Tagged Computers and the Internet

Why I Decided to Stop Writing About My Children

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Credit Giselle Potter

There is a hunger in our culture for true stories from the parenting trenches where life is lived mud-flecked and raw. I’ve written extensively, intimately, damningly, about my children for seven years without once thinking about it from the point of view of their feelings and their privacy. A few months ago I stopped.

I wish I could say that I deeply reflected on the ethics of writing about my children and heroically pivoted myself out of a concern for my character, but here’s what really happened: My father called.

He called me after reading a blog post I had written about my son’s first signs of puberty. It seems an obvious line-crossing that I wrote about such an intimate detail, but I did. At the time I didn’t pause for a split second; I was more than willing to go there. I had been writing and reading extensively about parenting tweens. I knew people might be mildly shocked, but mostly interested.

We live in a break-the-internet arms race of oversharing. And adolescent sexuality is an emergent, fascinating topic, especially for parents who are figuring out how to address difficult questions with their children. For example: I ate up Peggy Orenstein’s marvelous new book, “Girls & Sex,” with a spoon, shocked and upset the whole way through.

But when my dad said, “Elizabeth, are you pausing to deeply consider what you’re writing about?” I wanted to get defensive. I said, “Uh. I kinda perceive myself as a confessional poet, Dad,” I said, “Heir to Plath, Sexton and Sharon Olds. And the photographer Sally Mann, if I’m honest, Dad.”

But he said, “I’m not talking about art. I’m talking about my grandson.”

He was a lion for his grandson. I listened. I heard him. His words went to my heart, my maternal heart, which is in equal parts steel and cornmeal mush. I thanked him honestly for his feedback, got off the phone, and cried into my daughter’s stuffed animals, which are very soft and plush and forgiving.

So began my wrestling with my relationship with the Nora Ephron line, “Everything is copy.” Until now it has been my battle cry and artistic excuse for printing whatever I wanted whenever I wanted with very blinkered vision. Maybe, in fact, not everything is copy. Maybe it’s people’s lives, and we should be considerate and loving and respectful of their privacy. It’s a new point of view for me in our clickbait culture of confessionalism and parading nakedness.

When I started blogging, my kids were babes in arms, hardly people; they were creatures, mewling, milk-drunk, with eyes so deeply slate they were alien-denim blue.

I used the blog as a live journal to get me through postpartum depression and “the lost years” for me that were “the magic years” for them, when I felt overwhelmed by washing out sippy cups, lurking at the edges of the mommy wars, and co-sleeping and diapering.

Writing made the joys and the hardship of parenting into stories. Stories I could tell. Stories that I considered as one considers a diorama.

I was always the narrator, the main character, even if I was also the storm-tossed heroine, the hot mess in mom jeans who couldn’t get the overalls on her 2-year-old. Or figure out fourth-grade fractions homework. I was working out my issues. My kids were always satellites to the big round-faced moon of me.

I’ve shamed their eating habits in chat rooms. I have Facebooked the things they’ve said. I have skewered them horribly, but also with great interest and affection, as a collector might do to some butterflies.

I think Sally Mann’s photographs of her kids are luminous and transcendent, while others accuse her of child pornography. The lines between art and privacy are blurry. You have to consider what you are doing carefully. And previously I wasn’t.

Sally Mann and I don’t belong in the same sentence. I’ve been a Baltimore mommy-blogger writing about things like head lice. She is a world-class artist. But she and I have done the same thing: publicly disrobed our children.

My children didn’t give me their permission to tell their stories, or strike poses in a waterfall, naked, gorgeous as all get out, and human, with lives ahead of them, as Sally Mann posed hers. And now that I see that, I don’t want to mar my children’s glory and subvert their beginnings for my so-called art.

If I’m going to continue writing, I realize I need to find some new material, and for that I’m going to have to look more deeply within myself or entirely outside. For inspiration I have turned to writing about nature. The environment. The sea. Things that are bigger than me. I’ve been reading John Muir. I’ve been reading “Braiding Sweetgrass.” Nature is for all to see. Nurture is between me and my kids, off the record.


