Lately, there has been considerable discussion about the changing boundaries between physicians and patients. How quickly should doctors respond to portal messages? When does reasonable access become unreasonable intrusion? Where does professional responsibility end and personal time begin?
These are legitimate questions. Physicians are entitled to privacy, reasonable working hours, and protection from inappropriate demands. No one should expect a physician to be available to every patient at every hour through every possible channel.
But the discussion points to a much larger problem. Somewhere along the way, health care became inward-focused. The system increasingly organizes itself around managing its own complexity rather than fulfilling the core mission that justifies its existence: the care and well-being of patients.
Health care organizations devote enormous resources to managing access, workflow, documentation, scheduling, coding, utilization, authorization, compliance, liability, messaging, escalation, and productivity. Physicians spend increasing amounts of time satisfying requirements generated by this machinery. Administrators build processes to manage other processes. Technology is deployed to make the machinery operate more efficiently.
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Each layer has a rationale. Each rule can probably be defended. Collectively, however, they have changed the orientation of health care. The question too often becomes: How do we make the patient fit the system? It should be: How do we make the system serve the patient? That is not a subtle distinction.
An organization eventually becomes what it measures, manages, and protects. When health care spends enormous energy protecting schedules, workflows, productivity targets, documentation requirements, communication channels, and institutional boundaries, those things inevitably begin competing with the mission they were created to support. Patient care becomes something that must be accommodated within the operating system rather than the purpose around which the operating system is designed.
The patient experiences the consequences everywhere. Call a physician’s office and navigate a phone tree. Send a portal message and wait for it to be triaged. Need an appointment? Take the next available slot. Need a medication? Submit the request through the designated channel. Need a procedure? Wait for authorization. Have a question? Determine whether it belongs with the physician, nurse, pharmacy, insurer, scheduling department, or someone else.
Medicine has become remarkably good at telling patients how to interact with health care. It seems to be less concerned with how health care interacts with them.
Medicine is different from an ordinary service transaction. The Hippocratic tradition, stripped of nostalgia, rests on a powerful idea: A person possessing specialized knowledge assumes a special obligation toward another human being who is sick, frightened, uncertain, or vulnerable. The physician-patient relationship is therefore not incidental to medicine. It is part of medicine.
A physician does more than diagnose disease and prescribe treatment. A physician interprets uncertainty, explains what is happening, reassures when reassurance is warranted, delivers difficult truths when it is not, and exercises judgment when protocols cannot fully capture the individual patient. Sometimes the most important thing a physician does is make a frightened person feel that someone knowledgeable is paying attention. Medicine rarely measures that.
Instead, the vocabulary of modern health care revolves around access, throughput, productivity, documentation, utilization, response times, workflow, and boundaries. Consider what is largely missing: trust, compassion, reassurance, presence, understanding, and human connection.
This is not primarily an indictment of physicians. Physicians are trapped inside the same system. Electronic health records were supposed to make information more accessible but created enormous documentation demands. Insurers require authorization for treatments physicians have already determined are appropriate. Health systems measure productivity. Inboxes accumulate. Forms multiply. Clinical encounters are compressed into schedules driven by organizational economics.
Then we look at exhausted physicians and tell them they need better boundaries. Perhaps they do. But we should ask what created the need for so many of them.
Patients did not invent prior authorization. They did not create the electronic health record, productivity quotas, coding requirements, fragmented specialist care, utilization management, or endless documentation. Much of what we call physician burden is not created by patients. Health care created it for itself. There is something deeply troubling about allowing self-imposed administrative burden to consume so much physician time and attention that the remaining scarce resource, human connection, must then be protected from the patient.
Of course, patients can behave unreasonably. Some expect immediate responses to nonurgent questions. Some misuse portals. Some cross personal boundaries. Medicine needs sensible protections against those situations. But exceptional behavior should not become the organizing principle of the physician-patient relationship. A health care system designed primarily to prevent inappropriate access will eventually make appropriate access difficult.
Every additional layer of separation may appear reasonable by itself: a portal instead of a telephone conversation, a triage queue instead of direct communication, another staff member between physician and patient, another rule defining when contact is appropriate. Eventually, patients can have abundant access to health care while having remarkably little access to the person responsible for their care.
Technology, particularly artificial intelligence, gives us an opportunity to reconsider this trajectory. AI is already being used to reduce documentation, summarize records, draft messages, support clinical decisions, and automate administrative work. Much of the conversation focuses on how many minutes AI can save or how many additional patients physicians can see. That would be a poor measure of success.
If AI saves a physician 45 minutes and the health system converts those 45 minutes into three more appointments, we will have made health care more efficient without making medicine more humane and effective. Give some of that time back to the physician. Time to listen. Time to think. Time to explain. Time to notice what does not appear in structured data. Time to exercise judgment. Time to be present with another human being who entered the health care system because something was wrong and needed help.
Physicians need protection from unreasonable demands. But we have concentrated too much attention on protecting them from patients and too little on protecting them from the bureaucracy surrounding patient care. Reduce unnecessary documentation. Eliminate processes that add little clinical value. Stop treating every saved minute as additional capacity. Protect physicians’ ability to think, listen, explain, and care. Protect physicians from the bureaucracy so they do not have to protect themselves from their patients.
Health care can modernize its technology, improve its workflows, automate its administration, and establish reasonable professional boundaries. But none of those things is its mission. Patient care and well-being are. The physician-patient relationship is not another component of the health care delivery system. It lies at its center.
The task is not simply to make health care work better. It is to remind health care whom it is supposed to work for.
Matt Hasan is an economist, AI strategist, and founder of aiRESULTS. He advises health systems, payers, and life sciences organizations on the strategic implications of artificial intelligence, digital transformation, and emerging technologies. Over a career spanning more than four decades, he has held leadership and advisory roles with organizations including AT&T, IBM, Deloitte, Capgemini, and Citigroup, and previously served on the faculty of New York University’s Stern School of Business.
Dr. Hasan’s work focuses on the intersection of technology, institutions, and human decision making, with particular emphasis on how AI is reshaping medicine, governance, leadership, and professional practice. He is the founder of The AI Humanist Movement and an advocate for Human-AI Synergy, a framework that views AI not merely as a tool, but as a cognitive partner capable of extending human capabilities.
His writing includes “A Profession at the AI Frontier: Medicine Must Reinvent Itself or Cede Ground,” published in Health Affairs Forefront. He shares updates on LinkedIn and Medium.
