EP. 134: HOW THE INTERNET “SHALLOWS” OUR MINDS

WITH NICHOLAS CARR

Oct 18

WITH NICHOLAS CARR

An acclaimed journalist explores the cognitive, social, ethical, and philosophical implications of our increasing reliance on digital technologies and why limiting their encroachment on our lives may be essential to our wellbeing.

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Episode Summary

Digital technologies have saturated our lives and there is no going back. Given this, it's worth pondering whether and how they are fundamentally reshaping our mind and our relationships.

A seminal work that explores these issues is the 2010 book and Pulitzer Prize finalist The Shallows: What the Internet Is Doing to Our Brains, by journalist Nicholas Carr. In it, he argues that the internet is “shallowing” our brains, meaning that as we offload cognitive tasks to digital tools, our ability to read linearly, to absorb and immerse ourselves in complex information, is reduced. But more than that, the internet curtails our emotional depth and compassion, diminishing our humanity and rendering us more computer-like, as we process information in short bursts, skim for quick answers, and operate with frenetic attention spans. In Carr’s 2014 book The Glass Cage, he discusses how the increasing automation of tasks leads to a decrease in human agency, creativity, and problem solving capability.

In this episode, Carr joins us to discuss the neuroplasticity of the brain, the mechanisms by which digital technologies reduce our ability to think deeply, how the failures of electronic medical records illustrate the limitations of technology, what social media does to our relationships, the value of focused, reflective thought in a fast paced world, what we can all do to remain independent of technology, and more.

Nicholas Carr writes about the human consequences of technology. His books, including the Pulitzer Prize finalist The Shallows: What the Internet Is Doing to Our Brains and the forthcoming Superbloom: How Technologies of Connection Tear Us Apart, have been translated into more than twenty-five languages. He has recently been a visiting professor of sociology at Williams College, and earlier in his career he was executive editor of the Harvard Business Review. In 2015, he received the Neil Postman Award for Career Achievement in Public Intellectual Activity from the Media Ecology Association.
Carr has written for many newspapers and magazines, including The Atlantic, the Wall Street Journal, the New York Times, the Washington Post, Wired, Nature, Politico, MIT Technology Review, and The New Atlantis. His essays, including “Is Google Making Us Stupid?” and “The Great Forgetting,” have been collected in several anthologies, including The Best American Science and Nature Writing, The Best Spiritual Writing, and The Best Technology Writing. Since 2005, he has written the popular blog Rough Type.
In addition, Carr has appeared as a commentator on television and radio programs, including NPR’s All Things Considered and OnPoint, the PBS NewsHour, MSNBC’s Morning Joe, CBS Sunday Morning, and the Colbert Report.
In this episode, you will hear about:
• 2:42 - Carr’s path to researching and writing about the human consequences of technology
• 5:38 - The central thesis of Carr’s 2010 book The Shallows
• 15:27 - Whether the cognitive impacts of digital technologies are reversible or permanent
• 21:18 - Whether society is better or worse off due to social media and the internet
• 25:38 - How modern technology has changed the medical profession
• 38:22 - Carr’s thesis for his upcoming book Superbloom
• 45:21 - How society can address the loss of focus and empathy that has occurred as a result of social media
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:02] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build healthcare institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across healthcare, from doctors and nurses to patients and healthcare executives those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging, and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:02] Digital technologies have saturated our lives and there is no going back. Given this, it's worth pondering whether and how they are fundamentally reshaping our mind and our human relationships. A seminal work that explores these issues is the 2010 book The Shallows What the Internet Is Doing to Our Brains, by the journalist Nick Carr. In it, he argues that the internet is shallowing our brains, meaning that as we offload cognitive tasks to digital tools, our ability to read linearly, to absorb and immerse ourselves in complex information is reduced. But more than that, the internet curtails our emotional depth and compassion, diminishing our humanity and rendering us more computer like. As we process information in short bursts, skim for quick answers, and operate with short, frenetic attention spans. In Nick's 2014 book The Glass Cage, he discusses how the increasing automation of tasks can lead to decreased human agency, creativity, and problem solving capabilities. Over the course of our conversation, we discussed the neuroplasticity of the brain, the mechanisms by which digital technologies reduce our ability to think deeply, how the failures of electronic medical records illustrate the limitations of technology, what social media does to our relationships, the value of focused, reflective thought in a fast paced world. What we can all do to remain independent of technology and more. Nick, thank you for taking the time to join us and welcome to the show.
Nicholas Carr: [00:02:40] Thanks very much. It's a pleasure to be here.
Henry Bair: [00:02:42] So when I pull up your bio on your website, the first line describes you as a journalist who explores the human consequences of technology. Can you tell us what initially drew you to this issue?
Nicholas Carr: [00:02:55] I'd been writing about technology for a long time. I was an editor at the Harvard Business Review in the late 1990s, when there was the big dotcom boom, and I was the editor. That was pretty much dedicated to doing technology articles. And so I started off right then when I moved into to became a writer, I started to write about the management and business implications of information technology, of computers and the internet and so on. But my background actually was in college, in grad school as an English literature student. My real interest was more in the kind of humanistic side of technology, how it influences the way we think, the way we get along and so forth. The shape of society. And what really triggered the shift was in the mid 2000, the mid-aughts, let's say I started noticing, you know, as a technology writer, I'd spent been a lot, a lot of time in front of a computer. A lot of time surfing the web, as we as we called it then and I. I sensed that my own ways of thinking were changing, and not in ways that I saw as good. What was going on is that when I would get away from the computer and sit down to read a book or a long article, I found it increasingly difficult to maintain the concentration necessary to immerse myself in literature, in books, something that had been very natural to me for most of my life.
