I recently came across an article by a family physician that was posted on the popular medical website, KevinMD. The article popped up on my Facebook feed with the title, “Today’s medical students take great selfies. But are they ready to be doctors?” You can read that article here.
I have to say that, although this post poses some legitimate questions, as a third year medical student, I find it a bit offensive – particularly the title. I feel like my medical training has been very, very good. We were taught how to take a good history and physical exam. I have been told over and over again that a good history will give you the diagnosis at least 70% of the time. And a good physical exam another 20%. We were told to never order a test unless we need to – which means only if it will change how we manage our patient.
The author states, “A different time means different ways of learning.” This physician seems worried that myself and my fellow students are taught in a different way. Yes, I have been very open about the fact that I liked to listen to lectures on double, sometimes even triple speed. My entire class was issued iPads to download lectures and use for our exams. I got a smart phone once I started rotations because I knew that it was necessary.
All of this technology is awesome! Just the other day my preceptor was telling me how lucky I am. If I have a question about something I can look it up instantly. He recalls having to drive to the library and find giant books to reference. It also means that all the data I find it up to date. Medical knowledge is constantly changing. Instead of having to look up a book that is 20 years out of date, I can read the latest article from specialists in the field that was updated within the last few months.
I am not one to take a lot of selfies. In fact, I can’t think of many of my classmates who do. Sure we all have smart phones, but we are not nearly as bad as our attending physicians. The day the iPhone 6 came out, that was ALL I heard about during rounds. Every single physician was cursing the fact that he couldn’t be standing in line because he had to work, and they all looking jealously at the Hospitalist who already had his.
The author goes on to ask, “Will the next generation of medical doctors have the deep knowledge and insight to solve problems?” I chose to go into medicine precisely because I wanted to solve problems. Just because we are young and have access to technology does not mean we lack the ability to think deeply. We are just new and fresh to medicine. Give us a few years, and we too will gain the wisdom from experience that so many physicians of his generation have.
He says, “You can’t Google future unforeseen or complex problems.” I beg to differ. You can google anything, dude. Attendings ask me to look stuff up for them all the time. Google allows one to find everything from the simple to the complex. Rare diseases, as well as everyday ones. As a wise preceptor of mine once told me, “We need to know more than google.” I believe that. Our patients have access to google, so why do they need us? Because we are doctors. Google is just another tool that I have in my medicine bag that the author didn’t have when he started out.
“Education is engagement which technology should not replace.” I totally agree. I am learning more on my rotations that I ever did sitting in a lecture hall or using my iPad at home. No matter how much technology we incorporate into medicine, it is still all about human to human interactions. Computers can interfere with the doctor-patient relationship, and I see it everyday. It isn’t in the younger generation, though. Sorry, my friend. We are much better at typing and talking than anybody over 40. I had a preceptor who liked to use a program called “Dragon.” It was supposed to allow him to dictate his notes and it would recognize the words and type them for him, thus saving him time. However, it was really, really terrible at recognizing a lot of medical words. So he would repeat a word over and over and over and over…sometimes 20 times, before he would type it in himself. Nobody in my generation would waste that kind of time. Ever.
This physician is not alone in his concerns. I am sure a lot of his peers are of a similar mind. However, I think he is way off in a lot of what he says. Here is a 26-year old medical student’s take on things:
Our current medical system is really, really messed up. And it isn’t because of Obama (well, not just because of Obama). A lot of people are to blame for it, including physicians. However, the only people who aren’t to blame for it, are doctors in training. We didn’t have anything to do with it. We didn’t develop EMR systems. We didn’t instill the work restriction hours. We didn’t create a narcotic dependency problem in this country. And we didn’t decide to start prescribing antibiotics like candy, contributing to some serious antibiotic resistant strains of bacteria. We didn’t do any of it.
The problem is not with doctors in training, the problem is with the system that has been created by doctors and administrators of the past. I am appalled at how lazy physician notes have become using new EMR technology. Templates are terrible, and with one click physicians can fill in their entire physical exam. 90% of the time the physical exam in the patient’s chart is worthless because it is clearly a lie. It is too perfect, and it is clear the physician did not even check all of those things.
A lot of older physicians are distraught at what is happening because they are clinging to the past. They miss the “good ol’ days of medicine.” That is why so many physicians are getting out. They are retiring or committing suicide. (sad, but true) What I am trying to do is figure out how to become a good physician in spite of it all. How can I use a crappy EMR system as best I can? How can I get all my notes done in a timely manner so I can spend more time with my patients? How can I learn everything that I need to learn to be a good physician, and still find time to have a family? (you know, so I don’t get burnt out and want to commit suicide in 10 years?) These are my concerns. It’s a really hard time to be a doctor in training, and it doesn’t help to hear that the physicians responsible for training me lack trust in my abilities because they think I take too many selfies.
The fact is, the “good ol’ days” are gone. Whatever they were. I have never known any different. So, instead of sitting around and complaining about how things have changed, my generation is trying to fix the big issues. It’s a daunting task, and sometimes I feel like I am too young and too inexperienced to be able to affect change. But, I’m willing to try. Don’t write us off just because we like to take selfies. We aren’t the problem. We are the solution.