeting detractors, I think we can separate constructive criticism from calumnies and prove to those we serve that, whether in the flesh or virtually, we are, indeed, listening.
First, however, we need to turn our attention away from the screens and toward the people behind them whom we are duty-bound to serve.