Elizabeth Bastos lives in Baltimore and writes about urban nature. Follow her at thenaturehood.blogspot.com and on Twitter @elizabethbastos.

Living with a Teenage Data Hog

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Credit iStock

After children reach a certain age, most parents give in to their desire for a mobile phone. We like being able to find them at any moment, and they risk being left out if their friends can’t ping them. A Pew Research Center report from last year found that 88 percent of American teenagers now have phones.

But today’s smartphones have earned that name because of their ability to suck in and spit out data at ever-faster rates. That gets expensive, quickly, and figuring out who should pay for the data, how much, and according to what rules, can be a giant headache.

So first, an opening proposition: The ability to access the internet via a cellular signal, in those passing moments when Wi-Fi is not available, is a want and not a need for most teenagers. And if they want it, they should pay for it themselves.

But when I share that assertion with many parents I know, they often respond by patting me on the head and telling me to get back to them when my 10-year-old has a phone and all her friends do, too. To those parents, a data plan is no indulgence. Their kids are busy — constantly on the way to an athletic event or rehearsal. They don’t want to deprive their kids of the ability to stream music or stay connected with their friends on data-draining apps like Snapchat. So a data plan is a given, and the parents are willing to pay.

But just how high a bill is reasonable? I suggest the budgeting approach: Parents pay for a certain amount of data each month, the children track how much they’ve used, and then they pay for anything beyond that allotted amount.

It’s simple enough in theory. Carriers lets customers check to see how much data each person in a family plan has used so far during the month, and the privilege of having a phone should come with the responsibility of keeping track.

That approach does, however, require you to sit down with your teenager and identify the sources of data drain and perhaps set rules for when those apps ought to go off. The Times’s Wired Well columnist, Jennifer Jolly, lives with a data-draining teenager. She suggests turning off any features on a teen’s phone that drain data automatically in the background. Also, track the apps that use the most data and limit data hogs like Spotify or Snapchat to times when the teenager has Wi-Fi access. One additional hint: The more video an app records, transmits and receives, the higher the data bill is likely to be. Call your carrier or consult online forums if you need more help.

In an ideal world, this approach teaches patience, self-control and restraint. Your kids can always watch a video a little later over Wi-Fi, after all. And many messages – most, even – can wait a bit.

But in a less than ideal world, teenagers tend to go over their caps, especially if their friends send lots of videos back and forth via Snapchat. Some parents have enough money to simply pay for the overages. But discussions about those bills are useful. If we don’t set limits, after all, who will? And isn’t our job to get our kids ready for the moment when they really will be paying their own bills?

A few years ago, I wrote about the Russell Plan, named after Mary Kay Russell, a mother of four sons in Naperville, Ill. She added her sons to the family’s cellphone plan when they were ready for their first phones, and the cheap devices they received came with unlimited calls and texting. The boys were welcome to burn data to their hearts’ content on an upgraded phone, but if they wanted to do that, they would have to pay for the device and prepay $360 for a year’s worth of data. The oldest waited until age 21 to get his first fancy phone.

Perhaps his response to the family’s strategy was not such a big surprise. The cost of a smartphone plus data is a big pile of cash to a middle school student who may not have many ways to earn money. Parents who can afford it might consider raising a child’s allowance some to put the decision just within their reach – and make the possibility of waiting on an upgraded phone more enticing.

How much more allowance might they get? It depends on whether you’re asking them to use allowance to cover lunch, snacks, transportation and clothing, too. But you could increase the allowance enough to pay for 50 or 75 percent of a basic data plan, so that the choice to purchase it would involve some sacrifices elsewhere.

Yes, you’re technically “paying” for the data plan in this instance, but that’s true with allowance in general. Once your children have it, the money will feel like it’s their own, and the trade-off will feel real, too.

The Russell children could have asked for upgraded mobile devices and money toward data for birthdays or Christmas, but they often had other priorities. Which is great: We want our children making financial trade-offs, since that is what they’ll have to do as grownups just about every day of their adult lives.

