Millennials, Neymar and The Sea of Impertinent Negatives

As promised, the synopsis:

• I’m a millennial
• Soccer is very important to me
• Diving in soccer is a maladaptive behavior akin to the practice of current medical learners
• To better serve humanity, you need to “learn from the people whose lives you will touch.”

It seems only fitting to write my next blog post while sitting at an airport “restaurant” on the eve of the World Cup final. While I watch the lackluster and impassionate end of the 3^rd place match, the camera pans the crowd illuminating no dancing or singing, but most eyes in a downwards gaze locked tightly to their backlit handheld lifelines to the world. Peaking over my laptop screen is an incessant tablet that constantly barks at me with flashing lights to please pay attention to it. To please enable it to supply me with all the worldly information I could currently care less about. Don’t get me wrong, I’m not complaining. The freedoms of this technological world allow me to order without speaking to anyone and it is an introvert’s luxury I love to indulge in. A luxury of this generation.

I see myself as a pioneering millennial. Myself and others my age entered this world on the wave of the internet. And during the years that are most emotionally impactful (the hormone-injected teens), I was slapped in the face by TRL, AOL, MTV, VH1, N64, PS2, and TMNT. That last one is Teenage Mutant Ninja Turtles (not a product of my generation; I was just seeing if you were paying attention). In high school, the reality that every piece of worldly information was at my fingertips had not quite set in. Nevertheless, I had embraced the world’s interconnectivity through TFC (Team Fortress Classic, an addictive online team-based game and one of the firsts of its kind). Come undergraduate school in Nashville, the world that I had ignored so effortlessly was now so obvious and exciting. The slippery slope initiated by Facebook’s introduction during my freshman year.

The concept of being able to find out anything about everything is what I think forms the roots of millennials and is completely manipulating how we function in society. I could get political and use the fact-checking fad during the United States most recent elections, but I know better. Instead, I will re-invoke my passion in life. For the first time ever in the World Cup, referees are utilizing the simple fact that video replay brings to surface their biggest mistakes. The best way to evolve is to use this advantage for their benefit. To allow video review to increase their accuracy and to make their decisions super-human. But perhaps what helps make soccer so loved by the world is human error. From the ridiculousness of a constantly ticking clock to referee error, the game represented sport before technology. Unfortunately, the best in the sport learned to augment their effect on the game by exploiting human error. And, just as the Neymar memes have peaked and the game has deteriorated into a “telenovela” of box diving, video review is a millennial inspired fix to use technology to manipulate how the game is played. It’s been an interesting addition to the game and I’m excited to see where it leads.

At the very same time, our ability to pull any information in an instant seems to manipulate our most basic human priorities. I see this most evidently in our current medical learners. Similar to experiencing the transition to an internet-dependent world, I have also experienced the transition between handwritten notes to electronic medical records (EMR). When I first started training, to consolidate your thoughts after seeing a patient you needed to actively think about what to write down on the page. You would think to yourself, “in the fewest number of words, how can I describe whats wrong with this patient to another physician?” You would assemble a list of pertinent positives and negatives that helps paint the picture of a list of possible problems (a differential). You would then assimilate these lists into a cohesive sentence that shows everyone your thought process and your next plans to further evaluate and treat. This is how I learned to evaluate patients and this real-life exercise helped reinforce this skill. By the end, you are rehearsing this patient’s history over and over while you concisely report your findings and thoughts. Whenever you read one of these notes, you could quickly experience that physician’s intimacy with the patient and understand their logical thought process.

Without the help of natural selection humankind evolves with technology, and in medicine, that was with the introduction of EMRs. Admittedly, a necessary intervention to gather data to eventually be analyzed and used to further advance healthcare. Consequently, what used to be an intense active process of contemplation, documenting patient encounters devolved into passive reporting utilizing drop-down menus, standard templates, and zombie-like copy forward functions.

When today’s medical learners explore a patient’s chart in an EMR, they find themselves in a mindless sea of impertinent negatives. After experiencing just a few, they realize the futility in actually reading the reports and boil an entire patient’s history and physical into a 2-sentence history of the present illness (HPI), a video or picture and the bullet-pointed plan so you can figure out which chapter to read in the online textbook before surgery tomorrow.  As a result, today’s learners enter the OR knowing next to nothing about the patient themselves and instead are armed with an evening’s worth of objective data effortlessly obtained while sitting on a couch in their Wi-Fi smothered living rooms.

Again, I understand the irony here and I’m only sometimes a hypocrite. I feel comfortable expressing these maladaptive behaviors because I’ve committed them, time and time again. What I wonder, is how do we re-humanize this aspect of medicine? I certainly do not have an answer for this, but I’ll at least start with myself. When I first started posting about my new life in Ethiopia, many of my old friends and some strangers reached out to give support. One comment, in particular, caught me deeply and will stick with me. It was placed by perhaps the most intelligent person from my high school days, Vanessa. She has no background in medicine, but so correctly expressed: “learn from the people whose lives you will touch.” Even typing it here gives me that deep stabbing sensation that seems to affect my larynx and lacrimal glands simultaneously. The partially painful and visceral sensation you experience before that familiar salty liquid drips down your cheeks.

As a commitment to Vanessa and myself, I will follow her advice as I dive into a people I know so little about. To the Neymars and new medical learners that have taken advantage of some partial devolution of humanity, I encourage you to do the same, so we can all better understand why we do the things we are passionate about.