Saturday, March 12, 2011

Virtually living

So, I guess this post is kind of an apology. KC periodically sends out gentle reminders to post on MiM, and I receive them with all good intentions. Despite a number of ideas for posts, I just haven't been able to bring myself to write them. It's not only my blogging really that has suffered, but dictating notes on patients, taking/organizing photos of the family, and a whole host of other things. I have had a growing sense of disquiet that we--people living in 2011, Americans, mothers, bloggers, doctors, any number of groups to which I belong--are so caught up with documenting that we have, in some ways that matter tremendously, stopped living.

This all started when I was attempting to declutter my house last fall. I had decided to try to scan some of my kids' artwork to jpg files on our computer, with the eventual goal of making a little bound book for each of the kids. My two older kids were at school and my 3 year old was coloring on her craft table next to the desk in our home office, the very same sort of artwork in the making. She said, "Mommy, look at my picture." I responded "Mmm-hmmm, that's beautiful" or something absentmindedly, trying to finish what I was doing first. "Mommy, it's a picture of you," she persisted. "That's wonderful, honey," I said, giving it a quick glance and rushing to save the work on the computer as I sensed my personal time was coming to a close. "Mommy, LOOK!" she said. "LOOK WITH YOUR FACE." And it stopped me in my tracks because I knew she had, in the way that kids often do, spoken a truth that troubles me about our generation.

This wasn't the first time I have been a little exasperated by our generation's compulsion to document and report. I tried to tell myself: it's just that I'm kind of a Luddite, and the notion of blogging doesn't come naturally to me. I confess that I signed up for a Twitter account about 2 yrs ago, but have never actually tweeted anything or followed anyone. I watch exactly zero TV shows. I have only the vaguest idea of what Glee or any number of reality/competition shows are about, gleaned entirely from snippets of overheard conversation or references on NPR. These are aspects of popular culture that just hold zero appeal for me. I sometimes wish that I could bring myself to want to partake--the same way that I forced myself to learn to like tea in college as a non-coffee drinker because I felt the need for a hot "social" drink I could have with my friends (ps I now like tea a lot). I was also a very reluctant, very late adopter of Facebook. I have come to realize its charms, but I remain suspicious. In my heart, I know that the time I devote to tending my FB friendships has detracted from time for actual friendships with live friends and even people living in my own household. It alarms and frightens me that meeting friends "IRL" (in real life) has become somehow quaint and exceptional.

This issue of documentation for the sake of documentation has threatened much of what I love and value in medicine. I see it everywhere. The most obvious examples, of course, can be found in all of the things we now find ourselves forced to dictate to justify billing codes or levels of care or to avoid malpractice claims, but what I see happening in the exam room is what unsettles me most. When I got pregnant with my first child in 2003, I remember my OB visits as 10 minute conversations with my doctor. She sat in a chair, I sat in a chair, we looked each other in the eye, and we talked. Yes, she referred to my (paper) chart from time to time--how was my hematocrit? what was the last fundal height? how many cm dilated was I last week?--and yes, I often waited 30 minutes for that 10 minute visit, but I still felt that at my check-ups, a human being was, well, checking up on me and my baby. When I got pregnant with my last child in 2007, a mere 4 years later, I went back to the same OB. She came in and stood for the entire visit every visit, swinging down a new computer suspended by a metal arm from the ceiling so that it partially obstructed our ability to see each other, and proceeded to click and type until the 10 minutes was up. I felt as though I had been doused with a cup of ice water at the start of every appointment. If I had concerns (and I had some: exhaustion caring for my two toddlers with my husband deployed, and my failing pelvic floor to name a few I still remember well), the new style of appointments provided no invitation to express them. I had more than a dozen visits with her. I never mentioned any of those issues. The point of the check-up now appeared to be checking boxes. The humanity had been lost, and I wasn't sure we could get it back.