Ron Lieber is the Your Money columnist for The New York Times and the author of “The Opposite of Spoiled,” about parenting, money and values.

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Computer Vision Syndrome Affects Millions

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Credit Paul Rogers

Joanne Reitano is a professor of history at LaGuardia Community College in Long Island City, Queens. She writes wonderful books about the history of the city and state, and has recently been spending many hours — sometimes all day — at her computer to revise her first book, “The Restless City.” But while sitting in front of the screen, she told me, “I developed burning in my eyes that made it very difficult to work.”

After resting her eyes for a while, the discomfort abates, but it quickly returns when she goes back to the computer. “If I was playing computer games, I’d turn off the computer, but I need it to work,” the frustrated professor said.

Dr. Reitano has a condition called computer vision syndrome. She is hardly alone. It can affect anyone who spends three or more hours a day in front of computer monitors, and the population at risk is potentially huge.

Worldwide, up to 70 million workers are at risk for computer vision syndrome, and those numbers are only likely to grow. In a report about the condition written by eye care specialists in Nigeria and Botswana and published in Medical Practice and Reviews, the authors detail an expanding list of professionals at risk — accountants, architects, bankers, engineers, flight controllers, graphic artists, journalists, academicians, secretaries and students — all of whom “cannot work without the help of computer.”

And that’s not counting the millions of children and adolescents who spend many hours a day playing computer games.

Studies have indicated 70 percent to 90 percent of people who use computers extensively, whether for work or play, have one or more symptoms of computer vision syndrome. The effects of prolonged computer use are not just vision-related. Complaints include neurological symptoms like chronic headaches and musculoskeletal problems like neck and back pain.

The report’s authors, Tope Raymond Akinbinu of Nigeria and Y. J. Mashalla of Botswana, cited four studies demonstrating that use of a computer for even three hours a day is likely to result in eye symptoms, low back pain, tension headache and psychosocial stress.

Still, the most common computer-related complaint involves the eyes, which can develop blurred or double vision as well as burning, itching, dryness and redness, all of which can interfere with work performance.

One reason the problem is so pervasive: Unlike words printed on a page that have sharply defined edges, electronic characters, which are made up of pixels, have blurred edges, making it more difficult for eyes to maintain focus. Unconsciously, the eyes repeatedly attempt to rest by shifting their focus to an area behind the screen, and this constant switch between screen and relaxation point creates eyestrain and fatigue.

Another unconscious effect is a greatly reduced frequency of blinking, which can result in dry, irritated eyes. Instead of a normal blink rate of 17 or more blinks a minute, while working on a computer the blink rate is often reduced to only about 12 to 15 blinks.

But there are additional problems. The head’s distance from the screen and position in relation to it are also important risk factors. To give the eyes a comfortable focusing distance, the screen should be about 20 to 26 inches away from the face. The closer the eyes are to the monitor, the harder they have to work to accommodate to it.

In addition, when looking straight ahead, the eyes should be at the level of the top of the monitor. The University of Pennsylvania’s ophthalmology department advises that the center of the monitor should be about four to eight inches lower than the eyes to minimize dryness and itching by lessening the exposed surface of the eyes because they are not opened wide. This distance also allows the neck to remain in a more relaxed position.

Yet, in a study in Iran of 642 pre-university students reported in Biotechnology and Health Sciences last year, 71 percent sat too close to the monitor for comfort, and two-thirds were improperly positioned directly opposite or below the monitor.

Improper lighting and glare are another problem. Contrast is critical, best achieved with black writing on a white screen. The screen should be brighter than the ambient light — overly bright overhead light and streaming daylight force the eyes to strain to see what is on the screen. A bright monitor also causes your pupils to constrict, giving the eyes a greater range of focus.

You might need to reposition the desk, use a dimmer switch on overhead lights, or lower window shades to keep out sunlight. In addition, using a flat screen with an antiglare cover, and wearing glare-reducing or tinted lenses can help to minimize glare.