Nicholas Carr: [00:04:31] What I further realized was what my mind seemed to crave doing was to be stimulated in the way it was stimulated whenever I was at my computer. You know, googling things, checking email, clicking on links, going from one thing to another. And so I found myself, instead of being able to pay attention for a sustained period of time to any one thing. I found myself constantly fighting my mind, which seemed to. You want, you know, want more stimulation. And I began to wonder, you know, could the technology itself be training me to want that kind of stimulation at the loss of an ability to concentrate and focus and maintain my attention? So that started the research that first led to an article in The Atlantic magazine called Is Google Making Us Stupid? That was in 2008, and that turned into the book The Shallows in 2010, which both of those are on the subject of how technology in general, but how the internet in particular may be shaping the way we think.
Tyler Johnson: [00:05:38] So, briefly, for our listeners, can you outline the thesis of The Shallows? In other words, what is it that you think that the internet is doing not just to what we think about, but to how we think? In other words, what is the internet doing to our brains?
Nicholas Carr: [00:05:56] So the basic thesis of The Shallows is that there's a fundamental paradox in our use of the internet. We all believed that this new medium that offered us almost unlimited access to information, information that used to be difficult, if not impossible to come by or very expensive to come by, or that used to be relegated to the elites, was now open to all of us. And I think all of us would probably agree, and I agree as well, that that in general is a good thing. Having more access to more information is a good thing. But in our rush to go online and enjoy this access, what we didn't pay attention to is what I ultimately think is a more important quality of an information or communication technology, and that is how it provides information to us. And I believe if you look at or you can just draw on your own experience of interacting with your computer, or even more so with your with your smartphone or whatever, the way the internet provides information is as a jumble. It's a multimedia system, constant messages coming through all sorts of links to click on all sorts of stimulus stimuli coming at your ears and your eyes.
Nicholas Carr: [00:07:16] And so it provides this kind of welter of information. And if you look at how the human mind transforms raw information into knowledge, which I think is the basis of deep thinking, a lot of it hinges on our ability to manage our working memory and working memory. For those who aren't familiar with the term, is is the short term store of information that essentially forms the contents of our conscious mind at any given moment. So it's it's the information you're conscious of and working with in doing whatever you may be doing. And what we know about working memory is that it has a very small capacity. It used to be thought you could fit like seven items of information or chunks of information, as it's often called in your working memory at any given time. More recently, neuroscientists have come to believe it's even less than that 2 to 4 pieces of information. So in order if your working memory is full, in order to take in a new piece of information, something has to go. And what the internet does as a information system, a communication system is it's providing us so much information, overlapping in many different forms all the time, constantly allowing us to shift our focus.
Nicholas Carr: [00:08:36] It's constantly overloading our working memory. The problem there is that the key to knowledge, and I think deep thinking is being able to transfer For information from our working memory to our long term memory. Through that process of what's called memory consolidation, we form the associations in the connections between pieces of information that is essential to knowledge. It's what allows us to think contextually, critically, creatively, and so forth. And if we're constantly bombarded by information, as I think we are when we're looking at a computer screen these days, we only weakly consolidate information. We're pushing information into and out of our working memory so quickly that we don't have the time to really attend to any given piece of information in its attention that really forms the key to memory consolidation. So what I argue is that we've created this incredibly rich store of information that also happens to be a distraction machine, an interruption machine. So we're getting tons of information passing through our mind all the time, but we're thinking shallowly. Hence the title about that information. Rather than tapping in to our brain's capacity for deeper, more attentive thinking and cognition.
Henry Bair: [00:10:01] So I spent most of my teenage years overseas in Taiwan. Growing up there didn't have a smartphone, even though most of them were made in Taiwan. But I did not grow up with a smartphone. I didn't grow up with a personal computer. We had a family computer that we shared in the common room. That's it. Got a smartphone, got a laptop for the first time. When I came to America for college when I was 18, and even then I wasn't using it aggressively. I used my phone to call people and to text people because I thought, that's what phones are for, right? I only use my laptop for work. It wasn't until maybe halfway through college that I started using a phone for its social media functions, or using my laptop to watch literally almost every movie that I could think of whenever I wanted to, or watch really short videos on YouTube for free, things like that. And I remember the change. I remember realizing maybe junior year or senior year that I was not able to read the books that I used to enjoy reading in high school or in early college. I would physically sit down, open it, and then just get bored after like two pages. And I would think, am I a different person now? Am I less able to appreciate, have I matured or is this just actually is this material I'm reading actually boring now? And I'm just coming to realize that? What is it like? What is the reason? I guess my question for you is, since it sounds like you experienced something similar as well, do you think this is something that's like a transient thing, like we're training our minds to be less able to pay attention, to be more distractible? Or do you think there is something deeper going on? Is there some fundamental rewiring of our brains that's actually, you know, changing it, maybe even permanently.
