Anyone who has grocery shopped at a large supermarket recently will notice that you’re now confronted with a decision at check-out time. You can line up as usual to have a clerk check and bag your items, or you can opt to go to the do-it-yourself kiosk, where you have the privilege of scanning and packing your items yourself. I’ve been tempted to canvass folks who choose the clerkless option. I suspect some feel it’s faster (by my observation, that’s dubious at best). Some may be obsessive-compulsive enough to want to handle and pack their own things in some preferred manner. I suspect some may simply wish to avoid the need to interact with another person, however briefly.

grocery-store

Whatever the reason, it seems likely that the option we’re currently being provided is not going to continue, but rather is a transition process preparing us for a time when grocery chains will no longer hire actual human beings for the purpose. When that happens, your friendly check-out person will join the growing list of community roles that are no more, or exist in a much more limited capacity:

people

In fact, it’s now entirely possible to leave your home in the morning and carry out all your domestic and business chores without ever having to be troubled with the need to interact with an actual human being. Moreover, we don’t require another person’s help to accomplish many of the functions of day-to-day life. In essence, we’re paradoxically becoming more isolated in the midst of increasingly crowded and busy urban environments.

Recently, we’ve witnessed a further blurring of the boundary between our personal space and the wider world. The introduction of Pokemon-Go basically makes the wider world a personal playground. In the words of the manufacturers, “Travel between the real world and the virtual world of Pokémon with Pokémon GO for iPhone and Android devices. With Pokémon GO, you’ll discover Pokémon in a whole new world—your own!”

So, what are we to think of all this increasing detachment from the people with whom we coexist, sharing our communities and services? Is it a problem, or simply evolution towards a greater, technologically driven efficiency? Is there a price to be paid for our virtual isolation from the growing number of people around us?

At the risk of sounding like a sentimental reactionary, I’ll admit that a few concerns come to mind.

Firstly, on a purely pragmatic level, these jobs provided income and, for those who engaged them as full time occupations, a sense of identity and purpose within our communities. They, in turn, were able to support their families and local economies. Jobs, all jobs, are likely our best social investment. A loss of jobs, even unglamorous jobs, should concern us.

They also provided part-time employment opportunities for young people, valuable experiences in self-sufficiency and human relations that informed and supported future careers. Interacting with various folks in the course of our routine day promotes “people skills”. One learns how to “read” people, sense concerns, respond appropriately.

Moreover, the need to interact and communicate on a regular basis with other folks of diverse ages and backgrounds, I believe, promotes tolerance, civility and fundamental sensitivity to the challenges faced by others in our midst. How much do children learn by simply observing how their parents interact with all the folks they encounter in daily life? How much is lost if that never occurs?

I believe we’re seeing some consequences in our medical schools.

One of the most stressful moments for medical students is their first encounter with a patient. At our school, this takes place in first term Clinical Skills. Very early on, students are taught and expected to introduce themselves to a patient, obtain some basic information, and begin the encounter that will eventually allow them to obtain a complete and accurate clinical history. It all starts with simply introducing oneself and beginning a basic conversation, which, one might think, would come quite naturally to bright and gifted young people. Amazingly, many students find this quite difficult and even unnatural. In fact, students vary considerably in their comfort and aptitude for the patient encounter, and this has very little to do with their academic qualifications. It does, however, have much to do with their prior experience engaging people on a personal level, particularly those of diverse ages or backgrounds. That ability is (or should be) learned through real life everyday experiences, at home, in their communities, in their workplace. In our competency-based world of medical education, it’s easy to forget that the most essential physician competency is the affinity for effective and comfortable exchanges with people of all types. That particular skill is first developed, not in medical school, but in our homes and communities.

It would be silly to expect that technology will not continue to advance and that the now redundant occupations described above will make some sort of magical resurgence. However, we should recognize that something has been lost and not replaced. These roles were not just jobs or functions. They were actual people, with faces, personalities, roles in our communities for which they became known and identified. They contributed something far beyond the tasks they performed. They contributed to our learning, our sense of community, and our comfort with personal interactions. In their absence, we must find ways to identify and develop those skills in our students who are products of a rapidly changing social structure.

 

Anthony J. Sanfilippo, MD, FRCP(C)
Associate Dean,
Undergraduate Medical Education