Be sure to use a font size best suited to your visual acuity, and have your eyes examined regularly — at least once a year — to be sure your prescription is up-to-date. This is especially important for people older than 40 and for children who are heavy users of computers because visual acuity can change with age. Make sure, too, that your monitor has a high-resolution display that provides sharper type and crisper images. And clean the monitor often with an antistatic dust cloth.

Those who work from printed materials, moving back and forth from them to the screen, could minimize neck strain by mounting documents on a stand next to the monitor. If, like me, you use many different printed documents at the same time, consider getting special computer glasses — bifocal or progressive lenses with the upper portion ideal for screen reading and the lower designed for print distance.

While prevention is most important, if you already have symptoms of computer vision syndrome, there are ways to reduce or eliminate them. Ophthalmologists suggest adhering to the “20-20-20” rule: Every 20 minutes, take a 20-second break and look at something 20 feet away.

Consciously blink as often as possible to keep eye surfaces well lubricated. To further counter dryness, redness and painful irritation, use lubricating eye drops several times a day. My ophthalmologist recommends products free of preservatives sold in single-use dispensers.

You can also reduce the risk of dry eyes by keeping air from blowing in your face and by using a humidifier to add moisture to the air in the room. And Dr. Reitano said her eye doctor also suggested applying warm moist compresses to her eyes every morning.

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Giving New Doctors the Tools They Need

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Credit Early Wilson

They say if all you have is a hammer, everything looks like a nail. I wonder, then, why my toolbox often seems so inadequate for fixing my patients.

I open one recent afternoon in clinic with a middle-aged man I’ve come to know well. He’s drunk. His breath smells of alcohol and he slurs his words. He tells me his brother’s in jail, his mother died, and he punched a neighbor who tried to steal his wallet. In the past year, he’s been admitted to the hospital countless times for everything from falling to getting injured in a fight to failing to take his medications.

“High risk for readmission,” an automated email plops into my inbox each time he’s admitted. Thanks, I’m on it.

I search for mental health and substance use resources we haven’t yet exhausted. I speak briefly with a psychiatrist and case manager and a social worker who is arranging transportation back to the housing he’s in danger of being thrown out of.

“Maybe we increase his mood-stabilizer?” I offer, mostly just to say something. When all you have is a hammer…

The afternoon doesn’t get easier. I see a patient whose heart failure had been in good control with a telemedicine service that had checked his weight at home and adjusted his medications accordingly. But the service has been cancelled, and now he’s in our clinic, gasping for air as fluid fills his lungs.

He’s followed by an older man who’s been on opioid painkillers for a decade — and who I now suspect is selling extra pills on the street. I’m running 45 minutes late by the time I greet an understandably frustrated woman who, a computer alert informs me, is overdue for her first colonoscopy. She balks when I bring it up, and I don’t have the words or the time to convince her otherwise.

The afternoon was not unusual. At the end of most days, I find myself searching for nails that I can hammer.

Part of the problem is the tool kit we assemble during medical training. We’re educated largely in a biomedical framework. We diagnose disease with textbook knowledge and prescribe medications because those are the hammers we have.

But consider the skills I would need to be more effective in just this one clinic session: understanding social issues that contribute to health; marshaling support resources like case management, social work and rehabilitation centers; exploring my patients’ values and goals and encouraging behavior change; leading interdisciplinary care teams; employing new technologies and methods of patient engagement like telemedicine; and appreciating how health systems fit together to influence an individual patient’s care — from home care and community centers to clinics and hospitals. None have traditionally been emphasized in medical education — and, unsurprisingly, doctors in training like myself are often ill-equipped to practice in today’s health care environment.

Medicine has long been a discipline predicated on memorization, which made sense in a world of textbooks, microscopes and information monopoly. But rooting medical training primarily in knowledge acquisition is increasingly insufficient and inefficient. In an era of big data, Google and iPhones, doctors don’t so much need to know as they need to access, synthesize and apply. We’re increasingly asked to consider not just patients, but communities. We’re expected to practice not as individuals, but as team members. And now — liberated from carrying every diagnostic and treatment detail around in our heads — we have both the responsibility and the luxury of deciding what a doctor should be in the 21st century.

