- Email: [email protected]
Information Overload
INVISIBLE TO THE EYE
RICHARD B. GUNDERMAN, MD, PhD
Information Overload What information consumes is rather obvious; it consumes the attention of its recipients. Hence a wealth of information creates a poverty of attention, and a need to allocate that attention efficiently among an overabundance of information sources that might consume it. —Herbert Simon
The situation is familiar to any radiologist who has faithfully attended sessions throughout a large professional meeting, attempted to read every page of each month’s journals, or simply spent an entire day in a large shopping mall or museum. Before long, we reach a state that cognitive psychologists have sometimes called “information overload,” a term coined in 1971 by futurist Alvin Toffler. Information overload is a state in which we are confronted with so much information that our cognition is dulled, decision making is impaired, and mental exhaustion sets in. This state threatens our ability to perform effectively. To prevent and correct it, we must first understand it. These days, the pace of technologic change is vastly outstripping that of biologic change. We are developing more and more effective and efficient ways to collect, store, and disseminate information, and the rate of progress is accelerating at an exponential rate. The number of words per minute we can hear or read, however, and the number of voices to which our neurologic apparatus enables us to attend simultaneously, are changing very slowly, if at all. Glorying in our ability to rain more and more information down on our minds makes about as much sense as gloating over our ability to load more and more weight on our bodies. At some point, it starts slowing us down, and eventually, it may break us.
We live in an age of unprecedented information saturation. This is due in large part to the rapid advance of technology, which has opened up communications media such as radio, television, and the Internet and greatly expanded human mobility. In past centuries, channel surfing was a technologic impossibility, and scenery could whiz past only as fast as our feet or the hooves of a horse could carry us. Now music videos pepper us with multiple scenes in a single second, and automobiles and airplanes thrust us through space at breathtaking speed. Additional sources of information today include voicemail, faxes, cell phones, pagers, personal digital assistants, books, catalogs, and so on. What is the magnitude of information overload? It is estimated that 100,000 new book titles are published every year. Over 60 billion pieces of junk mail turn up in US mailboxes annually. The number of electronic junk mails, or “spam,” that the average American receives every year has more than quadrupled in the past 6 years. Many e-mail providers now block more e-mail than they deliver each day. It is estimated that the amount of visual information we produce each year in print, film, optical, and magnetic content would require about 1.5 billion gigabytes of storage, or 250 megabytes for every man, woman, and child. We can claim that new information technologies are at our service. We may even suppose that we can always slow down the flow of information, if we so choose. In fact, however, when it comes to information technology, at times we more closely resemble slaves than masters.
© 2006 American College of Radiology 0091-2182/06/$32.00 ● DOI 10.1016/j.jacr.2006.03.021
In radiology, our recently acquired ability to transmit images instantaneously has increased referring physicians’ expectations for the timeliness with which radiology reports should be available. Far from freeing us, picture archiving and communication systems have left many radiologists feeling more than ever chained to view stations. Instead of liberating us from the workplace, some kinds of information technology may be Trojan horses that allow work to invade new territory, such as our homes. What can we infer from this state of affairs? For one thing, we can be confident that more information is not necessarily better information. In some cases, knowing more not only fails to enhance our performance but may actually degrade it. It is possible to be bombarded with too much information. Our impulse to learn more and more can paralyze us even when adequate information for decision making is available and further delay may cause irreversible damage. We should not infer that getting updates weekly instead of monthly, daily instead of weekly, hourly instead of daily, or minute by minute will necessarily prove beneficial. The information age is a boon to our well-being only if we make good choices about which sorts of information to access. Merely having a bigger library does us no good if it only leaves us more bewildered about what books to read. We need to judge which books are really the best, or which offer the greatest insight into the problems currently before us. Similarly, being able to store more and more image data, or to manipulate that data in an ever more sophisticated fashion, is of lit495
496 Invisible to the Eye
