After spending some time away from medicine, I return to find that there seems to be a surreptitious, mysterious pandemic infiltrating the junior doctors that practice medicine in the United Kingdom. The cause of this pandemic has largely been overlooked but recent research can now confirm the existence and rampancy of the condition, which can now be revealed as Robotisism. Although the mechanism remains unclear it is thought that Robotisism metamorphose human doctors into machine like –robots programmed to solely perform tasks. They may look like the epitome of the healthy doctor, but closer inspection reveal that they are far from this.Epidemiology
The exact magnitude of the problem has yet to be ascertained but preliminary data suggest that it could be classed as a pandemic of mass proportions. Nevertheless, estimates of prevalence of Robotisism are grossly underestimated due to difficulty in detection. Cases of Robotisism remain undetected for quite some time as it can often be erroneously misinterpreted as “focus” or “discipline”. Robotic symptoms can be masked and mislabelled by health professionals as being single-minded, career orientated and determined, delaying detection and treatment.
Transmission
The culpable pathogenic agent is the gram positive S. Robotoseus organism. Transmission is airborne and has been demonstrated to be highly contagious. The pathogen is ubiquitous and contracted by repeated exposure to the S. Robotoseus organism in hospitals. Those particularly highly prevalent areas include the “doctors mess” and doctors nights out.
Presentation
Spectrum of disease: signs and symptoms.
The condition has a wide spectrum of multi-system manifestations affecting both the physical and psychological state. Physical manifestations include disruption of the ambulatory system, with cases developing a distinctive swaggering gait. Opthamological involvement can be a key clinical clue as eyes may often appear glazed over especially when confronted with any form of culture or politics.
Although normally vociferous they can often become aphasic when placed in non-medical social settings. Whilst, social conversation are heavily tainted by medicine, Psychological symptoms often predominate and thus the paradigm of the mental state examination is highly relevant.
Mood
Patients display gross disinterest in anyone unless they can offer some form of career advancement, real or perceived. Frustration is compounded by ruminating, intrusive thoughts of completing at least one more audit and publication than their colleagues.
Abnormal beliefs
Patients often have abnormal ideas, delusions of grandeur for example often supported by other co-infected doctors. This can often be accompanied by a deep- routed inability to appreciate other sectors and an unshakeable belief that non-medics, most notably philosophers, writers, artisans alike occupy a lower echelon in society.
Thought content
A key feature of Robotisism is the seemingly insurmountable disruption to the thought process, marked by an inability to think freely and suppression of imagination. Other non- specific features attributable to Robotisism is a desperate need to conform to a herd mentality and a startling lack of insight into their condition.
Tests
Diagnosis is based mainly on clinical presentation in the absence of rapid diagnostic tests and a high index of suspicion is required. Genetic markers to detect Robotisism are not yet being considered for development however there most probably is some genetic susceptibility as the progeny of doctors seem to be more affected. There also seems to be decreased t-cell immunity in certain surgical specialities. Potential exacerbating factors are changes to MTAS/MMC, early super specialisation with conveyor belt run-through training schemes and perhaps status anxiety.
Long term sequelae: Terryfying!
Studies of the natural history of the disease are alarming with psychological sclerosis and impoverished interest in life. Most disturbingly, at its most severe form infected patients brains are replaced with circuit boards and they are no longer capable of any autonomous thought. The condition although not lethal, does have significant social morbidity and the burden of disease in hospitals is great.
Treatment
Fortunately, treatment is freely available but requires a multi-modal approach otherwise resistance develops. One off doses or brief glimpses of the odd inspiring person are ineffective and only offer short term respite. The best solution is far removed sanatoriums in the countryside. Some suggested treatment regimens include travelling, frequenting art galleries, cinemas weekly (world cinema if tolerates). And perhaps, most importantly, interaction with people outside of medicine.
There has been some issues around compliance, understandably but this can be overcome with information and education. Prevention is the mainstay as individual response to treatments vary; a public health approach must be taken. Potentially preventable, health professionals have a responsibility to act and it is imperative that they do so. Call for action.
Sima Barmania