Some medical educators are trying to figure it out, with a greater emphasis on new technologies, collaborative care, wellness and community health.

The new Dell Medical School at the University of Texas, Austin, which enrolls its first class in June, is hoping to revolutionize medical education. The school plans to focus on helping students understand how health systems, communities and social issues contribute to individual health through a variety of innovative methods.

Instead of traditional lecture halls, Dell’s students will learn in collaborative workspaces with a curriculum that emphasizes team-based management of patients. They’ll take weekly classes with pharmacy, nursing, social work and engineering students. Dell’s “Innovation, Leadership and Discovery” program affords students an entire year to pursue projects related to population health and delivery system redesign.

Dell also features a unique collaboration with the university’s College of Fine Arts — known as the Design Institute for Health — to bring design thinking to health care. Here students will learn to think about everything from better hospital gowns and more hospitable hospital rooms to how patients access services online and how to make waiting rooms obsolete.

“It’s an incredible gift to start from scratch,” said Dr. Clay Johnston, the school’s first dean. “We can start by looking at where the biggest gaps and problems are. Then say, O.K., given those needs, what should doctors and the medical system look like in the future?”

The health system Kaiser Permanente recently announced its own plans to open a medical school in 2019, in Pasadena, Calif. The medical school, like the health system, will emphasize integrated care, the latest medical evidence and new technologies like online doctor visits.

“We recognize the importance of providing care in alternate settings,” says Dr. Edward Ellison, who is helping to oversee the creation of the school. “We’ll take care of you when you’re sick. But we’ll also help you stay healthy when you’re home.”

While most medical schools are trying to get students out of lecture halls and into hospitals, Kaiser Permanente hopes to get students out of hospitals and into communities. Students will visit patients in their homes to see how they live and what behavior change looks like in living rooms instead of hospital rooms. They’ll also be trained as emergency medical technicians — riding in ambulances alongside other medical professionals, responding to accidents, violence and trauma in their communities.

The American Medical Association, for its part, has provided over $11 million to established medical schools to reimagine their curricula and better prepare students for a rapidly evolving health care environment.

Older physicians, medical educators, policy makers and patients will continue to debate what doctors should be taught and what they should know. But the deeper question is how doctors can learn to think — to solve problems that can’t be solved with the tools we currently have. Because ultimately, there’s no better hammer than that.

Dhruv Khullar, M.D., M.P.P. is a resident physician at Massachusetts General Hospital and Harvard Medical School. Follow him on Twitter: @DhruvKhullar.

Aging in Place

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Credit Paul Rogers

When I asked the other three members of my walking group, all of whom are in their mid to upper 70s, whether they had any concerns about future living arrangements, they each said they had none despite the fact that, like me, they live in multistory private homes without elevators and, in two cases, without bathrooms on every floor.

My Los Angeles son asked recently what I might do if I could no longer live in my house, and I flippantly replied, “I’m coming to live with you.” The advantages: I’d be surrounded by a loving and supportive family, and the warm weather is a benefit for someone like me who becomes increasingly intolerant of the cold with each passing year. The disadvantages: I’d lose a familiar community and a host of friends, and his house, unlike mine, is on a steep hill with no nearby stores; if I could no longer drive, I’d have to be chauffeured everywhere.

Probably my biggest deterrent would be relinquishing my independence and the incredible number of “treasures” I’ve amassed over the last half century. The junk would be easy, but parting with the works of art and mementos would be like cutting out my heart.

I suspect that most people are reluctant to think about changing where and how they live as long as they are managing well at the moment. Lisa Selin Davis reports in AARP magazine that “almost 90 percent of Americans 65 or older plan to stay in their homes as they age.” Yet for many, the design of their homes and communities does not suit older adults who lack the mobility, agility and swiftness of the young.

For those who wish to age in place, the authors of “70Candles: Women Thriving in Their 8th Decade,” Jane Giddan and Ellen Cole, list such often-needed home attributes as an absence of stairs, wide doorways to accommodate a walker or wheelchair, slip-resistant floors, lever-style door knobs, remotely controlled lighting, walk-in showers, railings, ramps and lifts. Add to these a 24-hour help system, mobile phone, surveillance cameras and GPS locaters that enable family members to monitor the well-being of their elders.