tle value unless it enables us to do our jobs better. Of all the medical specialties, radiology is one of the most technophilic. Our journals, meetings, and work environments all testify to our love of new gadgets. Yet we need to scrutinize carefully the marketing nostrum that newer is necessarily better. In what ways is a 16-slice computed tomographic scanner better than a 4-slice scanner, or a 64-slice scanner better than a 16slice scanner, and at what point does advancing to 128 or 256 or 512 slices cease to offer sufficient benefit? More broadly speaking, what is the role of radiologists in medicine? Are we medicine’s mechanics, the high priests of technology? Or are we diagnosticians? If the former, then newer technology equals better radiology. If the latter, then new technology should be evaluated in light of larger purposes. To cope with the information avalanche, we need to pay more attention to the kinds of information we have available, and make some informed choices about which sources to admit to our consciousness and how often. When we drive a car, we do not focus all our attention on the surface of the road. Similarly, we need to determine what we really need to see and know to navigate in our daily professional lives, and focus on that. Which is more important to our professional performance, getting another update on the weather or stock market or digging more deeply into a patient’s clinical history? How often throughout the day do we really need to check our e-mail? Happily, radiologists are quite familiar with one of the most essential concepts in understanding information overload. This is the concept of the signal-to-noise ratio. We use this concept every day,
from designing the physical layout of our departments to the way we routinely inspect images. Visually speaking, the signal in a diagnostic image is represented by the diagnostic information-bearing photons striking our retinas. By contrast, photons streaming through windows or from overhead lights are noise. They only drown out the diagnostic signal. To improve the signal-to-noise ratio, we can do 1 of 2 things. First, we can attempt to increase the signal. This might involve installing a more powerful lamp in a projector or altering the imaging or display parameters of a study to accentuate particular features we are trying to see. Alternatively, we might decrease the noise. Examples of noise with which radiologists frequently must contend include ambient lighting, irrelevant conversations, and malfunctioning imaging equipment. Determining the more appropriate approach to the signal-tonoise problem depends on the particular situation at hand. The key is appropriateness. Taking it to the limit is often a bad idea. If we turn up the gain on a computer monitor too much, we are presented with a screen full of static. If we turn it down too low, we face a blank screen. If we are to respond appropriately to the challenges of information overload, we need to keep in mind what we are ultimately charged with accomplishing. A more aesthetically pleasing image is not always a more diagnostic one. As the cost of disseminating information has fallen, the cost of receiving information has tended to increase, at least in the sense that the signal-to-noise ratio is always in danger of decline. This may account in part for our culture’s renewed interest in meditation, prayer, and the “slow” movement.
People feel a greater need than ever before to take time out, get off the information superhighway, take a deep breath, and experience the sound of silence. At times it is only in silence that we can hear the voice of the truly important. What do we really need to know to do our jobs well? When does doing our jobs well begin to interfere with our personal lives and, ultimately, to undercut our professional effectiveness? There is a difference between knowing a lot and being knowledgeable. The annals of neurology furnish examples of remarkable individuals with memories so prodigious that they were known as mnemonists. They could, for example, easily memorize reams of information, such as the listings in a telephone directory. However, such people often fared poorly in life, precisely because they could not distinguish the signal from the noise. The problem of information overload imposes responsibilities on professional organizations. It is great to share information throughout an organization, but there is a limit to how much information each member wants and needs. We need to apprise colleagues of the wealth of information they have available, but we also need to let much of the responsibility for accessing that information remain with each member. Rather than “push” everything we have available, we need to allow members the opportunity to “pull” from a menu what they want to see. Sadly, it is often the people in leadership positions who suffer most from information overload. The chair of a department or president of an organization may receive dozens or even hundreds of e-mails each day. Even more problematically, many people reflexively copy superiors on each piece of corre-
Invisible to the Eye 497
spondence, forgetting that several dozen others may be doing the same thing, thereby presenting leaders with an insurmountable pile of e-mail each day. To be knowledgeable means not only having a lot of information at our fingertips but being able to distinguish what is irrele-
vant or at least relatively unimportant from what must be known. A true expert is not the person who knows the answer to every question but the person who knows what questions to ask. The best physician is not a walking data repository but a good investigator, who knows what to
look for. A photographic memory does not make a person wise. In this information age, when the rate of information bombardment is increasing at an exponential rate, it is more vital than ever before that we cultivate our ability to discern and focus on what is really worth knowing.
Richard B. Gunderman, MD, PhD, Indiana University School of Medicine, Department of Radiology, 702 Barnhill Drive, Room 1053, Indianapolis, IN 46202-5200; e-mail: [email protected].
