Physicians Need to Emphasize Medicine’s “Core, Not Chores”: Reclaiming the Essence of Health Care

In the constantly changing realm of contemporary medicine, doctors and other health care providers are confronted with a pressing challenge: how to differentiate the crucial act of healing—the essence of medicine—from the growing administrative responsibilities that increasingly consume their time and focus. In a recent episode of The Podcast by KevinMD, physician executive Dr. Grace E. Terrell addresses the urgent necessity for health care professionals to “innovate and concentrate on medicine’s core, not chores.”

This enlightening discussion highlights the increasing bureaucratic load in health care and explores potential solutions.

Understanding the “Core vs. Chore” Quandary

Dr. Terrell presents a compelling framework to grasp the modern physician’s challenges: “core vs. chore.” Core responsibilities encompass what physicians are trained and destined to pursue—listening to patients, diagnosing ailments, prescribing treatments, and establishing the human connections essential for healing. Conversely, chores involve excessive documentation, insurance approvals, data entry, inbox management, regulatory compliance, and other non-clinical responsibilities.

A notable illustration in Terrell’s article referred to a scenario where staff prioritized accurate electronic health record (EHR) entries over ensuring a patient obtained necessary oxygen—a stark reminder of the consequences when technology and bureaucracy encroach upon care.

Time Wasted on Administrative Duties

Terrell underscores a troubling trend that resonates throughout the profession: doctors are dedicating almost twice as much time to EHR and desk-related work compared to providing direct patient care.

This disparity contributes to:

– Physician exhaustion and moral distress
– Increasing shortages of primary care providers
– Decreased quality time with patients
– Patient dissatisfaction and poorer outcomes

For physicians like Terrell—an internist with a medical career spanning the 1990s—the difference between the past and present is pronounced. What was once a profoundly human, intellectually rewarding career has become mired in checkbox medicine and late-night charting in pajamas.

Underlying Issues: Flawed System Design and Outdated Technology

Terrell highlights various systemic factors fueling this crisis:

1. Electronic Health Records (EHRs):
Developed more for billing and compliance than patient-centered care, EHRs often turn doctors into data clerks. The overly complex interfaces necessitate repetitive clicks and disrupt the doctor-patient relationship.

2. Inefficient Processes:
Numerous medical offices utilize outdated or poorly developed workflows that overwhelm physicians with tasks better suited for delegation.

3. Payment System Flaws:
A fee-for-service model penalizes time spent with patients and emphasizes documentation as a means of revenue generation rather than care.

4. Staffing Gaps:
There’s frequently a shortage of skilled staff to handle these clerical duties.

Towards Solutions: Genuine Innovation, Not Temporary Fixes

Dr. Terrell fervently supports a mix of technological, operational, and policy changes to alleviate the chore burden, which includes:

1. Redesigning Practices:
– Physicians and clinicians should operate “at the top of their license.”
– Non-clinical duties should be reassigned to support personnel or automated systems.

2. Technology Overhaul:
– AI-driven tools such as virtual medical assistants and ambient transcription can minimize the burden of clicks.
– Human-centric technology redesign should focus on usability for clinicians and patients alike.

3. Comprehensive Platform Development:
– Rather than layering one tech solution over another (as seen with the “five waves” of health care IT), an integrated, unified platform managing care delivery, documentation, and patient engagement is essential.

4. Reforming Payments:
– Terrell stresses that long-term results hinge on value-based models that prioritize patient outcomes and extended care over mere checkbox compliance.

The Role of AI: Microsoft Dragon Copilot and More

Dr. Terrell’s insights are particularly relevant with the introduction of support tools like Microsoft Dragon Copilot—an AI-driven assistant that simplifies documentation, highlights pertinent clinical data, and alleviates clerical overload. This is one compelling illustration of how machine learning can liberate physicians and redirect their attention toward patients.

However, Terrell warns that technology is not a panacea. Without intentional implementation and human-centered design, even the most sophisticated tools can introduce new friction points.

Redefining the Clinical Experience

In her ideal vision, Dr. Terrell envisions a workflow where:

– Patients are comprehended before visits through intelligent data collection.
– Clinicians dedicate their time to personal interaction—not staring at a screen.
– Notes and orders are created via ambient listening tools and supportive AI.
– Post-visit follow-ups are smooth and streamlined through patient engagement platforms.
– Ultimately, care becomes more accessible, responsive, compassionate, and sustainable.

A Call to Action—Macro and Micro

Terrell’s concluding message is both strategic and personal:

– On a broader level, health care organizations, technology companies, and policymakers must