The struggle of a computer-based doctor

I saw shocking photos from Northern Italy and New York City, reviewed my life insurance, and thought about my three kids. I didn’t chicken out, but I thought about it long and hard as I sat, sipping tea through trembling lips, preparing—whatever that meant. In the end, I got COVID twice while working the frontlines. A few scars, disorders of my hearing, smelling, and tasting. I am dealing. Today, COVID is preventable, so I’m unlikely to cash my policy, making Erica a suddenly rich, yet sad, widow. My personal problems, small potatoes in the grand scheme.

Elated in this post-COVID landscape, I’ve resumed my regularly scheduled programming. With the panic button off, I face a more insidious death–being killed, slowly over time, by my computer. It would have been wonderful if this could have been mutilated by COVID, but, alas, like a cockroach, it survived. I wish I could find the comic silver lining in this slow-moving tragic farce.

I’m a doctor minted from an era of paper charts, the impending electronic age not yet arrived. There were few computers when I graduated from medical school in 2002. I watched with curiosity as electronic medical records, and hundreds of computers, arrived in the hospital, 2012 to present. Seen any Star Wars movies with rows of marching stormtroopers? There are several parallels.

Like many internal medicine doctors, I spend my days–working, breathing, eating–at my computer. My employer provides it just like most medical offices in America. What matters: it dominates my life and is slowly killing me. A bulky desktop, a throw-away Windows piece of junk. I don’t miss paper charts, believe me. I remember the pain when you couldn’t find the chart you wanted, couldn’t read the goddamn handwriting. If you’ve worked less than ten years in health care, this may sound like a quaint ditty—ye olde medicine. My memories of paper are not sepia-toned nostalgia.

After a decade as a computer-based doctor, this experience has altered me, and none of it is good. As an internist, what I actually do is prescribe medication and monitor its effects on humans. Blood tests, X-rays, biopsies, CT scans, and others, this is how I analyze bone marrow and whatnot. A computer is superior to a stack of papers. I get reports with details—patients seen, diagnoses, revenue, office visits.

Medical Big Data is here, courtesy of computer code. I am counted, sorted, analyzed—a unit of work, an unwitting participant in a digital “observation state.” My employer does not watch me moment to moment, believe me. But, make no mistake, they can easily determine the records I’ve accessed—in an instant. I stare at a computer but, in a very tangible way, it stares back at me.

Today, all patients are encouraged to contact me via an email messaging app. How is it even possible to simply add that to the other things that I do? You may (or may not) believe the short stories–novels–people write to me, simply because they can. It’s free, easy, and just like leaving a Yelp! review or ordering pizza. How any doctor can be expected to return this ever-growing pile of messages is beyond me.

Where the road of computer help ends and the vast territory of pain begins: Computer ergonomics leave me bent, leaning, squinting, inched up on the edge of a stool, one which is too small. My middle-aged eyes struggle under harsh fluorescent lighting to see numbers and letters. I had fog on my glasses because of my mask for three years. My keyboard dominates the small desk where I often awkwardly write documents. It’s the dumbest arrangement I can think of.

At day’s end, my neck, shoulders, hands, and lower back ache from craning to see the computer. I make it worse because, while I am typing, I address my patient, looking them in the eyes, doing my best to engage in the moment. I bend away from the computer, not hiding how much I love my patients, gleefully performing for them. Doing so pushes me away from my computer, making me squint harder.

That’s an apt image: me, bending away from the machine, reaching for the human in my exam room. After a decade, the impossible ballet of dancing between a computer and simultaneously performing for patients has left me worn. In my head, I picture a plant reaching for sunlight.

Depressed because this computer situation is my professional life, from now until I retire, I wonder if there’s an off-ramp or alternate option? None I can see. I am a buoyant extrovert, but the computer’s ability to drain my emotional reserve is unmatched by anything I’ve experienced. This cockamamie work environment gives me a never-ending headache, one which I have reluctantly accepted. Of all my midlife issues, this situation aches in my heart more than any other.

The computer depersonalizes my role, turning me into a pseudo-customer service representative, the difference between ordering pizza and contacting your doctor blurred substantially. In the past, these were different concepts, but I now resemble medical Netflix. Or, Amazon, except I deliver biopsy results. Society increasingly expects immediate communication from technology, and–more importantly–me. The line between technology and humans is now smudged. If we still had paper charts, my name would be smeared off the page, the letters illegible.

One of the saddest things I have sacrificed at the altar of medical records are lunch breaks. I left my building, a solid hour to myself. Early in my private practice career, 2006, I went–get this–jogging at lunch. This is not exactly ancient history, but it feels like it. Today, I work at lunchtime, every day, because I have to, the amount of computer work: fucking ridiculous. Skipping a lunch break is how I get prescriptions signed, labs reviewed, and office notes finished. Today, I ate lunch in 10 minutes, signed prescriptions, and used my second computer screen to glance at the headlines in The New York Times.

I greatly miss the downtime that lunch afforded me. And, make no mistake, it appears gone–forever. All of these negative computer-inspired changes lead me to believe I am no longer a human being in health care; I am now a unit of human doing. The computer has me constantly doing–clicking, signing, replying, sorting. I even have to pick a billing level and close the chart, or the computer will tell me I forgot these things.

The computer has destroyed time-honored concepts. It used to be clear just how many patients I could see, how many charts I could stack on my desk. Today, these items are “invisible” inside the computer, so it is not apparent how much work is involved. The number of electronic labs, prescription refills, and messages from patients–no limit whatsoever.

I struggle to maintain the strength to bend towards the human being and be recharged. It takes so much energy to do the basics, which are now complicated by passwords, clicking, signing, pop-up alerts, and hard stops. This device is slowly grinding my humanity into computer code.

Recognizing the negative impact is my first step in navigating the next twenty years. I find my first impulse when I leave work: move, give my eyes a rest and unwind the contortions inside my body. I now have technology-free hobbies. It was unintentional at first, but I don’t play video games, hardly watch TV, and avoid computers like the plague.

I had a terrible day at my computer this week, but a Seamus Heaney poem rescued me. A few brief, handwritten lines were all it took to remind me of the humanity coursing within me. I am constantly searching for songs, photos, poems, movies, and other art which stirs my soul.

Having survived a pandemic, one which cemented my instinct to trust my gut, I know exactly what I am going to do. I am doubling down on my arts and humanities, piling extra servings on my plate. Finding the Heaney poem was not an accident. I need this sustenance for the journey, one which requires I recharge under technology tyranny.

Thank God creative sparks light the fire and burn off the computer’s negative effects on me. I can’t make the computer go away. But, as the man who sits on the stool, I can decide whether I inch towards the screen or bend away towards my sunshine.

Ryan McCarthy is an internal medicine physician.

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