Nicholas Carr: [00:11:46] I certainly think it's changing our habits of thought because of the technology. We're we're essentially training ourselves to be fast paced processors of information, and we're getting very good at that, but at the expense of this ability to really pay attention to one thing contemplative thinking. Reflective thinking. All all of those things that that at least at one point for most of civilization were considered the highest forms of of thinking. Now, one thing we know about the human brain is that it is malleable, as scientists say. You know, there's neuroplasticity. The brain adapts to the environment in which we're thinking into to our modes of thinking. And once, not so long ago, certainly when I was in college, in grad school and so forth, the assumption was that neuroplasticity, the brain's malleability lasted until you're about 20, and then everything was basically fixed. Your brain circuits were set. You weren't creating new neurons. Though you might eventually, as you got older, start losing neurons. And now the view of the brain has changed. And it's kind of recognized that neuroplasticity lasts throughout our life. There's a famous saying neurons that fire together, wire together. In other words, our brain optimizes itself for whatever habits of thought we have. It wants to be efficient. The brain is a huge energy hog in our body, so it wants to be efficient, and it recruits new neurons and forms new circuits to support whatever habits of thinking we engage in a lot. And on the other hand, we began to lose the brain structures associated or supporting thinking functions that we don't practice much. It's kind of it's kind of a use it or lose it type thing as with your muscles. And I mean that's overstates things.
Nicholas Carr: [00:13:46] It makes it sound like it happens really quickly. This is something that happens slowly, but it certainly happens. So you can theorize at least. And I think there's some evidence, some scientific evidence to indicate that this is so that as we train ourselves to be distracted, we begin to optimize our brain physically, structurally for that kind of thinking. And we begin to lose the ability to engage in more attentive forms of thought. Or if we're if we're doing this from a very young age, we never actually create the ability in our mind to pay deep attention, because that's really something that has to be learned. I don't think it comes naturally to people or other animals. So I think what we know about neuroplasticity and what we know about the way we use the internet and the way we think today, my feeling is this isn't just transient. Even if it was transient, it would probably still, because our habits have changed so deeply. You know, calling it transient means it would be easy to change our habits, which I don't think it is, but I think there is something probably deeper going on. This is very hard to as you can imagine, there are limits to our ability to probe inside the human brain. So I can't say there's a lot of documentary evidence of this, nor do I think it's possible to gather that evidence. But there is some fMRI brain scanning evidence that people who use who spend a lot of time online have different patterns of brain activity when they are online than people who spend a little bit of time. That's kind of what I think is going on.
Tyler Johnson: [00:15:27] So let me interrupt here for a second and ask this question. If there were someone who were listening to the program today and they thought to themselves, gosh, I used to have that ability to think deeply, to think contemplatively. Or maybe I never had that ability as much as I wanted to. But in any case, I would like to gain or to regain that ability towards contemplative thinking. Can it work in the other direction? In other words, can someone build those muscles to be able to think contemplatively? And if so, practically, what would that look like? How would you do that?
Nicholas Carr: [00:16:03] Yes, I think it happens in both directions. There's a couple of answers, I think, to this question. First is, I mean, a lot of us who are older, Henry, you know, this was your experience in Taiwan as well. If you don't grow up with the technology, then at least you have a foundation of having learned, hopefully to pay attention, to read deeply, or to exercise your attention. Otherwise, if you grow up with a with smartphones and tablets from an early age, then my fear is you really don't even develop that baseline. It's a big struggle to learn that. But I do think if we change our habits and really make an effort to spend less time looking at the screen of our phone or tablet or computer or whatever, and more time actually deliberately engaging in activities that require a high degree of attention, then yes, I think, you know, I think it goes both ways. But one thing we know from people's habits is that it's very hard to change those habits, particularly when it comes to our use of smartphones and other technologies, because these these technologies tap into very deep instincts we have. We have a seeking instinct. We want to know what's going on around us all the time. And this goes back probably in evolution that helped keep you alive. And we also have a profound social instinct. We certainly want to know if anybody's talking about us or if our status, social status has changed. So the technologies tap into these deep instincts so profoundly that it for most people, I think and, you know, even knowing all this, I find it hard to change my habits. Most people, even if they know that this kind of intensive use of the internet and social media and so forth, is perhaps stealing some of their important abilities to think they still can't change. Because this is they're just I'm not sure addiction is the right word, but kind of this compulsive need to check the technology all the time.
Tyler Johnson: [00:18:13] So I think the other thing is that it's not as if social media or any media has to be built necessarily in the way that it is, but the way that it is built right now is underwritten by enormous and deep and thorough financial incentives. Right. So if I log on to the online version of The New York Times immediately. I'm going to be flooded with advertisements that are pulling me in all sorts of directions. And even if I sit down and I try to read, say, a long form essay on whatever news website or whatever website, there are going to be things that are going to be pulling me to hyperlinks and to advertisements and to this and to that, and then even more so on social media. The longer a social media site can keep my eyeballs on that site, the more able the owner of the website is to monetize my attention. Right? And so the longer that I stay there, the more money they make, because the more advertising their advertisers are going to know that I am exposed to. And so in addition to, yes, this evolutionary drive, there is also this enormous corporate incentive that makes it sort of an unfair fight, especially because many of us, when we are doomscrolling or cruising through social media or looking at whatever our favorite news or sports or whatever website is. We may not be aware that in the background everything seems not everything, but many things online seem like they're for free. But what we are not recognizing is that there are actually paid corporate interests that are striving to keep us either distracted in the one case, or to keep our attention riveted on a particular social media site or what have you. Because the longer they keep our attention, the more money they make, such that our attention has become one of the most valuable commodities in the world.
