The end of reading?

This post is not medical/health/doctor-related. It comes from a recent article by Rose Horowitch in The Atlantic, which I found rather alarming and worth sharing. It appears that young people increasingly view reading as an unnecessarily burdensome way of acquiring knowledge.  

Here are some of the salient points, gleaned from a variety of studies:

• A 2025 survey found that most middle- and high-school English teachers assigned zero to four books a year.
•  Average IQ scores are declining by about three points a decade.
• Scores on ACT’s reading and English sections are at their lowest level in more than 3 years.
• Nearly 30 percent of adults cannot paraphrase or make inferences from a multipage text.
• In 1984, 8 percent of 13-year-olds said they rarely or never read for fun. In 2025 that number rose to 29 percent.  High schoolers in focus groups think of reading for pleasure as an “alien practice.”
• By eighth grade, the average kid spends four and a half hours a day on social media, often watching at 2x speed.
• In 2004 the average attention span on a screen was two and a half minutes. By 2025 it had dropped to about 47 seconds.

People do read in “textual fragments,” but even those textual fragments are losing ground:  Social media, once mainly text-based, has been overrun with short-form videos, such as TikTok, YouTube Shorts, and Instagram Reels. Experts tell us that filling time with short-form videos instead of books degrades the complex cognitive skills that reading fosters, including concentration, extended focus, logical deduction, and analytical thought. Video does contain more information than text (language, sounds, moving images) but does not stimulate deeper thinking. 

In The New York Times, David Foster Wallace offers a rebuttal to Horowitch's arguments, noting that you can slice data in different ways. He cites some studies showing that young Americans are reading more than they did a couple of decades ago, and that the decline in reading is driven by older Americans--those 65 and up. At the same time, he notes, book sales are near record highs, with more books sold these days than a decade ago.

He does admit, however, that “reading comprehension is indeed falling.”

Over past decades, screen time of one form or another has been five to ten times as common as reading. In the 1980s, for example, the TV in the average American household was on for more than nine hours a day, a figure that’s been dropping—probably because of the smart phone.

Who knows what the future might bring? As Horowitch suggests, "maybe the generations growing up with their brains hooked to endless video feeds are developing some kind of novel, as-yet-undefinable cognitive brilliance." Perhaps we are entering a phase of "secondary orality" in which a once-literate society reverts back to some of the conventions of preliterate cultures. Perhaps our literate era will prove to be a brief interlude between the oral and digital ages.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

AI medical scribes

Thanks to AI, doctors no longer need to write summaries—clinical notes—of patient exams. Now, scribe applications, installed on their phones, will do the job. The apps eavesdrop on their conversations with patients, synthesize the information, and produce a polished document with the details, structure, and tone of a proper clinical note—notes with no typos, proper grammar, and written in complete sentences.  After the apps produce the notes, the doctors read, correct—if necessary—and sign them.

AI scribes not only relieve doctors of a tedious chore, they also make it possible for doctors to focus their attention on the patient instead of a computer screen. (Doctors also find that the AI scribes increase productivity and revenue.) What’s not to like?

Companies, many of them start-ups, create and sell the apps to medical facilities. They’ve raised nearly $5 billion since 2019. So far, the rate of adoption has reached as high as 80 percent in some clinics and departments. It’s been the fastest-adopted medical technology of all time.

One doctor, while initially thrilled, found that, by letting the AI scribe write the note, she was “no longer thinking through the interaction with a patient and the meaning of the information” she had gathered—that the writing process itself helped her formulate her medical decision-making. Her cognitive labor was being “offloaded to a machine.”

Three years ago, I wrote a blog post about the rise in medical scribes: humans who accompany the physician during an exam and enter the relevant information into the computer. At that time, it was the fastest growing healthcare profession in the nation. I suppose most of those people are now looking for work.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

The rise in urgent care clinics

A few months ago, I lacerated my lower leg by smashing it into the corner of my car door. I considered just bandaging it but then thought the better of it. My husband drove me the 40 minutes to our nearest urgent care place and they stitched up the laceration. That visit was among those deemed appropriate for urgent care.

According to a recent article in The New York Times, urgent care is one of the fastest-growing sectors of the U.S. health care system. The number of urgent care clinics has risen from 7,000 in 2014 to over 15,000 in 2024.

Apparently, this rise has been partly driven by the decline of primary care, that is, increasing numbers of people finding it difficult to find a regular provider or to be seen quickly. Urgent care is also usually cheaper and faster than the ER.

Urgent care clinics are designed to handle illnesses and injuries that come on suddenly but aren’t life-threatening— “episodic” conditions such as colds, sprains, cuts, and urinary tract infections. Clinicians can order X-rays and basic blood work. They’re not equipped to handle longstanding symptoms or conditions. Only about 15 percent of urgent care providers are doctors. Most are nurse practitioners and physician assistants.

Where I live, we used to have an old-fashioned clinic that took care of urgent cases. The Dignity Health corporation bought it, closed it, and moved their staff to a mall a half hour’s drive from our house. When I went to that office recently to get a tick head removed from my arm, the receptionist said, “We don’t take walk-ins.” That’s why the number of urgent care clinics has doubled.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Elder care

A recent article in The Atlantic tells us that the Netherlands offers “the world’s most generous long-term care insurance, covering professional nursing or home care for all residents who can demonstrate need.” That country spends 4.1 percent of its GDP on formal elder-care services. In the U.S., the percentage is 1.3.

The point of the article is to expose the false belief that, with sufficient savings and adequate public services, care of the elderly can be handled by professionals. In fact, most elder care is still done informally—that is, by relatives or friends. This is true even for the elderly Dutch. Plus, even if the elderly are in residential care, family members tend to be highly involved.

One woman, in commenting on this article, wrote the following: 

“My mother had to go into a senior living facility after several falls and had become increasingly confused. I lived a 5 hour drive away and my brother lived 3,000 miles away. She kept asking when she could go home (we had to sell her house). She had long-term care insurance but it did finally run out because even though she made over $300,000 for her house her monthly fees at the facility were inching up to $10,000/month. Eventually she needed to be moved to a nursing home in my home town ($4,000 for the ambulance) and now the monthly cost was $15,000. Outrageous is the only word for it. We can pay $16,000,000 for the reflecting pool fiasco but not health care. The whole thing is devastating and depressing.”

Agreed.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.