In many communities, volunteer organizations, like Good Neighbors of Park Slope in Brooklyn and Staying in Place in Woodstock, N.Y., help older residents remain in their homes and live easier and more fulfilling lives.

While many young adults chose to live and bring up children in the suburbs, a growing number of empty-nested retirees are now moving to city centers where they can access public transportation, shop on foot for food and household needs, and enjoy cultural offerings and friendly gatherings without depending unduly on others.

One reason my friends and I are unwilling to even consider leaving our Brooklyn community is our ability to walk to supermarkets, banks, food co-ops, hardware stores, worship and recreational facilities, and get virtually everywhere in the city with low-cost and usually highly efficient public transportation. No driving necessary.

We also wallow in the joys of near-daily walks in a big, beautiful urban park, remarking each time about some lovely vista — the moon, sunrise, visible planets, new plantings and resident wildlife.

Throughout the country, communities are being retrofitted to accommodate the tsunami of elders expected to live there as baby boomers age. Changes like altering traffic signals and street crossings to give pedestrians more time to cross enhance safety for people whose mobility is compromised. New York City, for example, has created Aging Improvement Districts, so far in East Harlem, the Upper West Side and Bedford-Stuyvesant, to help older people “live as independently and engaged in the city as possible,” Ms. Giddan and Ms. Cole wrote. In East Harlem, for example, merchants have made signs easier to read and provided folding chairs for seniors who wish to rest before and after shopping.

In Philadelphia, a nonprofit organization, Friends in the City, calls itself a “community without walls” designed to bring members closer to the city’s resources and to one another. It offers seniors a daily variety of programs to suit many cultural and recreational interests.

Also evolving is the concept of home sharing, in which several older people who did not necessarily know one another get together to buy a home in which to live and share responsibilities for shopping, cooking, cleaning and home repair. For example, in Oregon, Let’s Share Housing, and in Vermont, Home Share Now, have online services that connect people with similar needs, Ms. Giddan and Ms. Cole report. There’s also an online matching service — Roommates4Boomers.com — for women 50 and over looking for compatible living mates.

Of course, there are still many older adults, widows and widowers in particular, who for financial or personal reasons move in with a grown child’s family, sometimes in an attached apartment or separate floor. Host families may gain a built-in babysitter, and children can develop a more intimate relationship with grandma or grandpa.

For those with adequate finances, there is no shortage of for-profit retirement communities that help older people remain independent by providing supportive services and a host of amenities and activities. Some have extensive recreational and exercise facilities, as well as book and craft clubs, discussion groups and volunteer opportunities. Some take residents to theatrical productions and museums and on trips to nearby attractions.

I confess that retirement communities that house only older adults are not my style. I can’t imagine living in a place where I don’t see and interact with children on a daily basis. I find that nothing cheers me more than a smile or comment from a toddler. I guess I take after my father, who used to flirt with every child he noticed in a car near his. But I realize that, just as some people are averse to dogs, not everyone enjoys the companionship of a high-energy child.

For older people likely to require help with the activities of daily living, there are many assisted living facilities where residents can get more or less help, including aid with medications, feeding and ambulation, according to their changing needs.

And should I ever have to leave my home, Ms. Giddan and Ms. Cole point out that there is a new and growing cadre of professional organizers and moving managers to “help people sort through accumulated belongings, distribute and disperse what won’t be needed in the new setting, and assist with all stages of packing, moving and then unpacking, and staging the new home.”

This is the second of two columns about adjustments to aging. Read the first part: “Thriving at Age 70 and Beyond.”

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Favorite Moment of a First-Year Doctor

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Dr. Dhruv Khullar

Dr. Dhruv KhullarCredit Tom Fitzsimmons

My favorite moment in residency was hearing about my friend’s favorite moment in residency.

