April 11, 2039, 9 a.m.

Siri says it’s a rainy morning as I clamber out of bed to see my first patient. It’s amazing to do this from home!

I open iDOCTR. Fifty new messages with requests for emergency appointments today! It’s a brisk morning at the virtual emergency department. A minute or two per patient and then another five for charting and billing. I can do this.

9:02 a.m.:

Tommy, 19

6’4″, loves to hike, stab wound to the chest

Active today! Now about 21 miles away.

9:03 a.m.:

I message Tommy, but it’s no use as he bleeds out.

<SWIPE LEFT>

9:11 a.m.:

Sandi, 52

Blood type: O+, proud mom to Tommy

Active today! Now about 21 miles away.

I begin, “Ma’am, we did all we could, but we could not save Tommy—”

Her screams and tears are familiar, yet somehow not as chilling as those I remember from when we did this in person. And 48 messages await…

<SWIPE LEFT>

If the horror of swiping left to reject a human being isn’t enough for you in dating, try it in medicine. On the front lines, we see how medical care continues to be shaped by our technologically driven, service-oriented economy. Most New Yorkers could tell you that every day the subway pulls up to the platform full of new ads hawking startups that promise less time spent in the company of actual people as we plan weddings, find business collaborators, buy apartments, order food, care for our pets, or shop for mattresses. Why bother asserting yourself in a social setting when you can order up a real, live human on a dating app?

Charm, it seems, is obsolete, but what about bedside manner? Medicine is about human contact at one’s most vulnerable moments—or, at least, it was. The health care delivery landscape has shifted dramatically with declining reimbursement, large-scale electronic health record (EHR) adoption, new delivery models, and increasing administrative burdens. Physicians are faced with the conflicting and unattainable pressure to care for patients faster and faster while being nicer. Something’s got to give.

As we scan our patient lists, it is still routine to refer to them as “that chest pain in room 7” or “you know, the one with lung cancer.” You can argue that we do so to avoid revealing personal information, but during daily practice, we may find ourselves engrossed in the computer screen and the endless boxes that need to be checked to the point that we feel we are treating the computer, not the patient.¹