Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Prescribing Less Screen Time


We need to turn our attention away from our screens and toward the people we serve.

As a pediatrician, my wife upholds a fiduciary responsibility to the well-being of children. She advocates for the safety of neonates by ensuring proper car seat installation. She promotes the effective and timely vaccination of infants against communicable illness. And, addressing another aspect of modern child-rearing, she counsels parents on the appropriate amount of screen time to which the young should be exposed while growing up in environments saturated with electronic media.


This worry about early overuse of technology arises partly from concern that the passivity of consuming content deprives children the physical benefits of active play, prefiguring sedentary lifestyles that will only cause our societal epidemic of obesity to worsen. Less tangibly, the plasticity of developing brains may also make them more vulnerable to delayed socialization in the absence of a hands-on upbringing; the artificial, unilateral stimulation of nascent attention spans by TVs and smartphones can never fully replace nurturing interactions with real-world caregivers.


Prescribing less screen time for OURSELVES

All of these anxieties about weaning the next generation off an unnourishing stream of digital content are well-founded. But I suggest issuing the same prescription for limited screen time to ourselves, lest our own computer-enhanced caregiving fall into the valley between genuine contact and the inauthentic mimicry of connection with a fellow creature.


Screens are now ubiquitous in clinics and hospitals, to the point that they are literally and figuratively coming between us and the patients we treat. Medicine’s core encounter between two humans — one seeking help, the other offering it — can sometimes seem like a depersonalized exchange, inflected more by checklists than compassion. There has been an appreciable shift in emphasis during in-person visits from patients’ needs to the needs of our electronic medical records.


From portraiture to pointillism

As we pivot from portraiture to pointillism, patients’ unique details are being elided for the sake of expedient keystrokes; social histories have morphed from explorations of identity to reductive inventories of vices; billing and compliance have taken precedence over sympathetic listening and earnest problem-solving. The EMRs’ hunger for information is insatiable, and, for some healthcare administrators, our discrete value as revenue-generating clinicians lies in how many quanta of patient-derived data we can feed into these systems’ gluttonous cores.


The more that monitors have diverted our focus during “face-to-face” encounters, the more patients have used their own virtual tools to recapture our attention, using extreme measures when necessary (look no further than the vitriolic outrage fueling the #doctorsaredickheads hashtag that trended on Twitter). The correct course of action in response to this recent unpleasantness is to reassert our own identity as healers.


Reasserting our identity as healers

Yes, we will still have to click the mouse and match misfortunes to the arrestingly comprehensive list of vicissitudes encoded by ICD-10 (the elementally improbable ‘V91.07: burn due to water skis on fire’, anyone?). The contemporary clinician may indeed remain under tremendous pressure to maximize efficiency, tempted to spend their precious minutes with each patient engaged simultaneously in data entry. But our gaze is too easily diverted from the person in need to the documentation of their problem. Furthermore, it has long been known that a mere forty seconds of kindness can effectively comfort those under our care, and if we cannot spare a minute for such solace, then perhaps we are in the wrong profession.


I do not condone the trolling tactic of puerile insults; in the case of #doctorsaredickheads, though, the coarse, chorused language of the otherwise-unheard signifies a cry for recognition that I believe should be heeded. There is value in feedback, no matter how caustic or unsolicited, because it gives us insight into our patients’ interiority, otherwise unknowable, far beyond the discernment of labs and scans.


In acknowledging our Tweeting detractors, I think we can separate constructive criticism from calumnies and show those we serve that, whether in the flesh or virtually, we are, indeed, listening.


First, however, we need to turn our attention away from the screens and toward the people whom we are duty-bound to serve.