Excited to have finished our first year as doctors — the most unsettling and demanding in medical training — we swapped stories of our most memorable experiences. He told me about his final evening in the intensive care unit, the end of a grueling month. He had made plans to unwind with a friend from out of town whom he hadn’t seen in years. Before leaving, he checked in on a patient he’d admitted the previous week, an elderly woman with dementia and a bad pneumonia that was getting worse. Her oxygen levels had now dipped so low he feared her heart would stop beating.

He’d grown close to the patient’s daughter, who had been at her mother’s bedside each day. The daughter had been struggling with whether her mother should be intubated if her condition deteriorated, which seemed likely. My friend told her he was transitioning off service and would be leaving for the night, but assured her that the next team would take good care of her mother.

She hesitated. Her brothers and sisters were flying in from around the country that night, she told him. They planned to discuss their mother’s life, her condition, her wishes moving forward. And she wanted him — the junior member of the team — to lead the family discussion.

He called his friend. He wouldn’t be making dinner. Then, he had his most meaningful conversation as a doctor.

As he gathered with the family, they told stories of who their mother was, what had been most important to her, and how she would want to die. Ultimately, they decided against intubation and focused on keeping her comfortable in her final days.

What struck me about my friend’s story is not only that he acted as an exemplary physician and helped his patient die a dignified death. It’s that it was important that he was the one having that conversation.

Too often in medicine, you feel like part of a machine, a cog in a massive bureaucracy. We cover each other’s shifts, we maintain a hospital’s patient flow — and at the end of many days, you feel nothing would have been different if another doctor subbed in.

This isn’t necessarily a bad thing. I don’t want a patient to fare differently simply because I’m on call rather than my friend. Much of medical training is an exercise in reducing this kind of variability from one doctor to the next. We start medical school with creative and distinct ways of thinking, but we soon learn to recognize patterns and approach problems in a standardized way: when you see X, think Y, and do Z.

Risk calculators, diagnostic algorithms and treatment guidelines support us in this role. Surgical checklists can prevent infections; timely stents can save lives; computers can reduce medication errors. But not always. Sometimes checklists don’t help, stents hurt, and computers lead to overdoses.

But standardized care, by definition, is not personalized care: it fails to acknowledge patients’ individuality. A calculator can predict your risk for disease, and a clinical trial can reveal the possible side effects of treatment. Neither, though, can tell individual doctors or patients what to do — what tradeoffs to make, what quality of life to accept.

Standardization can also strip doctors of a sense of ownership and autonomy. In a health environment bustling with protocols and metrics, we sometimes feel less like doctors caring for people than technicians generating outcomes. With a growing reverence for algorithms comes a perception that physicians are somehow replaceable, or at least interchangeable. But individual doctor’s judgments, patients’ preferences, and connections between clinicians and patients are what make health care meaningful.

New technologies will likely further complicate the issue. Standardized care may soon give way to computerized care. Already, hospitals are teaming up with IBM’s Watson — the computer that won “Jeopardy!” — to digest new medical knowledge, collect data, diagnose disease, adjust medications and check for errors. A recent report by McKinsey & Company found that almost half of all activities American workers perform could be automated by currently available technologies. Contrary to prevailing thought, it’s not just low-skilled occupations at risk: physicians, financial managers, senior executives and the like will have significant amounts of their work automated.

Will doctors, then, soon be replaceable?

A better question is how best to incorporate new technologies into the day-to-day work that doctors do. The best medicine is an essential art, and algorithms, if thoughtfully deployed, can free us to make more of it. The great contribution of technology, then, may not be improved efficiency and safety. It may be crystallizing what only doctors — as humans — can offer: critical thinking, clinical intuition, empathic care, exploring what’s important to patients so they can make the decisions that are right for them.

We haven’t yet found the right balance between standardized care and personalized care — between automation and autonomy, algorithms and art. We know that protocols can improve care, but also that they can diminish individuality. We shouldn’t think of them as replacing what we do, but rather, as making room for what only we can do.

Dhruv Khullar, M.D., M.P.P. is a resident physician at Massachusetts General Hospital and Harvard Medical School. Follow him on Twitter: @DhruvKhullar.