Curbside Consult with Dr. Jayne 1/6/25

Since the Snowpocalypse is upon large portions of the US, I decided to show solidarity by staying home, making baked goods, and working on my reading list.

I’ve gravitated towards audiobooks in a big way. They have become my preferred way to consume fiction because I can enjoy them while doing household tasks, driving, and in many more situations than I can enjoy a paper book or even one on my trusty Kindle. For non-fiction, I still like to have a physical book in hand, especially one that references previous sections or chapters since it’s so much easier to flip back and forth.

This weekend’s paper read was one I had picked up from the library a number of weeks ago. I decided to finish it so that it could go back into circulation. I was originally drawn to the book through a reference in an article I was reading that talked about how the internet is responsible for making people “dumber.”

Barely into the first chapter, I was seeing parallels between the book’s discussion of how true expertise is being devalued and the conversation I had recently with a colleague who cited “patients arguing with me all the time” as the chief source of her burnout. The first chapter addresses the idea of differentiating “experts” from “citizens” and the role that each has played in society. Experts typically have specific credentials, although the book identifies different levels of experts bearing credentials: those with aptitude or talent or experience in the field who also have credentials, and those who just have credentials.

We see the latter in medicine and I see it often in the startup world. People who have the MD or DO degree decided to go into business rather than completing a residency, and thus have never cared for patients independently or learned to bear the direct individual responsibility for another person’s life. It’s different when you’re talking about lives in the abstract or in the aggregate than when you’re sitting at the bedside with a patient and family whose treatment didn’t go the way they expected. Those with credentials but not experience or aptitude may be charismatic and may be recognized as entrepreneurs, but they will never be recognized in the same way as a physician who actually went through the steps to be board certified and to carry that kind of a load personally.

Partway through the first chapter, I had to check on its publication date. The copy I had in hand was a first edition version from 2017. On one hand, I was relieved, because reading about the debacle that was the first couple of years of COVID is still triggering for me as a frontline provider who had COVID deniers coughing in my face during the 12-hour shifts that were nearly always 14 hours long.

A lot of us who went through that experience felt at the time that COVID had magnified the willingness of patients to argue with us, largely due to conspiracy theories and medical misinformation that was found all around us. But the book reminds us that it was happening well before then, which reminds me of a patients who would arrive with stacks of pages printed from internet blogs that they would cite as evidence for the treatments they were demanding.

The book also talks about influencers and uses Gwyneth Paltrow and her GOOP brand as a prime example. I’ll admit my bias upfront here – it is my strong personal belief that “influencers” will be the death of Western Civilization as we know it. I remember when I was a kid, and there was such a focus on the idea of peer pressure and how it was something to be avoided, and that people should be critical thinkers and use their own values rather than doing something just because their friends were doing it.

The in-your-face nature of influencers and the rise of social media and TikTok have been terrible for many segments of the population, whether it’s because they wind up in the emergency room after doing some inane TikTok Challenge or whether they waste their money on unproven treatments or so-called wellness products that are more multilevel marketing than evidence-based.

The book has a short section on conspiracy theories that made me chuckle. At least to me in hindsight, the conspiracy theories that were out there in 2017 were far more benign than some of those we hear today. There’s an interesting section on how changes in higher education have led to the death of expertise, including the up-branding of small local colleges to universities without a commensurate change in the education they’re delivering, along with an attitude that people attend college or university because they are pressured to do so or feel they have to as a next logical step in their lives.

The author talks about the difference between “having a college experience” and “getting an education” and how the former has changed attitudes at institutions of learning. We’ve definitely seen this in healthcare and I’ve seen it quite a bit in the for-profit healthcare training programs out there. Graduates come out of some of these programs with no experience other than shadowing, which is truly a travesty.

My favorite chapter is the one titled “Let Me Google That for You,” which really should be the anthem for my generation. I run into a lot of people who think that because it’s on the internet it must be true, and I agree with the author that many people don’t have the skills to critically appraise their sources and to determine whether they should be trusted. Honestly, if I see one more friend posting on “cough CPR” — which is where if you think you’re having a heart attack while driving you are supposed to cough forcefully while driving yourself to the hospital — I am going to scream. This is a myth and that has been debunked by numerous reputable sources. I always post links to those sources when I see that post and remind people that if you think you’re having a heart attack while driving, you should pull over and dial 911 or hit the emergency button on your phone rather than trying to drive yourself and risk the lives of those around you.

Even in 2017, the author touches on Robert F. Kennedy, Jr. and vaccines and other medical misinformation. He reminds us that “a search for information will cough up whatever algorithm is at work in a search engine, usually provided by for-profit companies using criteria that are largely opaque to the user.”

He notes that “The deeper issue here is that the Internet is actually changing the way we read, the way we reason, even the way we think, and all for the worse. We expect information instantly. We want it broken down, presented in a way that is pleasing to our eye – no more of those small-type, fragile textbooks, thank you – and we want it to say what we want it to say.”

People do not do research so much as they “search for pretty pages online to provide answers they like with the least amount of effort and in the shortest time.” The resulting flood of information, always of varying quality and sometimes of uncertain sanity, creates a veneer of knowledge that actually leaves people worse off than if they knew nothing at all. It’s an old but true saying: “It ain’t what you don’t know that will hurt you. It’s what you do know that ain’t so.”

He also tackles the evolution of journalism (fun fact: I now know the origins of the TV show “Nightline”) and reviews some specific studies from the University College of London about how people often interact with the internet by “reading” articles by consuming the first few lines or sentences and then going on to the next thing.

The phrase “power browse” was used and I definitely see that in some of my own behavior, usually when I’m trying to cull through all the noise out there in order to write for HIStalk. It’s useful in that context, but might be dangerous if I’m trying to read about patient care or learn the nuances about a specific course of treatment. It makes me wonder how easily people can shift between those approaches in the fragmented timeline of a day caring for patients.

The book is a relatively quick read at 230 pages, and of course you can power browse it if you’re not quite ready for a deep read. I’d encourage the latter, however, because they author has a couple of really funny statements in there that I would have missed by skimming.

Have you read it and what did you think? Any other good reads you’d recommend for 2025? Leave a comment or email me.

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