What We Lost While We Were DocumentingMy Frustration Spoken Out Loud
- Apr 20
- 4 min read
I started medical school in 1992 at Emory University.
The system was imperfect. But it was clear.
Doctors took care of patients. Doctors taught students.
And the system made room for both.
Time was the currency.
The currency bucket was massive.
And we spent it on people, the patient and the student.
Attendings taught.
Residents practiced and learned.
Students watched, tried, failed, and grew.
Failure was expected and utilized to press mental growth.
The hierarchy wasn’t always about power.
It was mostly about flow.
Knowledge moved downward.
Responsibility moved upward.
Patients sat at the center. Always at the center.
No one said it out loud, but everyone understood the deal:
You are here to learn medicine by doing medicine.
The Art of medicine.
And it was as Good as it was Hard.
Then I went to the University of Virginia from 1996 to 1999.
Same system. Same clarity.
Residents wrote the daily notes.
Awesome attendings verified, corrected, and taught.
The chart was just a tool.
Not the job.
Education was immersive.
You learned by proximity. You learned by repetition. You learned by being there. Long hours with dirty hands and limited sleep.
And because the attending wasn’t buried in paperwork, they were present.
Present to teach. Present to challenge. Present to notice.
The teaching process worked.
Then came practice.
And everything shifted.
Not all at once.
But steadily. Relentlessly. Like the crashing of waves. One, then another and on.
Insurance companies expanded their reach.
Hospitals aligned around billing structures.
The government layered in compliance.
Patients and providers stopped being important despite the lip service.
Documentation stopped being a reflection of care.
It became the price of care.
Every visit required proof.
Every proof required language.
Every line of language had to justify a code.
The chart was no longer a tool.
The chart became the new work.
This new work became wasted time.
Then came the electronic health record.
It arrived with a promise. A grand promise.
Better coordination. Cleaner data. Fewer errors.
A digital nervous system for medicine. Billions spent.
And on paper, it made sense.
Information would follow the patient.
Orders would be legible. Histories would be searchable.
Care would be safer.
But systems are not defined by their intent.
They are defined by their incentives and outcomes.
The EHR did not simply digitize the chart.
It redefined it. The note expanded. The inbox filled.
The click became the unit of work.
What was once a narrative became a checklist.
What was once clinical reasoning became templated language.
What was once a conversation became documentation of a conversation.
The computer moved into the exam room. The true nightmare began.
Then it moved between the doctor and the patient.
Eye contact broke. Attention split. Presence diluted.
Care became less personal.
And the work did not end when the clinic closed.
It followed us home. After-hours charting became routine.
“Inbox management” became a second shift.
The day extended quietly into the night.
Not because doctors wanted to work more.
But because the system required it.
Dr. Ken Walker, now in his grave, watched the decline in patient centered activity.
His pain then is my pain now.
The numbers tell the story.
In the late 1990s, physicians spent about 8–9 hours per week on administrative tasks, roughly 16% of their working time. (Woolhandler et. al. 2021)
Today, that number has nearly doubled to 15–16 hours per week.
And for every hour we spend with a patient,
we now spend up to two additional hours documenting, coding, and managing the electronic record. (Sinsky et. al. 2016)
That time comes from somewhere.
It comes from teaching. It comes from thinking. It comes from noticing.
It comes from the moment when a student asks,
“Why?”
And instead of answering,
you say,
“Give me a second, I need to finish this note.”
I teach medical students.
They are bright. Curious. Capable.
And the system around them is quieter than it used to be.
Not because there is less to say.
But because there is less time to say it.
Every hour has competition.
The patient needs you.
The student needs you.
The chart demands you.
Only one of those generates revenue.
So we adapt. We teach in fragments.
Between clicks. Between boxes. Between signatures.
We compress what used to be immersive into something transactional. Less defined. Less quality. Substandard when compared to the excellence of the past.
It is not supposed to be this way.
And we tell ourselves it’s fine.
But it isn’t the same.
Medicine did not lose its intelligence.
It lost its time.
And without time,
teaching becomes optional,
thinking becomes rushed,
and presence becomes rare.
And in the end the patient suffers.
Future doctors are less well trained.
Future doctors already believe that fragmented time is normal.
Computers between the physician and patient are no longer foreign,
they are expected, normalized.
Time connecting with the patient is diminished.
And what is lost in that space is not trivial.
It is where trust lives.
It is where insight forms.
It is where medicine actually happens.
So we are left with a simple, uncomfortable question:
Who wins in this new world of medicine
if not the patient,
not the physician,
and not the student?
Dr. M
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