RICHARD B. GUNDERMAN, MD, PhD
Information Overload What information consumes is rather obvious; it consumes the attention of its recipients. Hence a wealth of information creates a poverty of attention, and a need to allocate that attention efficiently among an overabundance of information sources that might consume it. —Herbert Simon
The situation is familiar to any radiologist who has faithfully attended sessions throughout a large professional meeting, attempted to read every page of each month’s journals, or simply spent an entire day in a large shopping mall or museum. Before long, we reach a state that cognitive psychologists have sometimes called “information overload,” a term coined in 1971 by futurist Alvin Toffler. Information overload is a state in which we are confronted with so much information that our cognition is dulled, decision making is impaired, and mental exhaustion sets in. This state threatens our ability to perform effectively. To prevent and correct it, we must first understand it. These days, the pace of technologic change is vastly outstripping that of biologic change. We are developing more and more effective and efficient ways to collect, store, and disseminate information, and the rate of progress is accelerating at an exponential rate. The number of words per minute we can hear or read, however, and the number of voices to which our neurologic apparatus enables us to attend simultaneously, are changing very slowly, if at all. Glorying in our ability to rain more and more information down on our minds makes about as much sense as gloating over our ability to load more and more weight on our bodies. At some point, it starts slowing us down, and eventually, it may break us.
We live in an age of unprecedented information saturation. This is due in large part to the rapid advance of technology, which has opened up communications media such as radio, television, and the Internet and greatly expanded human mobility. In past centuries, channel surfing was a technologic impossibility, and scenery could whiz past only as fast as our feet or the hooves of a horse could carry us. Now music videos pepper us with multiple scenes in a single second, and automobiles and airplanes thrust us through space at breathtaking speed. Additional sources of information today include voicemail, faxes, cell phones, pagers, personal digital assistants, books, catalogs, and so on. What is the magnitude of information overload? It is estimated that 100,000 new book titles are published every year. Over 60 billion pieces of junk mail turn up in US mailboxes annually. The number of electronic junk mails, or “spam,” that the average American receives every year has more than quadrupled in the past 6 years. Many e-mail providers now block more e-mail than they deliver each day. It is estimated that the amount of visual information we produce each year in print, film, optical, and magnetic content would require about 1.5 billion gigabytes of storage, or 250 megabytes for every man, woman, and child. We can claim that new information technologies are at our service. We may even suppose that we can always slow down the flow of information, if we so choose. In fact, however, when it comes to information technology, at times we more closely resemble slaves than masters.
© 2006 American College of Radiology 0091-2182/06/$32.00 ● DOI 10.1016/j.jacr.2006.03.021
In radiology, our recently acquired ability to transmit images instantaneously has increased referring physicians’ expectations for the timeliness with which radiology reports should be available. Far from freeing us, picture archiving and communication systems have left many radiologists feeling more than ever chained to view stations. Instead of liberating us from the workplace, some kinds of information technology may be Trojan horses that allow work to invade new territory, such as our homes. What can we infer from this state of affairs? For one thing, we can be confident that more information is not necessarily better information. In some cases, knowing more not only fails to enhance our performance but may actually degrade it. It is possible to be bombarded with too much information. Our impulse to learn more and more can paralyze us even when adequate information for decision making is available and further delay may cause irreversible damage. We should not infer that getting updates weekly instead of monthly, daily instead of weekly, hourly instead of daily, or minute by minute will necessarily prove beneficial. The information age is a boon to our well-being only if we make good choices about which sorts of information to access. Merely having a bigger library does us no good if it only leaves us more bewildered about what books to read. We need to judge which books are really the best, or which offer the greatest insight into the problems currently before us. Similarly, being able to store more and more image data, or to manipulate that data in an ever more sophisticated fashion, is of lit495
496 Invisible to the Eye
