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- Anthony N. DeMaria, MD, MACC, Editor-in-Chief, Journal of the American College of Cardiology⁎ ()
- ↵⁎Address for correspondence to:
Dr. Anthony N. DeMaria, Editor-in-Chief, Journal of the American College of Cardiology, 3655 Nobel Drive, Suite 630, San Diego, California 92112
While visiting my daughter and her family recently, I picked up a book entitled Hooked Up (1). It was 1 of 4 books authored by Jack Myers, described as a “media ecologist” who is an authority on the impact of emerging media technologies in society. The book deals with the “Millennial Generation” overall, and specifically with the subgroup of “Internet Pioneers” born between 1991 and 1995. It was based on a research survey of 1,000 individuals in this age group as well as interviews with educators and other experts. The book provides a fascinating perspective on the impact that this demographic group is likely to have on society, including the medical profession.
The division of society into individual generations is not an exact science but rather an imprecise and somewhat arbitrary sociological construct. It is not based upon strictly chronological landmarks, but upon social demographics (such as the spike in births following World War II). Nevertheless, there is general agreement that at least 4 different generations existed in the last century: the Silent Generation, those born between 1928 to 1946; the Baby Boomers from 1946 to 1964; Generation X from 1965 to 1980; and Millennials born from 1980 to the turn of the century (2). Each generation has its own political and social priorities and lifestyles, and each has had a significant impact on society. However, the overwhelming consensus is that the Millennials, and particularly the Internet Pioneers, will have a unique and transformational impact upon the world. Some have already assumed an important role in society, and there are many more yet to come.
Based upon a report from the Pew Research Center (2), Millennials have a number of unique characteristics relative to older generations. They are ethnically and racially far more diverse, less religious, and about to become the best-educated generation in American history. Three-quarters have a page on a social networking site, and 20% have posted a video of themselves online. They are wary of others, and human nature in general. Only about 60% of Millennials were raised by both parents, and it is estimated that in a recent calendar year more than one-third of children were born to women under age 28 years who were unmarried. Fewer have served in the military than in prior years, and due to the recession, many have moved back home to live with their parents. As evidenced by recent presidential elections, they have a liberal political orientation. Millennials often place more emphasis on quality of life than work ethic. However, clearly the most distinctive characteristic of Millennials is their use of technology.
It is the role of the Internet and the use of technology that not only characterizes Millennials, but provides them with the opportunity to be a transformational generation. Their lifespan holds the same potential for change as the Industrial Revolution. It has been speculated that, at current rates of advancement, we could experience the equivalent of a century of progress in 25 or even 10 years (3).
In 2012, there were already 6 billion wireless phone subscriptions among the 7 billion people on earth, many of these subscriptions to lower economic classes. As Myers indicates, in the future we can anticipate ubiquitous wireless access and unlimited storage in the cloud, organization of millions of contents into personalized and curated resource centers, and wireless global communications and instant translation that will disrupt international borders. From the standpoint of medicine, we can envision computer chips embedded into the body continuously connected to a variety of networks to monitor and perhaps even intervene in physiological functioning. Education will likely leave the confines of the traditional classroom, and it is speculated that newspapers and journals will disappear. Millennials will shepherd these changes, and these developments will color their views and behaviors.
Of all Millennials, Myers selects out the subgroup of those born between 1991 and 1995, termed Internet Pioneers, as having a unique influence on the future. These individuals are the first to be born into a world in which the Internet and cell phones already existed. They have taken this technology for granted and have adapted their lifestyles accordingly. They have a continuous flow of information at their fingertips, and are nearly always in communication with friends and associates. They often awake in the morning to a phone alarm and instantly check for news and messages. They are typically seen with a cell phone to their ear, and either sending or receiving texts or posting or reading entries on social media. According to Myers' survey, 95% are on Facebook, nearly 50% on Twitter, and 90% shop online. Importantly, they are accustomed to 2-way communication, and seek not only to receive content, but to actively respond to it. They draw much of their importance from being the leaders of the second stage that, following the initial breakthrough invention, develops the actual applications of transformational technology. They are the bridge between the pre- and post-Internet Millennials.
The maturation of the Millennial generation will have many implications for and effects upon medicine. I anticipate a greater degree of self-measurement and quantitation of physiological functions, such as body composition, blood pressure, and sleep patterns, than has existed previously. As patients, Millennials will be much better informed than prior generations and can be expected to play a much more active role in their medical care. We physicians may often act as advisors to medical decisions rather than as decision makers. Millennials will likely share medical experiences on social media with others having similar problems, and expect that the performance statistics for doctors and hospitals will be transparent and readily available to the public. They will seek rapid and frequent communication with their physicians using the same media that they are accessing for other information. It is likely that such communication will provide an important complement, and perhaps on occasion substitute, to the office or clinic visit. Open access to the electronic medical record is just a harbinger of things to come.
We can also expect that the presence of Millennials as medical students, trainees, and attending physicians will change the face of both medical education and clinical practice. The role of lectures in medical student education is already under revision, and the use of online resources increasing. Medical students will increasingly want an interactive relationship in learning, and seek to provide input as well as receiving output. Millennials will be more familiar and facile at using online sources for rapid information, and using social media to solicit consultation and advice from associates. In the future they will have access to as much information at their fingertips as is available in most medical libraries. They will freely exchange opinions about current practices and new advances, and not merely be consumers. It is likely that they will strive to utilize an increasing array of sensors to achieve at home monitoring and progressively reduce the role of the hospital. From the standpoint of medical journals (a topic of interest to this editor), the literature will be increasingly provided and consumed online, with a concomitant reduction in the use of print.
As stated earlier, the Internet is transformational, so those who have been raised with it as part of their everyday world will play a major role in the transformation. Millennials will bring a markedly different mindset and skill set to medicine that, along with technology, will result in major changes, many of which are indeed, underway. Patients and doctors will increasingly look to the Internet for information, consultation, and to interact with each other. Patients almost certainly will seek to play a more important role in making decisions about their own clinical care, and physicians will strive to use online vehicles and social media to deliver care. Outpatient monitoring of physiological functions will be commonplace. However, in my opinion, one aspect of medicine that will not change is the importance of the in-person interaction of physician and patient. The role of the history and physical examination, with the additional information provided by affect and body language, will remain of critical importance. In addition, direct contact will provide the opportunity for “the laying on of hands” and conveying reassurance that is such a critical component of the art of medicine. I do not believe that the value of the human touch in medicine will ever be replaced by the internet, even for Millennials.
- American College of Cardiology Foundation
- Myers J.
- ↵Millennials: Confident, Connected, Open to Change. Pew Research Center. http://www.pewsocialtrends.org/2010/02/24/millennials-confident-connected-open-to-change/. Accessed March 2013.
- Kurzweil R.