Friday, March 30, 2012

The Internet Clouds Your Mind, Even If You’re a Doctor

A Sermo post on March 5, 2012 concerned a paper from the Archives of Surgery stating that over 15% of surgeons either abused or were dependent on alcohol. The results were obtained using the Alcohol Use Disorders Identification Test (AUDIT-C), a survey that has been widely employed as a screening tool for alcoholism.

The post generated 58 comments, many of which were highly critical of the AUDIT-C survey. Several commenters were critical of the first of the three questions on the survey, which is reproduced below.

1. How often do you have a drink containing alcohol?

a. Never     b. Monthly or less     c. 2-4 times a month    d. 2-3 times a week     e. 4 or more times a week

According to the points linked to each answer, a man who answered “e” or a woman who answered “d” would appear to be categorized as a problem drinker. Commenters correctly stated that having a drink 4 or more times a week does not make one a problem drinker. They then said this question not only invalidated the AUDIT-C  but also the paper itself.

But wait. Those who interpreted the question that way did not notice the explanation of the scoring system which clearly states the following:

“However, when the points are all from Question #1 alone (#2 & #3 are zero), it can be assumed that the patient is drinking below recommended limits and it is suggested that the provider review the patient’s alcohol intake over the past few months to conform accuracy.”

Why did several people, all of whom are physicians who you would expect to be more careful, overlook the above explanation of how the AUDIT-C scores are calculated?

I blame the Internet, which like the radio hero of the 1930s known as “The Shadow,” apparently has the ability “to cloud men’s minds.”

Technology expert Nicholas Carr has written extensively on this topic. In a 2010 piece for Wired magazine entitled “The Web Shatters Focus, Rewires Brains,” he wrote, “We start to read faster and less thoroughly as soon as we go online.”

Is it only the Internet or is this phenomenon common to all documents displayed on a computer screen? Does this problem spill over into the sometimes mind-numbing task of wading through a consultant’s report taking up five screens of an electronic medical record?

What do you think?

Note: I am now writing a column for Sermo, a physician community on the Internet, every Thursday. This blog was published on Sermo yesterday.


Huhet said...

Hopefully it's not all on screen reading because I'm 100% paperless for school notes and slowly converting to all kindle textbooks.

Skeptical Scalpel said...

I don't know if it's all documents on a computer but I would not be surprised if research showed that it was.

Anonymous said...

I'm almost halfway through med school and have done everything paperless. So far so good. However, I interact with my school notes in a completely different way than web content. I frequently stop half way through a news story after skimming it half-heartedly to figure out what it's "about"... but I never do that with my school content. Perhaps the difference is that in one setting I'm attempting to learn, and in the other I'm seeking entertainment? The Carr article suggests that the issue isn't screens per se, rather it is the structure of the content on the screens (e.g. presence of hyperlinks).

Skeptical Scalpel said...

That's a good point. Carr is right, but there are a lot of distracting things on most websites. Hyperlinks are certainly a problem. I find that I can't read more than about 2-3 pages of just about anything including an EMR on a screen.

Document writing programs for the iPad, such as IA Writer, tout their simplicity and lack of distracting buttons, etc.

Lisa said...

I think we all read faster because of the internet and we could miss things especially with the info on the sidebars and links like you said in the middle of reading information. I imagine it must be wrecking havoc on our eyesight's as well.

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