The problems facing medical doctors regarding technology, education, and gaming addiction

My recent interview on Osmosis.org.

http://blog.osmosis.org/2015/04/leaders-medical-education-dr-andrew-doan-head-department-mental-health-addictions-resilience-research-us-navy/

Dr. Andrew Doan is an Ophthalmologist and serves as the Head of the Department of Mental Health, Addictions, and Resilience Research at the US Navy, Deputy Editor-in-Chief of the Ophthalmic News and Education Network by the American Academy of Ophthalmology, and serves as a clinical professor at Loma Linda University Medical Center. His academic research focus is on neurobiology and physiology of process addiction. He has also written a book Hooked on Games: The Lure and Cost of Video Game & Internet Addiction.

What was your background and how did you get interested in medicine?

I come from an immigrant family. I was from Vietnam and came over in 1975 at the age of 4. Most readers of this blog will understand that parents of immigrant families tend to push their kids towards medicine or law. I was interested in science however and was fortunate enough to get involved with a NIH program for underrepresented minorities during my senior year of high school. I was placed at a Primate Research Center in Oregon and was able to do neuroscience research during my senior year of high school. I went to Reed College afterwards and continued my research. I knew when I was done with my college career that I wanted to be a medical scientist. I enrolled into Johns Hopkins University for Medical School as part of the Medical Scientist Training Program (MSTP).

I studied learning and memory and how circadian rhythms of the mammalian brain controls reproductive cycles. At Hopkins I studied Alzheimer's and learning and memory in the brain. It was related to what I did at the undergraduate level. It was a very consistent research foundation which I developed.

What made you want to pursue ophthalmology and eventually shift your attention towards neurobiology and physiology of process addictions?

Eventually I started my career and became a faculty member and started to divert that addictive energy to academia when I became a teacher. I also became an eye surgeon.

The vast research potential was what really drew me in to ophthalmology. Also, when I saw how cataract surgery was done, I felt like I was playing Asteroids, the video game. I had good hand-eye coordination and was able to do things over and over again like a video game.

Can you touch base a bit more about your research and how you grew interested in addiction?

I wrote a book called "Hooked on Games." It was my story on how I became addicted to video games during medical school. I was playing 50-100 hours a week over 10 years. I was blessed enough to have the skills to get through medical school. Also, I was fortunate that the old adage that a B = MD in medical school is true. I was bright enough to get through my MD/PhD courses and was in the top half of my class, but I was addicted. I slept 2 to 3 hours a night and although I was a functional addict, my family life came apart. I realized I that I was a gaming addict and suffered from the various symptoms of one such as carpal tunnel syndrome.

I got involved in process addiction in 7 years after I had quit video games. I wrote the book because I saw other students fail. I did some research and saw in published work that gaming addiction affects 1 in 11 kids. Even though it is not a formal DSM diagnosis, there was evidence out of Asia from fMRI scans which show that gaming addicts light up the pre-frontal cortex dopamine system similar to brains of drug and alcohol addicts. It is time to do more research in this area.

There are even many medical students who fail out due to video games. I thought it was my social obligation to share my story, to be clear and transparent about my past and bring real science into the discussion as well. Once I did that, the Navy gave me a position, heading addiction research because it affects service members in the Navy. People suffering from this were ignored. For example, there were 3 marines that had severe sleep deprivation. They were prescribed sleeping meds, but the providers didn't ask why they were sleeping. They had been playing video games for 30-60 hours a week on top of their work. They had depressive symptoms, poor work performance, insomnia, etc. Once we took the video games away, those symptoms dissipated.

We want to improve force readiness so that they are more stable at home and work. My theory on this is that addictions are tied to genetics. Some Type-A people can be driven hard and drive themselves with little sleep and that's about 1 in 11 of the population. This is the go-getter gene, and when a person can't deal with stress properly and handle it properly, they get bad behaviors. They need to divert their energy into positive things to help society and not be so self-destructive.

What are two or three changes you would like to see in how healthcare is run in the US today?

I think that healthcare reimbursement needs to be worked out. The Medicare Sustainability Growth Rate formula is completely broken. We need a better way. We need to really provide healthcare so it is more accessible to everyone. A discussion of this is needed. We have to decide if healthcare is a right or a privilege. I think it's a right that belongs to everyone because tax payer money helps train physicians in the United States since every residency spot is in part funded by Medicare and congress. Training physicians is a societal investment. I think investments by society should be available to people. We need to find a way to actually provide healthcare to all.

Also, we need to fairly compensate physicians across the board, specialist or not. There is a huge disparity currently in terms of reimbursements.

What was your motivation behind founding Free Education Publications International?

I founded this in 2005. It stemmed out from when I stopped playing video games and had a lot of free time on my hands. I started Eyerounds.org at University of Iowa as an online reference for eye problems. I showed the University that that through SEO and improving page rank of their site, that we could get the case reports on the first page of Google and share info around the world without a publisher.

One day while eating lunch with professors, who poured their lives into textbooks while making only pennies on the royalty earnings, I decided to create a venue for online publishing for academic papers on the internet, and allow these researchers to reach people without having a publisher. At the time it was a cost effective way through distributing knowledge. Now that the internet has exploded, everyone publishes on the internet. Now we have transitioned into more of an online review site for doctors. Medrounds.org publishes Verified Reviews(r) where patients can review services of their physicians and share their experiences as patient-doctor narratives. Our goal is to help doctors protect their online reputation while allowing patients to honestly share their opinions about their doctors.

What are the biggest issues facing medical educators today?

The growth of technology is huge. The amount of information in this world is growing logarithmically. There is more information to learn for both educators and students. However, they have the same amount of time to train medical students. Ophthalmology only has 36 months to train residents, but the amount of information to teach is several folds higher than before. We need to find a way to deal with the volume of information and find an effective way to teach it. Educators need to stay on top of things. Instead of having the same lectures repeated, it might be best if the lecturers produced videos and medical schools shared those videos.

How do you foresee medical education changing in the coming years?

Technology is going to be the biggest piece with all of the new information. I think the other challenge is that we have to manage technology too so students don't become technology addicts. Evidence of this is shown by the dopamine rush that occurs. There was a service member I dealt with who was addicted to Google Glass. He was wearing it 18 hours a day and shared that his craving for Google Glass was greater than his alcohol addiction.

This was because he was getting affirmation and positive reinforcement from his ability to look up information with the Google Glass. His short term memory has begun to dissipate. It's similar to how we can hardly remember anyone's number because our cell phone stores them.

But, we know it's not all about knowledge acquisition, and it's the application of the knowledge that's needed to become a good doctor. You need to show creativity and problem solving skills. The tech is beneficial but it is easy to be addicted to and depend on Google to find information instead of understanding concepts so you become an innovative creator in the field of medicine versus a robotic regurgitator.

Do you have any final thoughts you would like to add?
Medicine right now is an exciting field despite the problems and changes. You can make a huge impact on people's lives around the world. When the Navy sent me to a medical mission in Africa, I saw how restoring vision can restore people's hopes and livelihoods. A person may walk in with his friend for over 200 KM for an eye surgery, but he would be able to walk back alone because of his ability to see after the operation and he is so thankful. There is a huge opportunity for doctors to donate skills and talents around the world while making huge impacts. There are so many opportunities to do that especially now with medicine and technology and the way they can collaborate with each other because there is now opportunity to share knowledge around the world via collaboration.