A young doctor-in-training examines a new patient. Should she draw information for the diagnosis from her “E-memory” — electronic memory, the kind that’s available on a computer? Or should she dip into her “O-memory” — organic memory, the old-fashioned sort that resides in the brain?
Research shows that apprentice doctors are increasingly relying on E-memory, often in the form of a digital resource called UpToDate. This is an electronic reference tool, accessible on physicians’ laptops or mobile phones; tap in the patient’s symptoms, and up comes a potential diagnosis and a recommended course of treatment. A recent study found that 89 percent of medical residents regard UpToDate as their first choice for answering clinical questions.
Like many of us, doctors are shifting their stores of knowledge from O-memory to E-memory. That’s not to say that they, or we, are doing so consciously. Electronic memory tools are now so convenient and omnipresent that we often aren’t even aware that we’re using them as extensions of our organic memory. But some thinkers — including Robert W. Clowes, a philosopher from the New University of Lisbon in Portugal who proposed the E and O terminology — argue that it’s important to recognize the two types of memory, and the differences between them.
Making this distinction leads to several useful insights. The first is exemplified by young doctors’ use of UpToDate. E-memory is suited for targeted searches, while O-memory is best for building a broad, deep base of knowledge.
As even their critics acknowledge, E-memory resources like UpToDate are remarkably efficient tools. Like Google and the other search engines the rest of us use, they offer instant access to the bits and pieces of information we need in the moment. That’s their value to novice doctors — and that’s what has some more senior doctors and medical professors concerned. They lament that this kind of “just-in-time,” “just-enough” learning is shallow and fragmented. Medical residents are, or should be, in the process of becoming experts, and that process involves building a rich and interconnected database of knowledge in one’s own mind. Research in cognitive science and psychology demonstrates that the ability to make quick and accurate judgments depends on the possession of extensive factual knowledge stored in memory — in internal, organic memory, that is, and not in a device.
Such mental databases used to take shape as a byproduct of reading through medical journals, notes Jerome P. Kassirer, a professor of medicine at Tufts University. It was exactly the un-directedness of that kind of reading that led to an important kind of incidental learning. In medicine, writes Kassirer in an essay in the British Medical Journal, “we don’t always know what we need to know, and searches that are constrained to information we need at a given moment may not generate information that may be critically useful later.”
Precisely because they only return the results we ask for, search tools don’t introduce us to a wide, unfiltered array of information. For that, says Kassirer, we need to browse. Browsing, as another physician put it in a commentary on Kassirer’s essay, is “an open-ended exploratory strategy that is driven by curiosity and creates the conditions needed for serendipity.”
Kassirer offers an example from his own experience: “From the beginning of my third year at medical school I subscribed to two general medical journals, and I scoured each issue. Then, during my first week of internship, I was asked to examine a patient with hypotension, flushing, diarrhea, and hepatomegaly. About a year earlier a report on the carcinoid syndrome had caught my eye in one of the journals because of its unique metabolic characteristics. I correctly made the diagnosis because the article I had found in browsing had evoked the diagnosis.”
When they rely on what Kassirer calls “quick and dirty summaries,” medical residents no longer give themselves opportunities to enrich their memories with unlooked-for facts.
The second insight that emerges from a close look at electronic and organic memory is that E-memory is good for invariant storage, while O-memory is good for elaborated connections. If we make note of an upcoming appointment in our smartphone, its digital calendar won’t misremember the date or time, as our all-too-fallible brains are apt to do. On the other hand, if we enter the germ of an idea in our phone’s note-taking app, we won’t return after a busy weekend or a good night’s sleep to find that the idea has grown new connections and layers of meaning, as an idea planted in our organic memory is likely to do. (Although, as Clowes points out, even E-memory repositories “increasingly transform and augment what they hold”; with the growing sophistication of tagging, indexing and A.I. systems, Clowes writes, “we can expect E-memory systems to not merely store and re-present information, but restructure it.”)
The third insight into E-memory and O-memory is that electronic memory is useful for checking the accuracy of our impressions, while organic memory is valuable for the self-knowledge it can foster. Think of the life-blogging and quantified-self data-keeping that many of us now engage in — from snapping cell phone pictures of the meals we eat, to tracking the number of steps we take each day with a Fitbit monitor. We employ these forms of E-memory as a check on the distortions endemic to organic memory; soon after our vacation is over, the details of what we dined on may have grown fuzzy, while it’s all too easy to “remember” having been more active than we actually were. E-memory acts as a check on O-memory. But only O-memory endows recollections with meaning. Food photos and step counts matter only insofar as they complement our sense of ourselves, our past experiences and our future goals, and these things are the province of the organic kind of memory.
With our computers, we can search, store, and check. With our minds, we can browse, elaborate and reflect. The intelligent user of memory in our connected world — what the philosopher Andy Clark calls a “canny cognizer” — combines the best of E-memory and O-memory, and knows what she’s up to as she does it.