Returning home from a vacation in Europe I read a delightful and insightful piece by David Brooks in the International Herald tribune entitled "The External Brain". It can be found here.
I actually still have my little black book which was a lab coat pocket sized binder notebook in which house officers in the day wrote things that they thought they needed to know and no, I don't use it anymore. That and the Washington Therapeutic Manual were our "peripheral brains." I find an 40 year old entry under CHF which talks about how to slowly "digitalize" a patient with congestive heart failure and another on how to do the "Ivy bleeding time, both of which are medical museum pieces.
Brooks, in what I believe to be at least in part a tongue in cheek essay talks about how by becoming progressively reliant and dependent on his GPS system he was discovering the "Sacred order of the External Mind." He could now out-source mental tasks to a satellite brain, an external Mind. He says he may now no longer need a memory because with a few key-board strokes he can get what he needs on Google or Yahoo and the drudgery of having to remember so much stuff is eliminated or for more personal material open up his Blackberry.
He writes that he discovered that the magic of the information age was not we could now know more but that it "allowed us to know less."
The clunky,relative information-poor little black book of yesterday's intern has morphed into the powerful PDA through the mystery and magic of the silicon chip animated by the unforgiving logic of the algorithm.This can not only hold a PDR, one of the available antibiotic guides and five Minute Clinical Consultations,etc,etc but when Internet-enabled the entire universe of the external brain can be accessed.
Brooks continues " I have relinquished control of my decisions to the universal mind...Life is a math problem and I had a calculator"
One possibly disturbing counterpoint is noted in Brooks' reference to a piece by Clive Thompson in Wired which claims that one third of folks under age 30 can't remember their own telephone number.
Of course, physicians cannot really relinquish control to the universal medical mind. However, when you have the background and the context of experience, access to the "outboard brain" is unbelievably empowering and having tasted of it you never want to do without it. But as Clive Thompson said in his closing, I would like to still remember my own phone number.