Nicholas Carr: [00:20:03] I agree completely that one thing that internet companies, and particularly social media companies. One advantage they have is because everything everybody does online is being recorded. They can constantly and they do constantly run. These extraordinary kind of experiments at everything going on is just an experiment that gives feedback to them that they can automatically tweak their algorithms and stuff because they know exactly what kind of information A keeps you on the screen, keeps you watching the screen, and also keeps you interacting with the screen, engaged with the screen. And if you see a platform like TikTok, they've kind of perfected this ability to feed people stuff that they know is going to grab their attention. So it's on the one hand, there are these fundamental instincts we have that make us naturally prone to want to constantly look at the new and interesting and often personal information coming through our phones. But then we have companies who are making money from this and have the ability to constantly fine tune what kind of information they supply to us and when.
Henry Bair: [00:21:18] So I have a maybe a deeper question here. As someone who's, you know, someone listening to this conversation might think, might point to the fact that, okay, so we've had, uh, three decades now of the internet, give or take. We've had about a decade and a half of the smartphone as we currently know it, and we're still doing well as a species. There have been multiple studies. I've seen numbers floating around that economic productivity has escalated since the advent of social media, digital technologies, the internet, communications and makes collaboration easier. It makes education easier democratizes knowledge to places in the world that never would have been able to achieve the kinds of productivity that they can now. So someone might take a look at all of that. And even though they agree with your assessment that, okay, we're losing, we're sacrificing our ability to think deeply or to pay attention. But they may then they might say, so what? I mean, like, we seem to be doing well, you know, we're healthier than before in some ways. Generally, you know, human health, longevity, all of that stuff. Productivity. You know, on many metrics we seem, as a species, seem to be doing pretty well. What would be your response to that?
Nicholas Carr: [00:22:32] Well, I'm not sure. I see things quite as sunny as as you've made them out to be, or as your theoretical person has made them out to be. On the productivity side, there's long been the famous what's called the productivity paradox that information technology in general has not, has not seemed to translate into productivity gains. There are some signs more recently that productivity is increasing again, which may well be because of these technologies. But I think historically it's not particularly clear cut that information technology itself. Computer technology has produced the kind of productivity gains we saw, for instance, in the first half of the 20th century when you had industrial machinery come in. And then there's, you know, the question of our society's health. And At in the kind of robustness of democratic institutions of political discourse and so forth. And I think we can have a debate about whether social media and smartphones and stuff have been good or bad for that. But there's no question that you're right, that this is not a one sided thing, that it's certainly not all bad. And you're right that people can collaborate much more easily when you're doing a particular task. You can get access to information that's relevant to whatever you're doing much more quickly than before. And all of these things are have benefits and they're important benefits.
Nicholas Carr: [00:24:05] So I think for many people it will it will come down to what values they hold. And, you know, I think I certainly believe that having the ability to engage in attentive, contemplative, reflective thought is extremely important to the overall satisfaction and fulfillment an individual gets from life. But you could have another other view. I'm sure there are plenty of people who don't particularly enjoy contemplative thought, or aren't particularly capable of it, who find it very stimulating to be able to, you know, text and send messages all the time. So, yeah, I mean, there's good and there's bad. My own feeling and it reflects, I'm sure my, my own value system is that the negatives, I think, in the long run, outweigh the positives. And I fear that in some of those things that I talked about, the way we get along or don't get along these days, the the state of our politics, the kind of anger and anxiety and stuff that that social media use seems to breed in everyone, I think, or generally I should say, but particularly in the young make me and I think a lot of other people as well, kind of worried about this mirror world we've created online and how it's influencing the quote unquote real world.
Tyler Johnson: [00:25:38] Yeah. You know, all of this makes me think of this old movie that came out 20 or 30 years ago with Robin Williams called Patch Adams. In that movie, Robin Williams plays this sort of iconoclastic doctor Who is roommates with this very traditional by the books and very serious doctor to be their medical students. I guess Robin Williams character seems to be almost a savant. He studies very little and yet gets, you know, very good grades on all of the exams and what have you. But his various his very serious roommate has to study really hard. And in one scene in the movie, his very serious roommate gets really mad at him for not studying more and says, don't you understand that every moment I spend in this room studying could be the moment when I learned the fact that eventually we'll save a patient's life. Because there may come a moment when a patient's life hangs in the balance. And the only thing that will save it is me knowing the thing that I learn in this textbook, on this afternoon, in this very moment, that's sort of the message. The thing that's so striking about it is that when that movie was made 20 or 30 years ago, that scene made perfect sense, right? Because if doctors studying from old textbooks didn't learn the facts and didn't have them residing in their physiologic brains, then when a patient came in with an obscure diagnosis or a life threatening problem, how else would the fact possibly be known? But of course, now that scene makes almost no sense, because what every doctor knows is that, yes, doctors look things up on Google, or usually more to the point, they look them up on up to date, which is sort of the doctor's Google.
