In Search Of A New Primary Care Physician

[Image AI Created]

My 80-year-old primary care doctor is retiring, forcing me to find someone new. A huge shoutout to Dr William Mugg in South Hadley, Massachusetts who got me this far and who always conducted thorough physical exams, checking my throat, ears, heart and body with careful attention.  

I’ve been shopping for a replacement and found a highly rated doctor in his 40s. My first physical with the new guy was surprisingly different. The initial meeting was excellent - he showed genuine interest in connecting and made me feel comfortable and valued. Things changed though when the exam started, he spent most of the time looking at a laptop asking me questions from a list, clicking answers into an electronic health record (EHR) system and ordering lab work, with minimal physical examination. 

 

What has changed?

I recently read an IEEE Spectrum article titled "The Doctor Will See Your Electronic Health Record Now" that perfectly described this shift. The article explains that today's doctors spend up to 6 hours daily on documentation with only 27% of their time actually interacting face-to-face with patients. While I left with comprehensive lab orders, I missed the hands-on approach that made me feel thoroughly examined and cared for by Dr Mugg. Here’s some background on how things have changed.

 

Looking Back

In 2004, President George W. Bush set an ambitious goal for U.S. healthcare providers to transition to EHRs by 2014, with the vision that a person's complete medical information would be available "at the time and place of care, no matter where it originates." This initiative gained significant momentum with the 2009 HITECH Act, which budgeted $49 billion to promote health information technology.

 

Today

Fast forward to today, and the U.S. has spent over $100 billion on healthcare IT. While nearly 80% of physicians and almost all non-federal acute-care hospitals now use EHR systems, the implementation has fallen short of its original vision in several key ways according to the article:

• Poor Usability: EHR systems rank in the bottom 10% of IT products for usability. Physicians spend between 3.5 and 6 hours daily on documentation, with only 27% of their time spent face-to-face with patients.
• Clinician Burnout: 71% of physicians feel EHR systems contribute to burnout, with half of U.S. physicians experiencing burnout symptoms.
• Limited Interoperability: Despite progress, sharing patient data between different systems remains difficult. An average hospital uses 10 different EHR vendors internally, and many specialists have unique systems that don't communicate with each other.
• Cybersecurity Concerns: Security was largely an afterthought in early implementations. From 2009 to 2023, nearly 5,900 healthcare breaches exposed over 520 million health records, with the average 2024 breach costing $9.97 million.
• Productivity Drain: Rather than increasing productivity as promised, EHRs have become "productivity vampires" that require extensive documentation and management.

Improvement Needed

EHR systems have transformed patient notes from thoughtful clinical assessments into bloated documentation driven by billing requirements and compliance metrics. Patient notes are now twice as long as they were 10 years ago, yet often contain less meaningful clinical insight. The focus has shifted from holistic patient care to satisfying digital requirements and insurance codes. The IEEE Spectrum article quotes Robert Wachter, Chair of Medicine at UCSF, who states that EHRs "became an enabler of corporate control and outside entity control" over medical practice. Many physicians now practice "checkbox medicine" to satisfy EHR protocols rather than applying the nuanced clinical judgment that characterized previous generations of doctors.

 

Perhaps most concerning is how EHR implementation has contributed to unprecedented levels of physician burnout. Emergency room doctors, who make approximately 4,000 EHR clicks per shift, report the highest burnout levels. This exhaustion inevitably impacts patient care. While old-school physicians like Dr Mugg could focus their energy on clinical reasoning and patient interaction, today's doctors must divide their attention between patients and an increasingly demanding digital ecosystem.

 

Looking Forward

While technological advances including AI scribes (robots) may eventually ease documentation burdens, the fundamental shift away from hands-on medicine represents a significant loss in healthcare delivery. The art of the physical exam—once the cornerstone of medical practice—risks becoming a secondary consideration in our digital healthcare environment.

 

As we continue to digitize healthcare, we must ask whether we've sacrificed something essential in the process: the irreplaceable value of a doctor who looks at the patient rather than the screen.

 

And finally – thanks again Dr Mugg. Enjoy your retirement!