Dickensian openings come to mind – the best of times, the worst of times; the height of free-thinking innovation, the pit of elitist centralization; a time when the internet buzzes with talk of artificial intelligence while the hospital residents continue to manually carry out tasks that could be easily automated by early 90’s technology.
It’s a curious time to become a doctor.
For residents my age, we were the last generation to have an early childhood without the internet. We remember when Youtube was new, when Facebook was cool, when Wikipedia did not yet have everything. Adapting to new technology has been our thing.
I started residency the year Uber became popular. I’d love to say I Ubered to the hospital on my first day to set up the metaphor, but I drove there. In any case, residency has been an experiment with time travel, and not in the forward direction. The regression is not just because hospital technology is 20 years behind, but because the entire system operates like a bulky and awkward dance that is trying to navigate today’s complex healthcare nuances with the same structure, isolationism and pedantry of a century ago. Through a pager.
If you are in medicine or have been a patient, then you probably know what I mean. If you are a guest to our spectacle, imagine you study for years to become a chef with the goal of helping people through delicious, healthy food. When you finally graduate and start an apprenticeship in a real kitchen, you find that you spend all day justifying the use of fresh ingredients according to the allowances of a diner’s meal plan, mixing things by hand because electric mixers, which you use at home, are not allowed. Putting any recipe together involves delivering letters on foot, written by hand, to different super-chefs. Some of them only give input on the amount of salt and sugar, others dictate the temperature of the oven (which might melt the sugar and change the recipe), and still others only cut the vegetables. You play on your iPhone while waiting for each super-chef to telegram you with his/her input, and wonder if it’s worth becoming a super-chef yourself. The people waiting to be fed get impatient because they are hungry and anxious, eventually receiving food that, for lack of a better word, is just meh. For most people, it’s their only way of receiving food. When they go home after rushing through the meal, you hand them a handout with vague rules about healthy eating, followed by recipes written in Finnish that they are expected to google-translate, and you have no time to explain further because you must run back to the kitchen.
If you are an apprentice chef and this is indeed the food industry, I’m sorry. And I hope you advocate for change.
While the rest of the world moves towards an open forum, medicine grinds on in a closed, unhealthy ecosystem. If the world of establishment medicine worked well – happy patients, happy doctors/nurses/staff, open access to healthcare, sustainable economics, pleasant work atmosphere – then maybe the two can co-exist. But the reality is we have none of those things, and we talk of physician burnout or resident suicide with equal parts concern and resignation. As the saying goes, it’s time to go back to the drawing board.
Now in my final year of residency, looking ahead like the proverbial ostrich looks around after taking its head out of the sand, I find that the landscape is changing. The eye of the storm is not quite here, but it’s gathering force.
The potential of technology in healthcare is much more transformative than faster MRI machines and fancier surgery robots. In the same way Amazon changed consumerism and Wikipedia changed information, applying technology can help us shed the baggage of doing things a certain way just because that’s the way it’s done. This transformation will happen whether the ivory towers resist or embrace it, and to resist would be to continue the most inexcusable waste – not just of money and material resources, but of human capital, creativity, time.
If residency is about learning as much as I can about what’s inside the box, then the next step is to think outside it, open it, and eventually replace it with an open space.