A newsletter from our Stanford medical school library reminds me that fifteen years ago, if I wanted to get the latest scoop on a disease, I'd have had to walk through the stacks where our library displayed the 3,600 journal titles its owns. Then, once I collected the bound volumes containing the articles I wanted, it was off to the photocopier area. An hour later (provided my coins and the machine lasted), I'd be done.

These days, my medical library (fittingly called the Lane Medical Library and Knowledge Management Center) has 6,500 journal titles available on line, along with 8,150 eBooks and 680 databases. Since this virtual library never closes, I can 'walk' through the stacks at three in the morning.

This ease of access characterizes so many aspects of medical practice:  I can access x-ray images of my patients from any computer; I can write my progress note in the patient's chart from wherever I am, even from home, because we use an electronic medical record and not a paper chart.

Progress is great! Who wants to go back to  the old ways of hunting in the file room in radiology for an x-ray image, only to find someone checked it out for a conference and didn't return it.   No more hunting for the right image in a thick manila folder in which the films are out of order.

But . . . I find I do miss visiting my colleagues in their dark dens, their lairs in the radiology department; similarly, I miss the camaraderie of seeing and interacting with colleagues from other disciplines as we congregate around the chart rack at the nurses' station; I miss the serendipity of running into a student in the library. I miss the hush of the stacks, the miasma that speaks of old books and collected wisdom, and how so often it was the book parked next to the book I had come to find that turned out to be the real treasure. Will I ever make that kind of discovery in a virtual library? 

"Information management" in the hospital world (and I suspect in other venues) has brought with it a certain isolation and solitude. On the one hand, I've never been more in touch with people all over the world, given that we are being Skyped, Twittered, CC'd, and BCC'd;  on the other hand I know too few physicians and nurses in the hospital even though we work in the same space. The chance conversations, the human-to-human exchanges that don't have a title in the subject line have become fleeting and rare.  I wonder if that strange term, "social networking," (who in the world coined that one?) came out as an antidote to the social isolation of cubicle and screen.  Indeed, the "nudge" function on Facebook seems to me to almost be a plea for human contact--I'd worry that the nudger was suicidal if I were ever the nudgee.

The one place where I seem to see people from all strata and every area of the hospital mingle and chat is around the outdoor picnic table in the shady, designated smoking area some distance from the emergency room entrance of our hospital. It's a choice spot where one can watch the ambulances pull in, the helicopters land and where one can leisurely observe the rest of us hurry by. When I raced by this morning, I saw the regulars sitting  with their coffee, chatting, exhaling out all their worries. Lots of social networking going on there. It made me envious. Is this the last bastion, the last outpost of true social networking of the non-Facebook kind at the hospital?  I tell you, it's enough to make one contemplate taking up smoking.