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After the Match

After the Match

A Tale of Two Brains

Cook, Thomas MD

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doi: 10.1097/01.EEM.0000503386.22483.08

    I worry when the information technology folks at my hospital make changes to our EMR system. An email is typically sent that says something along the lines of “In the future, when this happens, do not forget to click this box.” This usually happens about once a week (as in FIFTY-TWO times each year).

    My general impression is that it's difficult enough to learn so many new things when you are a resident, and when the EMR forces you to make incessant changes in your patient management, it adds more tension to a process that is already very, very stressful. But I am beginning to come to a realization: It's not the residents who are getting stressed.

    All residents will encounter an older attending that explodes in frustration about the excess information and work created by computer technology. These guys go nuts when endless lists of options for lab tests and medications show up on their EMR when all they want is a throat swab and some penicillin. In the old days, all the doctor had to do was scratch a few orders on a paper chart and ask the nurse to send the patient home. No login ID. No password to update (and remember) every six weeks. No notice regarding the software update taking place during your next night shift. Just see the patient, make the diagnosis, devise a plan, and execute.

    But for all the residents who think the old man is crazy, you need to appreciate how much more the older doctor has to change to keep up with your young brain.

    I was riding on the subway a couple of months ago in Shanghai, the largest city in the world. This city is off-the-charts big. Like 25 million people big. It's also incredibly new. The city's famous skyline was farmland only 20 years ago. It's also incredibly young. The vast majority of the city's working population is under 35.

    It's rush hour, and the train is packed with young professionals. But something is odd about this scene. It's really quiet. All you hear is the smooth, clean sound of an ultramodern train moving from station to station. As I look around me, I see everyone (and I mean everyone) has their eyeballs buried in their smartphone. It's the same scene everywhere in the world. Young adults' lives revolve around the screen in their hand. They cannot get enough of it, and they literally get separation anxiety if they cannot find their phones. Has there ever been a technology that completely overhauled how people communicate in such a short period of time? They not only surrender all their attention to these devices, they are shameless in their pursuit of interacting with it at all times. This includes eating meals, walking on a busy street, or driving a car.

    Humans have learned how to process the written word on a simple device called paper for the past 30 centuries. We adjusted our brains to create the neural pathways needed to use paper — with stunning results. Our species' ability to retain and pass on information through writing has allowed us to dominate (and potentially destroy) the world. However, 30 years ago the ultimate game changer appeared: digital communication. This marked the beginning of the end for the human use of paper, and the beginning of increasing frustration for older adults.

    If you were born after 1980 in the United States, you grew up interfacing with computer screens, and this was the driving force your growing brain used to figure out how to process information. You are a digital native, and words on paper seem awkward if not completely useless. Even words themselves have less utility for you. Common digital communication includes:

    ?4U I have a question for you.

    TTYL Talk to you later.

    YT? You there?

    LOL Laugh out loud.

    :) Smile (just kidding)

    :-< Very sad

    :-D Laughter

    For an LOL moment, check out this ESPN commercial with Duke's head basketball coach, Mike Krzyzewski, about emoticons:

    The commercial demonstrates young adult fluency in emoticon communication, but it makes old guys like me flinch. It's literally annoying to us. It's not that older adults cannot figure it out. Younger adults immediately understand every nuance of this type of communication, but older adults need to translate the information in their head to make sense of it. It may only take a couple of seconds, but over time this adds up and annoys. This is because older adults are not digital natives but digital immigrants, a slower thinking group of people who must use a different area of their brain to interpret this information.

    Now, when I say a different area of the brain, I literally mean different. Studies using functional MRI to look at which region of the brain is used to process information from digital communication find striking differences between digital natives and digital immigrants. This finding is incredible. After millennia of humans using specific areas of their brain to process written information, in the span of a few decades, digital technology is manipulating us to change how our brains are wired.

    To complicate matters, only digital natives create all the screen content on the web based on how they see and process information. Of course, this leaves the older brains in the proverbial dust. It's difficult enough to translate the odd abbreviation or emoticon, but to ask them to look at screen content through the eyes of someone with a brain that is structurally different sets the stage for frustration and nostalgia for simpler times.

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