Jay Kuten: Ghost in the machine

I'm giving away my age when I say I can remember when we weren't dependent on our devices, our cell-phones and our computers, to help us manage our busy lives. The takeover has been an insidious process that began, as all things nefarious, with the promise that these things, computers, would save us a lot of time

I had an inkling that the promise was an empty one back in the 1980's when I got started playing with the first available cheaper Korean knock-off of the IBM home computer — the one that cost $3000 USD — which had a DOS-based operating system and 360K of random access memory. Just trying to set the thing up to print out a string of words on my accessory dot-matrix printer frustrated me and sucked me in to spend an all-nighter. I was still asleep when my wife, discovering my zonked-out form, wrote on the paper roll, "Are we impacted yet?"

"Impacted", the conversion of a noun into a verb, had some currency for a time, when suddenly lots of things were "impacted". That's one part of the collateral damage we've sustained. Computers changed our language. Suddenly "impacted" was part of everyday conversation. It's jarring to these old ears but has become part of accepted English, alas. Techies begat jargon begat geek talk begat acronyms, begat Twitter and now look at the results.

In a manner that feels correct but is difficult to quantify — the very standard of computer success — my writing ability has been diminished by my use of computers. I gave up my #2 pencil and writing pad when even I couldn't decipher the words later, in favour of an IBM Selectric that I loved. The discipline imposed by at most a second draft and carbon paper meant I had to think through and organise before getting started.

Now cut-and-paste is obsolete. "Ctrl C" and "Ctrl V" means any number of false starts is possible. Unless I learn to write as well as Janet Malcolm, who can create an award-winning book out of "47 False Starts" all I have is an accumulation of fragments that sit permanently in a file called BitsNPieces, on my computer.

Enough about my personal lack of discipline. The true sympathy should be extended to the old, and even more to the new generation of doctors and, by implication, their patients. Surgeon/writer Atul Gawande's essay (New Yorker November 11, 2018) says almost everything necessary in its title alone: "Why Doctors Hate Their Computers." He tells the story of the promise of increased "efficiency"from electronic medical records that has led to high rates of burnout among practitioners, particularly general practitioners.

The original idea seemed a good one. The availability of data across disciplines and time would allow for better patient care and improved outcomes. But something has begun to go wrong.

The system that promised to increase the doctors' mastery over their work has instead increased the work's mastery over the doctors. And patients aren't necessarily better off. For many it's become frustrating, as their doctor's attention is to her computer, not her patient.

As the computer programs evolved within medical institutions, administrative demands for accountability resulted in increased workload. Time for interaction with patients is exceeded by the time necessary to input data about that interaction.

Moreover, the data required is made more standardised for efficiency's sake, squeezing out physician innovation. Loss of autonomy lowers innovation, increases burnout.

If the effect of standardisation is to eliminate individual initiative and therefore innovation, then we're all lost.

The science of medicine is an arc that bends toward better facts, by virtue of improved testing of hypotheses. The art of medicine inheres in the human interaction. As the magic is dispelled by science, patients and doctors are equally in need of resisting becoming a mere part of the system, to multiply their individual capacities for empowerment.

Unlike the binary logic behind computers, a dynamic doctor-patient relationship exceeds by far a zero-sum game.

* Jay Kuten is an American-trained forensic psychiatrist who emigrated to New Zealand for the fly fishing. He spent 40 years comforting the afflicted and intends to spend the rest afflicting the comfortable.