On the playgrounds and at birthday parties, I see it too. Everywhere, mothers with their gigantic SLR cameras, frantically snapping photos of their kids. I have literally watched them shoot and review pictures the entire time, ignoring or maybe not even hearing their kids' requests to be chased or tickled or pushed on the swing or helped with blowing out the candles. I wonder what kind of memories they will be creating with these photos. Surely when the kids are young, they will remember very little. They'll get older, look at the family albums, and invent memories that string together the images. But what about the kids who are already a little older? I fear what they'll remember is their moms taking their cameras to the playground and allowing them to come along for the ride.

I received a throw-away journal in the mail recently that had a "spotlight" on a woman--a dietician and Shiatsu practitioner who blogs about wellness. Over the course of the interview, it came up that, in addition to the wellness blog, she also writes a private blog about her kids for family and friends, a culinary on the cheap blog, a craft blog, and a blog about the challenges of reinventing herself to return to the workforce after years as a stay-at-home mom. The interviewer marveled at how she and her husband manage the demands of now being a dual career family with four young kids and maintaining all of their blogs. (Her husband is apparently an independent consultant who writes a high-profile blog about business/pharmaceuticals and travels frequently for work.) The interviewer asked how they cope with the separations and whether it's been a positive or a negative in their marriage. The woman reflected that it's been pretty neutral from a marriage standpoint and that she mostly feels the pinch as a parent; it's a little more work to get the kids to sports practices, to corral the kids into bath and the bed. What made my heart sink, though, was when she quipped something to the effect of: "If he's in town, we spend our evening on our laptops. If he's out of town, we spend our evening on our laptops. Now if my LAPTOP starts having to travel overnight for business, then I'm going to be distraught." Wow.

I know we have to document. It's a medicolegal necessity, a method of communicating our thought process, and a means to avoid retracing our steps unnecessarily with patients. It's a legacy for our families and a way to ensure that precious moments are not lost in the midst of years of perpetual exhaustion parenting small children. It's an opportunity to connect with family and friends we cannot see often because of the limitations of geography or time. It's a hope for finding community or support or fellowship in the small, dark hours of the night from your family room once all of your kids are asleep or your spouse is working. But I also think it's time for us to pause to make sure we're not letting the tail wag the dog. We need to make sure that we are documenting to capture and celebrate the life that we're living and not just living to document.


  1. For me, the documenting makes me more present most of the reminds me to slow down and pay attention to what is going on around me. But I kmow there is a danger in letting that take over...everything in moderation, as they say. Great reminder.

  2. Excellent post, Tempeh. You may be somewhat scarce (I fear the same for myself), but what you lack in quantity you always provide in quality.

    I'm glad I'm not the only one out there who has never watched Glee and has no idea of popular night time TV culture. I must confess I recently picked up a habit of watching John Stewart and The Colbert Report after exercising on Tue. and Thursday nights when my ex has the kids until 7:30.

    I rarely open my computer to look in my reader and respond to comments before the kids bedtime. I was alarmed the other night when I posted on my own blog about my daughter's 8th birthday that I hadn't taken a new picture of her in a couple of months. Maybe no pics, but the memories and together time - I think I've got a leg up there. I would much rather spend an extra half hour at bedtime reading more chapters from our chapter books than blogging.

    Kevin M.D. put up a blog post last week that I read - a heme/onc patient was lamenting the loss of her old face-to-face doctor visits now being largely replaced by her doctor clicking away while she played Angry Birds and answered questions for his EMR. She was glad to have the memories, which reassured her he was a good doctor, but said she might jump ship if she did not. Seems you aren't the only one with this experience.

  3. Neat post, juxtaposing personal and professional documenting! About the accumulated, un-filed, un-scanned photos in my closet, I can only share your disquiet. But
    I think we might improve our practice if we presented patients with screening questionnaires via waiting room computer stations, and used face time to discuss their responses, rather than having that be time to check off the boxes ourselves. Secretly,though, I suspect many doctors welcome every opportunity to take further distance from patients' distress and non specific concerns. I certainly see that as a progression that occurs between first and fourth year of med school--empathic listeners turn into test takers and data recorders before my very eyes.