tle value unless it enables us to do our jobs better. Of all the medical specialties, radiology is one of the most technophilic. Our journals, meetings, and work environments all testify to our love of new gadgets. Yet we need to scrutinize carefully the marketing nostrum that newer is necessarily better. In what ways is a 16-slice computed tomographic scanner better than a 4-slice scanner, or a 64-slice scanner better than a 16slice scanner, and at what point does advancing to 128 or 256 or 512 slices cease to offer sufficient benefit? More broadly speaking, what is the role of radiologists in medicine? Are we medicine’s mechanics, the high priests of technology? Or are we diagnosticians? If the former, then newer technology equals better radiology. If the latter, then new technology should be evaluated in light of larger purposes. To cope with the information avalanche, we need to pay more attention to the kinds of information we have available, and make some informed choices about which sources to admit to our consciousness and how often. When we drive a car, we do not focus all our attention on the surface of the road. Similarly, we need to determine what we really need to see and know to navigate in our daily professional lives, and focus on that. Which is more important to our professional performance, getting another update on the weather or stock market or digging more deeply into a patient’s clinical history? How often throughout the day do we really need to check our e-mail? Happily, radiologists are quite familiar with one of the most essential concepts in understanding information overload. This is the concept of the signal-to-noise ratio. We use this concept every day,
from designing the physical layout of our departments to the way we routinely inspect images. Visually speaking, the signal in a diagnostic image is represented by the diagnostic information-bearing photons striking our retinas. By contrast, photons streaming through windows or from overhead lights are noise. They only drown out the diagnostic signal. To improve the signal-to-noise ratio, we can do 1 of 2 things. First, we can attempt to increase the signal. This might involve installing a more powerful lamp in a projector or altering the imaging or display parameters of a study to accentuate particular features we are trying to see. Alternatively, we might decrease the noise. Examples of noise with which radiologists frequently must contend include ambient lighting, irrelevant conversations, and malfunctioning imaging equipment. Determining the more appropriate approach to the signal-tonoise problem depends on the particular situation at hand. The key is appropriateness. Taking it to the limit is often a bad idea. If we turn up the gain on a computer monitor too much, we are presented with a screen full of static. If we turn it down too low, we face a blank screen. If we are to respond appropriately to the challenges of information overload, we need to keep in mind what we are ultimately charged with accomplishing. A more aesthetically pleasing image is not always a more diagnostic one. As the cost of disseminating information has fallen, the cost of receiving information has tended to increase, at least in the sense that the signal-to-noise ratio is always in danger of decline. This may account in part for our culture’s renewed interest in meditation, prayer, and the “slow” movement.
People feel a greater need than ever before to take time out, get off the information superhighway, take a deep breath, and experience the sound of silence. At times it is only in silence that we can hear the voice of the truly important. What do we really need to know to do our jobs well? When does doing our jobs well begin to interfere with our personal lives and, ultimately, to undercut our professional effectiveness? There is a difference between knowing a lot and being knowledgeable. The annals of neurology furnish examples of remarkable individuals with memories so prodigious that they were known as mnemonists. They could, for example, easily memorize reams of information, such as the listings in a telephone directory. However, such people often fared poorly in life, precisely because they could not distinguish the signal from the noise. The problem of information overload imposes responsibilities on professional organizations. It is great to share information throughout an organization, but there is a limit to how much information each member wants and needs. We need to apprise colleagues of the wealth of information they have available, but we also need to let much of the responsibility for accessing that information remain with each member. Rather than “push” everything we have available, we need to allow members the opportunity to “pull” from a menu what they want to see. Sadly, it is often the people in leadership positions who suffer most from information overload. The chair of a department or president of an organization may receive dozens or even hundreds of e-mails each day. Even more problematically, many people reflexively copy superiors on each piece of corre-
Invisible to the Eye 497
spondence, forgetting that several dozen others may be doing the same thing, thereby presenting leaders with an insurmountable pile of e-mail each day. To be knowledgeable means not only having a lot of information at our fingertips but being able to distinguish what is irrele-
vant or at least relatively unimportant from what must be known. A true expert is not the person who knows the answer to every question but the person who knows what questions to ask. The best physician is not a walking data repository but a good investigator, who knows what to
look for. A photographic memory does not make a person wise. In this information age, when the rate of information bombardment is increasing at an exponential rate, it is more vital than ever before that we cultivate our ability to discern and focus on what is really worth knowing.
Richard B. Gunderman, MD, PhD, Indiana University School of Medicine, Department of Radiology, 702 Barnhill Drive, Room 1053, Indianapolis, IN 46202-5200; e-mail: [email protected].