Tyler Johnson: [00:27:13] But as a consequence, that has made it so that a smartphone becomes an almost physiologic extension of a doctor's brain, right? It is as if all doctors, at least in the United States, are functionally cyborgs. And to some degree, it doesn't really matter in a lot of ways whether a fact resides in one of your physiologic neurons inside of your brain parenchyma, or whether it resides in up to date. Because as long as you know that you're always going to have access to your smartphone and always going to have access to up to date, then what does it really matter? I will admit that this is something that I'm sort of ambivalent about. Like on the one hand, you could make the argument that, you know, why does it really matter as long as the facts are available and you can use them to make decisions, then who cares? But on the other hand, to your point, I have to wonder. I have to worry if something isn't being lost in the exchange. Like yes, maybe the facts are still virtually universally available, and in fact, maybe that has democratized their availability so that even doctors who previously would not have been able to so effectively memorize them now have access to them. And that's probably a good thing. Yet at the same time, I worry that there is something lost in the exchange that we are potentially losing a certain rigor or a certain methodological ability to think things through deeply and to understand things more rigorously than perhaps we do now.
Nicholas Carr: [00:28:46] Yes. And you two would be better able than I to discuss exactly how this influences the medical profession. But I do I think in this I think is also influenced by the technology we've come to value, having the right information available to us at the right moment to do some very well-defined task. And that's that's fine. But we've come to undervalue what I was talking about earlier, which is the way the brain forms associations and connections between all of this information, which comes by by really paying attention and thinking deeply about things, rather than just googling the right bit of information and applying it. And what's lost, I do think, is this ability to think contextually, to bring kind of seemingly unconnected information together to, in a kind of creative way that can be very illuminating. So not being a doctor, not being in the medical profession. You know, I've heard people say that diagnosis, for instance, you become better at diagnosis. The more experience you gain you have in the profession. In a lot of that experience, assuming you're actually paying attention and doing it yourself does get stored in your brain and it is all connected and associated. So is using software or Google or artificial intelligence. Can that replace all of that and just make it more efficient? And you get the right answer all the time, and you don't need that broader context. I don't know. I would think to some degree it becomes less satisfying to the doctor to just use the tool. What we saw in the last century is, you know, craft persons who who developed this rich knowledge of metal and materials and stuff were replaced by machinists who just push buttons. And the machine did it. They got paid less. It was less fulfilling, but it was efficient. So I there's there's these trade offs and I don't know how they all fall out.
Henry Bair: [00:30:58] Yeah. Speaking of the you know, you talk about the effects of machines replacing craftsmen. One of the sections in your book discusses the role of EMRs, electronic medical records and their deployment. They are now fairly ubiquitous in America at least, even though, you know, I think ten years ago, 15 years ago, they did not exist. Not nearly to the degree of pervasiveness as they are now. You know, I, I still come across so many who I think of as young attending physicians, my supervisors who talk about back in the day when these paper charts and I'm thinking, weren't you in residency like ten years ago, less than ten years ago? Like, how much has it all changed, as it turns out, quite a bit. Right. Um, so I'm wondering if you can share with us what the story of the adoption, the widespread wholesale adoption of electronic medical records. What does that story teach us about the promises and the failed promises of information technology adoption at a large scale?
Nicholas Carr: [00:32:00] Yeah, I researched and wrote about this in Not in the Shallows, but in the subsequent book called The Glass Cage, which is about automation in general. And this was this came out in 2014, which was kind of the end, I think of the first big investment stage in electronic medical records. I have not followed that story for the last ten years, so I can comment on what happened early on. I don't really know what's gone on since then, but there was, as you point out, records were not digitized medical records. So each doctor's office, each hospital had its paper records, its charts. And the obvious drawback to that is that it was very hard to share this information, particularly automatically. So you get sick in one place, and they don't know that your history from another practice or another hospital. So there was obviously a huge desire when the internet arrived and everything began to be digitized, to create electronic medical records and to have shared systems. And there was beginning with, I think, the George W Bush presidency into Obama, huge amounts of money invested in this billions and billions of dollars very quickly. And unfortunately, what happened is, is, as it turned out, a lot of that money was wasted because, again, software companies came in, they smelled the money. And so there were all these systems created, but they were still incompatible. And also they required a lot of time to on the part of doctors to learn them. There were bugs, there was problems. Um, some older doctors at the time told me that they simply left the profession because it was it.
Nicholas Carr: [00:33:44] It became so onerous to deal with the new systems that didn't work very well that they simply left. My guess is that, as is true of technology, those early hopefully. I hope this is true. Those early kind of bugs and problems and incompatibilities have been worked out, at least in part in the subsequent ten years. I think it probably meant a whole new round of investment. So certainly the computer companies made out very, very well. But I think one thing we learned is that you have to be very careful, particularly when it comes to information systems, to not simply throw tons of money at it all at once. But you need to test things, move carefully, see what works, what doesn't work, and then in a much more logical, rational way, expand so you can avoid these problems. So that's that's one part of the story. Then there's another part which I think reflects what people who study automation have found in general, which is when you automate a job, you don't simply make it faster. You change all sorts of aspects of it. And this is true of automation in general. You see with pilots, you see it with, you know, factory workers and so forth. And so one of the things that really interested me in looking into this is how automating medical records had unexpected effects and consequences, some of which were not particularly good. One thing that came out is that a lot of doctors, particularly general practitioners, actually used to learn a lot of specialized information by reading through the notes that specialists had put into the chart.
