The Future of Doctoring is Already Here: Do More, Give Less Or Burn Out

Old school doctors like me used to give the vast majority of our time and attention to our patients. Our documentation took very little time and our support staff sorted all incoming data – lab results, x-rays, consults and hospital reports. They would prioritize things for us: courtesy copies to just sign, tests we ordered that came back normal, our tests with abnormal results and so on.

In the new world order, doctors and other medical providers are the first ones to see incoming information. It arrives in our inboxes throughout the day and night, and then it is up to us to sort and delegate everything.

This is something we are never scheduled protected time for – we are supposed to do it “between patients”. What that means is that, in order for us to stay on time, no patient visit should ever be as long as it says in our schedule – since we’re expected to do all this important work “between patients”.

I have to admit this has been hard for me to swallow and adjust to. One reason is all the health maintenance and preventive medicine we are required to pay attention to, even though as I keep saying and writing to no avail, that isn’t usually something that requires a medical degree. The other reason, of course, is that if you ever hope to get people to follow or at least consider your medical advice, you need to have a relationship with them, and that takes a little time. You can’t treat people like cattle in a roundup and expect them to follow your suggestions and prescriptions.

I work hard at delivering technically good care. I put effort into my personal relationships with patients. I don’t mind that.

I keep falling behind in monitoring my 23(!) different inboxes. I think there are too many of them and I think much of what’s in there shouldn’t even be coming my way. It’s just a liability trap, designed to make sure that if anything goes wrong, the blame will land squarely upon us.

So how do I tell my patients I’ll be shaving some more time off what they think is the contracted amount of time they have come to expect with me?

We desperately need to reimagine the primary care visit and the primary care flow of information. Bottlenecking equals burnout.

Between Patients: The Myth of Multitasking

7 Responses to “The Future of Doctoring is Already Here: Do More, Give Less Or Burn Out”


  1. 1 Allen W. Ditto, M.D. January 22, 2023 at 8:08 pm

    You seem to be a gentleman, hard working, a caring doctor, up to date, and very smart. As I read your note today, I am starting my 5th year of retirement from family medicine after a 40 year career (including 3 years in residency). I am celebrating this occasion by spending a month in St. Croix, U.S.V.I. It is 80°, I am relaxing by the pool reading, and patient care and responsibility are not even in my most remote thoughts. I am 69 years old and loving my new life. Best wishes, Doctor!

  2. 3 Jamie Glover January 23, 2023 at 9:32 am

    This is so true. Failed faxes come to me first. Some admin issues too. Patient concerns over minimally abnormal lab parameters that they see in the portal. The rapid fire of all of this is undoable

  3. 4 marilyn Findlay January 23, 2023 at 1:09 pm

    YOU ARE SO RIGHT. EVERY TIME THEY CHANGE MY PRIMARY DOCTOR I REALIZE HOW GOOD THINGS WERE IN BUCKSPORT, I HAVE HAD AT LEAST FIVE PRIMARY DOCTORS IN THE LAST TWO YEARS. I COULDN’T EVEN REMEMBER THEIR NAMES OR WHAT THEY LOOKED LIKE.

    I SURE REMEMBER THE TIME YOU WERE MY DOCTOR. I WAS SORRY WHEN YOU LEFT. I HAVEN’T WRITTEN A POEM SINCE TO GIVE TO A DOCTOR, NOR BAKED
    BANANA BREAD.

    KEEP TELLING THE WORLD WHAT IS WRONG WITH THE SYSTEM. YOU KNOW, I FEEL THE REPERCUSSIONS.

    I WAS ONE OF YOUR HEALTHIEST PATIENTS, I MADE THE GRADE UNTIL I WAS 89, AND AFTER THE COVID SHOT I HAVE GONE DOWNHILL. SINCE LAST MAY AND CONTRACTING COVID A MONTH AFTER.

    I READ ALL YOUR POSTS AND LOOK FORWARD TO THE NEXT. THANK YOU FOR SPEAKING OUT. I CONSIDER YOU ONE OF THE BRAVE. THANK YOU, LYNNE FINDLAY

  4. 5 Sanjeet Narang January 23, 2023 at 8:58 pm

    My burn outs have burned out.

  5. 6 David Felker January 25, 2023 at 10:01 am

    Telling it like it is! Your fellow PCP’s in practice a few decades agree wholeheartedly

  6. 7 Sharon Fleischer January 25, 2023 at 5:11 pm

    150% agree. i’ll never regret the amazing relationships over 25 years nor the late notice of not finishing a chart or signing documents! Health care is meant to be the good old days way – about the health of the person in front of you! Part time now has given me the joy without the hassle and becoming a business leader in prevention and lifestyle medicine sealed the deal that the future of our children and grandchildren should not be left in the hands of the currently stressed out, admin directed physicians.


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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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