Years ago, a practice operations leader told me that every patient encounter -- no matter how urgent -- was an opportunity to capture a quality metric. She referred to this as "in-reach," complimenting outreach to patients when they are not in the office.
"Even when someone is acutely ill?" I asked. "Even then," she said.
The implication was clear: in the middle of treating a patient with gastroenteritis, I should also be thinking about overdue mammograms.
At the time, I was appalled. Today, as a medical director for a large primary care network, I better understand the forces behind that mindset. I help lead efforts to meet system-wide quality targets tied to value-based payment and reputation. I see their importance. And yet, the discomfort remains. The exam room, whether physical or virtual, is an intimate space where clinicians should be fully focused on the patient in front of them. Increasingly, it is also a place where competing agendas intrude.
As generative artificial intelligence (AI) rapidly enters primary care workflows, a new question is emerging: Will these tools restore the doctor-patient relationship or further entrench the metrics that have strained it?
