Finding the silver lining in ‘eFrustration’

I am spending more and more time in cyberspace. But as I approach 60, my long-term-memories of life before the Internet are becoming more vivid. Like many of our ancestors, I often marvel at the advantages of progress, but sometimes long for the good old days.

I remember roaming the bowels of the medical library for articles identified via the Index Medicus, taking time to sneer at the cigarette ads preserved in the bound journals. I also gathered every day at noon, a time to socialize with a group of fellow medical students on my VA rotation, waiting for the long, continuous sheaf of paper to roll off the dot-matrix printer, get torn at the scored lines and distributed to review the morning phlebotomy results.

Back to basics

As a pediatrics resident I had limited computer access, and all medical records were handwritten on paper, kept in giant notebooks, or tattered folders with torn or missing pages. We often had to call the lab for results, which gave us a chance to get to know the pathology residents. One of these discussions helped diagnose a case of Munchausen’s by proxy after we worked together to confirm a mother’s blood type from a smear on the diaper of her infant, who had been hospitalized several times for “bloody stools.”

Record-keeping during my dermatology residency was technologically advanced by comparison, but a little less personal. We dictated onto microcassette tapes. A team of nameless, faceless typists transposed the prose onto 8-by-8 inch folded cards.

Our chairman, John Strauss, was generous in many ways, but one of the most enduring was in building an image library for the entire department. We took pictures with the department camera - 15 or more shots of each view. Hand-labeled Kodachrome slides were distributed, one for every resident and one for the archive file. I still have a shelf full of notebooks with plastic-sleeve pages of carefully organized cardboard slides. Over the years, the best images disappeared into black plastic carousels. I may spend the same number of hours creating every new lecture, but PowerPoint, handheld devices, video animation, and the cloud have completely transformed the art of teaching.

My first home desktop computer arrived in 1986, a generous gift from my brother, who founded a computer company that year. It was a 15-inch with monochrome amber type (swankier than the green). It was a big step up from a typewriter, but couldn’t do much more than word processing and calculating.

A few years later, I rented my first car phone, a DC plug-in contraption that came in a small black suitcase. I didn’t get a personal desktop computer at work until 1992, along with a university email account. After that, the cyber changes were more frequent and more ubiquitous.

In 1994 we opened a bank account in California because online banking was not available locally. Back then, I spent more time sitting at the desktop computer, but without remote Internet access, I could leave a large fraction of work behind while on vacation. In 1999, I envied the BlackBerrys used by my early-adopter, multitasking colleagues.

Constantly connected

But by 2002, the “crackberry” phenomenon was unsettling. I vividly recall my discomfort that year, sitting around a table at a meeting, surrounded by incessant texters. I joined their ranks by 2007, happily discovering that texting was the most effective way to communicate with my teenage children. I resisted getting an iPhone until 2012. But since then, having 24/7 access to Google, apps, imaging and cloud-based files is no longer an option. I never leave home without it; it is an essential tool in my clinic, during my academic time, while traveling and even when grocery shopping.

The downside of this growing dependence is gradually materializing. Although there are significant risks like loss of privacy or the environmental impact of cyberspace, the daily hassles consume my attention: the need to sort through hundreds of new emails a day, increasingly complex online electronic requirements for manuscript submission, professional certification, IRB approvals and EMR documentation compliance.

Even the once-simple task of creating and remembering a personal login and password has become byzantine. I am now working in a system with two different servers, one for the university and one for the hospital. This generally necessitates manual computer sign-on multiple times a day, to overcome the three-minute, automatic logoff. Each system assigned me a slightly different user name and requires me to change my password at different three- and four-month staggered intervals.

For both systems the passwords can never be repeated and the requirements are unique: six characters for one, eight for the other with a different combination of numbers, symbols, letters and capitals. These identifiers are a small fraction of an ever-growing list of changing, nonsense codes that are beyond memorization, but need maximum protection.

The use of security questions only complicates matters for me. For example, was my birthplace Michigan or Saulte Ste. Marie? Did I enter the more common township name for my high school (Ladue) or the official name (Horton Watkins)? Which was my favorite movie? Did I name my oldest niece by blood or marriage? Did I capitalize the answer or not? Fortunately I have an app to store my logins, passwords and hints on the iPhone that is always by my side, with backups to support my addiction.

Whenever the dark cloud of eFrustration becomes overwhelming, I try to look for the silver lining. In the short term, the need to memorize nonsense passwords is good exercise for an aging brain. Technology will soon make fingerprint or iris recognition more readily available, and someday a computer that recognizes voices and takes notes will allow me to ignore it and interact with my patients - in person or online.