Portal de Periódicos da CAPES

Information Overload in the Digital Age

2003; Lippincott Williams & Wilkins; Volume: 112; Issue: 5 Linguagem: Inglês

10.1097/01.prs.0000079820.13187.87

1529-4242

S. Anthony Wolfe,

Anatomy and Medical Technology

At a recent meeting in Europe, a friend of mine who is from my generation—the generation trying to become computer literate in middle age—put together his own PowerPoint presentation. I was impressed, since I do not have the skills to do this quickly (or perhaps at all) and have always relied on a young guru to help me. Midway into the presentation, his PowerPoint went into a sit-down strike mode. Rien ne va plus. It turned out that this was death by overpixilization. Used to last-minute rearrangement of his slides, my friend had added some images that were still in the tagged image file format, or TIFF format. TIFF files can contain a full 16 megabytes per image, and his images should have been reduced to some lesser form (60 kilobytes per image), such as Joint Photographic Experts Group, or JPEG, format digestible by PowerPoint. A little knowledge is a dangerous thing, I thought. The management of digital data is a skill that all of us must now acquire, or at least find someone to guide us through the digital inferno. Thirty-five-millimeter slides have rapidly become history, in the same dustbin of history as lantern slides. They are increasingly not welcome at most of our national meetings. Digital photography offers the plastic surgeon a number of advantages over film-derived prints or slides. It is certainly cheaper, both for the practice needs and publication, and the storage of large amounts of digital data turns out not to be a great problem. Patients can see their own pictures on the spot; the digital image, if one wishes, can easily be altered to show a desired result, although there is now concern that this may be taken as some sort of implied guarantee. The possibility of surreptitious altering of a digital photograph has already risen as a source of concern for program committees of our national meetings, editorial boards for our journals, and the American Board of Plastic Surgery. The Internet provides a daunting amount of giga- and terra-bytage. Ask a search engine about breast augmentation, and 400,000 citations may pop up. Craniofacial surgery brings up 50,000. This Journal, as are most others, is available online, and there are numerous “e-textbooks” that one can visit free of charge. This is daunting indeed for the curious patient, who may be quite confused by finding conflicting statements and claims. At some point, a prospective patient who has been looking at a lot of cyber-information needs to sit down with a surgeon who has actually performed the operation in question and who will have the patience to explain why he or she does or does not agree with some of the statements extracted from cyberspace. A generation ago, there were four or five different television networks in each major metropolitan area; now, with cable and satellite, there may be 1000 or more channels to choose from, some of which include actual surgical procedures. We are bombarded by commercial messages and encounter hour-long “infomercials” by hair transplanters, followed by a testimonial given for a board-certified (?) plastic surgeon by a group of buxom nubile women in bikinis, followed by an offer by a lawyer to help those unhappy with their surgical result to “obtain their rights.” Counter-electronic warfare measures such as TiVo are available to help block out the constant chatter of advertising for those of us who do not unthinkingly already filter it out. Almost all of us use e-mail on a daily basis. It is a great way for communicating with friends and family, established patients, and colleagues. Parent networks for certain types of congenital deformities are often good sources of information for one parent from another who has been through the process. E-mail may not be the best way, however, to give medical advice to an anonymous patient you have never met. Whether to maintain a Web site, show before-and-after photographs, and list surgical fees are personal decisions, but they may lead one into fielding unreimbursed e-questions from potential patients, a process which actually may carry some potential ethical or even legal pitfalls. The digitalization of hospital medical records has been a great time saver, as long as we can master the system, remember our various passwords, and have a functioning computer system in the hospital when we need it. Personal digital assistants (such as the PalmPilot) can carry all of our Current Procedural Terminology (CPT) codes and a complete pharmacopeia. Computed tomography scans and magnetic resonance imaging have provided such detailed digital information of what is going on inside a patient that postmortem examinations, rightly or wrongly, have become a rarity. Digital technology is changing fast, and to paraphrase someone, you may not want to be the first one on your block to try something totally new, but neither do you want to be the last one. A mind-numbing amount of information is now available to anyone, anywhere, anytime with a multi-task cell phone/Internet accessor/personal organizer. Indeed, it is hard to think of any bit of information that could not be gleaned from the Internet, raising considerable concern about issues of personal privacy. Our offices are changing as e-mail replaces the fax and digital data storage replaces paper. Voice recognition technology will replace secretarial transcription as we learn how to use it, either removing the need for a secretary or freeing him or her up for other important duties, such as waiting on digital hold for a human being to respond at a health maintenance organization. More information, however, unfortunately does not mean more clarity or understanding. An experienced surgeon, taking a thorough history, performing a careful physical examination, and listening to a patient’s wishes in a face-to-face interview, the good old-fashioned way, is not likely to be replaced by a virtual interview with a computer. Information overload is not confined to the sea of digital data that can come across a computer screen. The combined weight of last Sunday’s Miami Herald and New York Times came to 10.5 pounds, a figure that would most certainly be less if all of the type had to be set by hand rather than by computer. And we have all seen the piles of legal documents an attorney with a computer can generate simply with the push of a button. No, Mr. Gates, the digital age is not necessarily going to be the salvation of our forests. We train our minds to simply screen out most of the sensory overload that we are subjected to on a daily basis. Only a small amount of the information that we are exposed to or that is available to us do we want to know about. Large amounts of information per se are of no use unless there is a discriminating function, a judgment of what is important and what is not. Our patients are still going to look to us for a broad overview of our field, clinical experience, and judgment. They may come to us brimming with information from the Internet, and we must not sound patronizing as we explain to them what is important and what is not, what is true and what is preposterous. Mies van der Rohe’s statement, “Less is more,” certainly now reaches beyond the realm of architecture.