Nicholas Carr: [00:35:34] Um, as soon as everything got automated, people, people started using boilerplate. It became a cut and paste game. You just cut and paste stuff from earlier records into the new ones, and a lot of the subtleties and the nuance that found their way into doctor's notes were suddenly lost. Um, so this this what had been kind of a learning tool in a way to exchange knowledge within the profession was much dampened. Um, and there were other. Kind of negative drawbacks in the in the kind of information sharing, how doctors work and so forth that came out of this rush to automate what had been a very manual practice. Again, maybe all of those things in the last ten years have been tempered or solved, or maybe doctors just got used to them and said, well, this is the way it is. So we're we may lose these things we got with manual records, but the efficiency and the ability to exchange information across practices and with patients and so forth was a trade off worth doing. But nevertheless, I think in in EMR and you see it in other aspects of medicine, one of the one thing we need to be aware of, because it always happens, is that when you automate a process, you don't just make it more efficient, you change the way work is done.
Henry Bair: [00:37:00] I hate to break it to you, but in the last ten years I don't think that much has changed. They're still it's still a fragmented system. My own hospital where I work in one hospital we deal with we residents, we deal with five different EMR made by four different companies, and they do not talk to each other. This is insane to me because we often have patients who see different practitioners from different departments in the same hospital. And yet when we have to are trying to piece together their story, we have to log in individually to all these different records we have, you know, like five different login credentials, which most of us forget, like at least once per year. It's it's very frustrating, first of all, to deal with that. But it also leads to, you know, actual harms to patients when someone comes into the emergency room and then the EMR and the emergency room is a different one from the one in the clinic's not even that. Sometimes the physical computers are we are unable to access some of the charts in the other facilities, the other locations. So yeah, things haven't changed, including the fact that the computer, the software company, still still made out successfully. I think they're still as wealthy as they were back then. But at the same time, to your point, you know, you ask everyone, would you want to go back to paper charts? And no, no one wants to go back to that either. So, you know, it's definitely a mixed feelings I have. Tyler.
Tyler Johnson: [00:38:22] I do want to bring up what I think is an important point here. You know, we could have an interesting discussion about whether, writ large, recent advances in technology have made the experience of being a doctor or a patient better. But I think that one unintended consequence that is essentially unquestionable about recent advances in technology is that, I mean, to be clear, doctors have always been a relatively distractible and distracted bunch, right? We long before people were commonly carrying cell phones, we were carrying pagers. And in effect, the whole point of pagers is to be able to, if you will, distract a doctor in the middle of something else so that you can get the doctor's attention so that they can go attend to emergencies and what have you. And so that has always been the case, but it feels like smartphones in particular have greatly exacerbated that tendency. Right. Because of course, now you're not only getting paged for what you hope were previously mostly emergencies, but you are also getting buzzed every time your social media updates, every time you get a retweet, every time you get a like on Facebook, every time you get a reaction on Instagram, there's a new video for you. On TikTok, you have a new email, you have a new phone call, text message, whatever the thing is. And all of that is just to say that I fear that we are losing the ability as doctors to be deeply and thoroughly present with our patients, which, ironically, is both increasingly Needed, I would argue, and which also is increasingly one of the few things that we may have left to uniquely offer given the technological revolutions that are coming, right, that if we have bots and AI and whatever that are going to be able to think deeply for us, it may be the case that one of the most important and unique things we have to offer in the doctor patient equation is precisely our undivided presence.
Tyler Johnson: [00:40:32] And furthermore, I worry that this also reflects a broader shift in society, where all of us are less able to be present for anything or for anyone, whether it's a friend or a parent or a sibling or a romantic partner or what have you. And so I understand that you have a book coming out early next year called, I think, Superbloom that is discussing in particular social media and the effects that that has on our sociability and the way that we interact with each other. And I was hoping that you could give us a little bit of a preview of what your research for that book showed, and what are the arguments that you will make.
Nicholas Carr: [00:41:13] Sure. Just as I talked about this, this paradox with information in that more information actually in many ways led to less knowledge or less less depth of thought. I think there's another paradox with communication we've always assumed, and you go through the history of communication technology. You see these kind of really almost utopian beliefs when when a new communication system comes along that by allowing people to talk more and share information more, it would have to have a good effect. It would have to bring people together. They would get broader minded, we'd understand each other. We'd have more empathy with each other or more sympathy. And what we've learned, I think we should have learned it with earlier communication technologies. But what we've learned with social media in particular is that once again, it's the way communication takes place. How we communicate that is more important than how much we communicate. And certainly social media encourages constant self-expression, constant exchanges of messages. But what it doesn't encourage is the kind of focused communication in person communication that's necessary to develop deep emotional connections with other people, to develop empathy. Empathy is what's known as a complex emotion. So unlike fear, for instance, which is immediate, empathy, like deep thoughts, takes time to emerge in the brain, and it really takes attention to another person in their situation, and often aided by conscious attention to their eyes and their gestures and their body language and so forth. And so we've created here again, we've created this incredibly powerful system for exchanging messages and broadcasting our thoughts and the minutia of our lives all the time. But I think it comes at a cost of those kind of deep connections that really require, once again, attention to another person as an entire person, not just as a stream of messages or likes or emojis on screen.