  4. I feel like I spent way too much time on the computer these days and I hate it. I meant to cut back when my daughter was born four years ago, but babies are kind of boring and surfing the web gave me something to do when she was nursing or sleeping on me. So I kept up this bad habit. I spend too much time, despite having never twittered and only posting on facebook once a month.

    A year ago, I decided I wasn't going to even start up my computer until my daughter was asleep. But then something would come up, like I would need to look up a recipe or ideas for craft projects or an address on google maps. I found it impossible to keep away.... like an addiction.

    I think I've been doing this forever, in one way or another. As a child, I was always reading or writing. Now I'm doing the same thing, but both those activities involve the computer. Which makes them worse somehow.

    I do watch Glee, but that only eats up 40 minutes of my week with tivo editing commercials, so I don't see that as a problem :)

  5. Totally hear you about technology getting in the way when I'm with patients. This has been thrown into high relief this past two weeks since we switched EMRs - the new system gets about 60% of my mental capacity and the patients a pathetic 40%. All those tempates and checkboxes! I am making a consious decision to go back to typing in free text boxes. Since I can touch type I can write exactly what patients say - fast - while looking them in the eye. It's a compromise, but the best I've come up with so far!

  6. Thanks for writing this - I've been feeling the same way recently, but you were able to put it in the words I haven't been able to find.

    I still haven't joined FaceBook - despite more and more pressure from work (!) due to the institutions that have set up pages (I can't even access these to look at them as I'm not a member).

    I think it's all a matter of balance, and finding what's best for you as an individual. We can all benefit from the thoughts of those who post frequently (no reason to feel guilty Fizzy!) - and the benefit we obtain is no less from those who post less often.

    Now, back to my own EMR updates . . .


  7. Thank you so much for the emphasis on the Mommy, LOOK WITH YOUR FACE, as I read your post with my brain and my heart, and reflect on my personal and professional documentation, and will revisit really being there and fully present for those for whom I care (family and patients).

    Still no FB for me (like Artemis even with the surprising pressure from work-related endeavors), and enjoying some Jon Stewart (like Gizabeth). Alas, with an EMR.

  8. Thanks for the comments everyone. I wrote detailed replies to the first 7 commenters a few hours ago and then blogger refused to let me post the comment. So, here's the abridged version. I'm glad I'm not the only one struggling with this--of course, when we blog, we often do it to "exorcise our own demons," so to speak--both as a doctor/mother and as a patient. I should also say that I have nothing against Glee (have never seen it, remember! :)). Just mentioned Glee, reality TV, and Twitter to make the point that it's entirely possible I'm stuck in the '80s and blogging, like tweeting, network TV-arranged marriages, and other phenomena, doesn't come naturally to me. Maybe I should start watching Jon Stewart or Colbert Report. I do enjoy stand-up comedy, so there's some hope I could get hooked on an evening humor show and then I'd have something to change the subject to when colleagues bring up Glee. Haha. For the Facebook-averse, KC can tell you what a reticent Facebooker I was. As I recall, when I accepted a friend request from her, she referred to herself as being in the "inner circle". I had only about 2 dozen FB friends for several mos. Facebook, like smart phones and no doubt many other trappings of modern life, are wonderful tools in moderation. The moderation, on the other hand, seems much harder to come by. I worry about the loss of mindfulness in our generation of parents, doctors, etc. Hoping we in time find some way to use technology to help us be more mindful, not less.

  9. I feel exactly the same. Strugling to cope with 2 jobs and 3 kids by myself alone, I regret the way the live has evoled to this. Malpractice complaints turned our patients into friendly fire that we must avoid and so we wright too many and talk too less. I myself feel like burning out about the whole thing of beeing a single mother with no spare time. My kids are growing up and I sure am missing a lot. But I´m afraid I can´t do any better. Pictures of them? sure! But not so many as they actually do...

    maria inĂªs, lisboa, portugal


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