Nicholas Carr: [00:43:25] And so my, my book looks at that, at that, at this kind of paradox of how more communication can lead to less understanding, both at a personal level and I think at a broader social and political level. And I try to show how our new social media system kind of fits in with, but is also different from things like the telephone, TV, radio going back earlier to telegraph and books and look at kind of aspects of human nature that we chose not to pay attention to. But that should have warned us that simply encouraging people to communicate more and in broadcast, more details about their lives may actually create exactly the opposite effects from those we anticipated. So there's, for instance, there's psychological research that shows the more a person learns about another person, it doesn't necessarily lead to more liking. It often actually leads to more disliking for a reason that's referred to as dissimilarity cascades. We know, and this is perhaps unfortunate about us, but that we tend to like people who are similar to us and dislike people who are dissimilar to us. And when we exchange information or see information about other people the way we do in a disembodied way on screen, When you start seeing dissimilarities, then you begin to place more weight on dissimilarities that come after that. And so dissimilarity kind of creates this cascading effect. So even just at the basic level of believing that simply learning more about another person would lead to better understanding, more empathy, even their human nature, unfortunately, is often pushing us in different directions.
Henry Bair: [00:45:21] So I don't think given the momentum and just how pervasive and how successful, social media is just totally interwoven within within the fabric of our lives, it is interwoven with within our professional and personal lives, actually. And I don't think we're going back to a time when there are no when social media didn't exist. I don't see how that could happen. Where do you think we go from here now? Now that you've done all this research, you've looked at all the all the dangers of it, but yet there's no real feasible way to scale back. What's next?
Nicholas Carr: [00:45:53] I agree. And I you know, I wish there was an expectation, particularly of book authors and stuff, that once you lay out a problem, then you give the, you know, spend the last ten pages saying, oh, here's eight steps to solve the problem. I certainly don't think we're going backwards. People are not barring some kind of incredible countercultural movement, which could happen, but probably won't. You know, people are not going to give up their phones, their lives now, not just social media, but all sorts of stuff is compacted into this little machine we carry around with us all the time. And, you know, even if you look at things the government is thinking of doing with social media, you know, with TikTok, for instance, requiring it to move away from Chinese ownership, breaking up, maybe meta, so that Facebook and WhatsApp and stuff are perhaps separate. These may be good things to do, but none of them are going to change the fundamental social media system and how it works. And on the one hand, you can see how it's very manipulative and the companies are making money by often tapping into our worst instincts. But on the other hand, they are instincts in people get a lot of pleasure from using the technology, so the manipulation reflects the pleasure that draws us to it in the first place.
Nicholas Carr: [00:47:13] You know, I do think there are things government can do to temper some of the ill effects, and I certainly think that each individual has it in their power to change their habits and how they use it, and maybe not carry their phone with them all the time, or to realize it's a tool that's good for some things but not good for others. But my own belief is that the speed of the network is going to continue to get faster. We're going to have more and more objects in the world are going to turn into either digital sensors or essentially computer interfaces. We're going to be surrounded by all this data more, not less, in the future. I think these trends are going to continue, and I think it is going to be a challenge for society, particularly when we look at kind of the broader sociopolitical aspects of this and the fragmentation and polarization of people, the kind of anger that courses through and is exaggerated by social media. It's going to be a real challenge to deal with this, because I don't think the technology is going to change in a fundamental way. So either we have to change our habits or we're going to see, you know, the bad things get even worse.
Tyler Johnson: [00:48:34] Yeah. I mean, I think if you think back to Aldous Huxley's Brave New World, I feel like in many ways, cell phones have become instant soma dispensers. Right? They're almost like instant soma injectors as if they have access to our veins, right? Because anytime I start to feel a little down or even a little not up, right, if I'm just sort of feeling baseline and that's bothering me, then I can just jump on my phone. And whether it's playing a video game and getting a lot of buzzy points or looking on social media and seeing that someone's given me a positive reaction, or for that matter, watching a movie or like whatever. The thing is, anytime I'm starting to feel like I need a fix, I just get on my smartphone, push a button and there is the fix, right? And the thing that worries me about this is that if we allow this to become the case all the time, then it is as if our cell phones become the instruments of our lives, devolving into little more than the thick of thin things, right? It is as if the only thing we are ever doing is looking for the next Soma hit. And to your point, it feels like at some level this is going to require, given that cell phones are, you know, probably not going anywhere, and that the tech is likely only going to get smoother and smoother as time advances. It feels like this is going to require personal, countercultural decisions to decide. I am not going to make my life be only about going after the next Soma hit. I am going to decide, like in order to have deeper relationships and a deeper sense of meaning in life, and a deeper ability to enter into the things that actually make life worth living, we are going to have to learn to reject the potentially evolutionarily wired impulse to always be going after the next thing. That will make me feel really good right now.
Nicholas Carr: [00:50:42] Absolutely. If you think about, you know, learning to pay attention has never been easy for people. We are distracted. You know, when a child learns to read, it's a really hard thing. And lots of circuitry in the brain has to change, and they really have to dedicate themselves to it. Or if they if they learn to play an instrument, you know, it means a lot of, a lot of hard practice that doesn't pay off immediately. And yet, if you become good at it, it adds this fulfilling aspect to your life later on. So there there's all these examples of how, you know, not allowing ourselves to take the soma to be distracted, to get the little pleasure hit. If we can withstand that, we can open up new opportunities and new horizons for ourselves. I hope people can do it. What particularly what particularly scares me nowadays is that we give children at ever earlier ages phones with social media, so they're never alone. They can socialize all the time. You know, when I was growing up, you were with your friends. Sometimes it was great. You were having fun. You were talking and stuff. But then there were times when you were in your room and you and you didn't have that social stimulation or gaming or whatever, and you kind of were thrown back to your own resources and maybe you felt bored, but you worked through the boredom and you figured out new ways to amuse yourself. That often turned into kind of hobbies or interests that broadened out as you got older. And if kids can socialize all the time, kids love to socialize. They'll socialize all the time. So. So in one way, I think unfortunately, we're stealing kind of even the the settings that encouraged people to develop other interests and learn to be attentive and, you know, broaden out their lives. And it seems to me that here too. Unless parents in communities really change the norms. It strikes me as here too. We're kind of not going to go back.
Henry Bair: [00:52:53] Yeah. With with the last few moments here, I'm wondering if now, now that you've told us sort of the what you're most worried about, but also what we can do in general. Just, um, you know, the benefits of scaling back for ourselves, at least on an individual level. Can you share with us maybe 1 or 2 of, you know, practical advice you have maybe inspired based off of what has worked for you? Yeah.
Nicholas Carr: [00:53:16] And let me let me preface it by saying that I struggle, struggle with this too, because the technology is extraordinarily compelling in all sorts of ways. But perhaps the most important thing, if you can do it is we kind of as soon as we got smartphones in particular, we assumed we had to carry them with us all the time. We never wanted to be out of touch or distanced from all the apps and all the function functionality they provide and stuff. And I think if the best thing you can do is kind of break that, hold that the phone has on you, and so actually go out if you're going to take a walk, don't bring your phone. If you're going to go out to dinner with your spouse or your or a friends or whatever, don't bring your phone. The more time you can spend separate from the technology and its stimulations and its its interruptions and distractions, the more you can exercise different ways of thinking and communicating and being present, as opposed to being half the physical world and half in the virtual world. So simply kind of spending a significant amount of your day to day life without your phone in your pocket or your pocketbook or your backpack is, I think, in many ways, the best thing you can do.
Nicholas Carr: [00:54:36] And then there are other practical things like seeing how social media companies and other internet companies kind of manipulate us and have set up these systems for manipulation. And so, so, for instance, turning off notifications wherever possible from social media and all the various other things. Now, every app wants to notify us all the time of some of the most trivial things imaginable. But just having the discipline to turn off notifications. So you choose when you gather information, when you look at something, rather than the technology and the company behind the technology choosing for you. So those are, you know, a couple of simple suggestions, but simple to say, hard to actually accomplish because we are we tend to these days, we're so entwined with the technology that you kind of feel panic if you don't have it at your beck and call all the time. But it seems to me that that, you know, reducing our reliance on the technology and reducing its ability to constantly interrupt our thoughts. If we do want to change our relationship, it has to begin with those kinds of things.
Tyler Johnson: [00:55:46] So, Nick, I know that our hour is up and we need to let you go, but I do want to say one final thing. On a personal note, 8 or 10 years ago, I stumbled on your book, The Shallows, as well as on some of Sherry Turkle's books in particular, Alone Together and Reclaiming Conversation. And I just want to say that there are not that many books that have had a what I would call a genuinely transformative impact on my life, but these are among them. After I read your books and all of those books that I was referring to and some articles and other things at the same time, these came sort of at a very formative time for me, and I made a very conscious decision to try to de wire my heart and mind so as to ensure that I was not just going after the next Soma fix or the next dopamine hit. And that's not to say by any stretch that I have done any of those things perfectly, because certainly I haven't. But even when I make mistakes, even when I don't do it perfectly, I feel like it is something that I am always thinking about. Like, I have rearranged the way that I use my phone, the way that I use my computer. It's helped in the way that I write, the way that we prepare for the podcast. Like, I am completely off of social media now. I have no further interaction with it. Anyway, all of that is just to say that all of this has largely come as a result of me finding the arguments advanced by you and Sherry Turkle and others to be so compelling that they really did bring me to make a significant change in the way that I lived my life. And for that, I want to thank you.
Nicholas Carr: [00:57:32] You're very welcome, and it's very satisfying to hear that. That people can change and that maybe I played some role in that process. So thank you.
Henry Bair: [00:57:41] All right. Well, thank you very much for your time. Thank you. Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at the doctor's Art.com. If you enjoyed the episode, please subscribe, rate, and review our show. Available for free on Spotify, Apple Podcasts, or wherever you get your podcasts.
Tyler Johnson: [00:58:06] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient, or anyone working in healthcare who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments.
Henry Bair: [00:58:20] I'm Henry Bair
Tyler Johnson: [00:58:21] and I'm Tyler Johnson. We hope you can join us next time. Until then, be well.