Not long ago, I opened my inbox and found myself flooded with lab results. Not unusual for a weekday, except these weren’t mine.
They were for a patient I had seen in a purely consultative role. A gastroenterology referral. I’d done my part: reviewed her chart, made recommendations, documented everything, and moved on. But now, I was being sent follow-up results for labs and imaging ordered by other physicians – her PCP, an endocrinologist, maybe even the hospitalist – none of whom I’d coordinated directly with. Somehow, I had become part of her “whole care” team in the electronic medical record (EMR), and suddenly, I was being held accountable for results I hadn’t asked for and decisions I hadn’t made.
Let me be clear: I care about this patient. I want her to receive excellent, coordinated care. But that’s not what’s happening here. What’s happening is disorganized delegation without communication, and worse, the silent shifting of liability.
The EMR, in its noble intention to promote “team-based care”, automatically assigns any physician who’s touched the chart to the “care team.” It sounds collaborative, but in practice, it’s a mess. By being attached to a patient’s chart, I’m now copied on every lab, image, and clinical message, regardless of whether it pertains to my specialty. This isn’t collaboration. This is administrative overload disguised as multidisciplinary care.
I’m receiving iron panels, thyroid ultrasounds, urine cultures – items I never discussed with the patient, never ordered, and don’t have the bandwidth to interpret in context. Yet from a medico-legal standpoint, I now have a duty to review them. If I miss something critical (say, a dangerously low sodium or an incidental lung nodule flagged on a scan) I could be held responsible, even if the ordering physician failed to act. This is not just inefficient. It’s unsafe.
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There is a real cost to this kind of digital debris. For every result I open, that’s time I’m not spending on my own patients, the ones I am directly managing. For every chart I’m pulled into that isn’t mine, I risk missing something in the ones that are. Multiply that across hundreds of patients, dozens of messages, and countless non-urgent lab results, and you have a recipe for cognitive fatigue, errors, and burnout.
We’ve known for years that physicians are spending more time on administrative tasks than on direct patient care. A 2019 study in JAMA Internal Medicine found that doctors spend more than half their workday in the EMR, much of it outside normal clinic hours. Adding unfiltered, non-relevant test results to that burden doesn’t just make our jobs harder, it threatens the very quality of care we’re all trying to uphold.
Here’s the part that worries me most: the diffusion of responsibility. When everyone is “part of the team,” no one is clearly in charge. The test was ordered by someone else, but the result shows up in my inbox. If I assume the ordering doctor will follow up, and they assume I will, guess what? Nobody follows up. And the patient? The patient assumes someone is paying attention. And if that patient is harmed because of inaction? A legal team won’t care whose name is next to the order. They’ll want to know who saw the result and failed to act.
This isn’t about avoiding responsibility. It’s about clarifying it. Team-based care works best when roles are well-defined and communication is clear. The EMR should support that clarity, not blur the lines further. If I’m being copied on a result, there should be a way to tag the responsible physician, not quietly shift the burden to whoever’s unlucky enough to open their inbox first.
When everyone is “part of the team,” no one is clearly in charge.
Doctors (especially specialists) should have the ability to opt out of being auto-enrolled into a patient’s “whole care” team if their role was limited in scope and time. Better yet, the EMR should allow filtering so that I only see relevant results, not everything with the patient’s name on it.
We are being asked to practice medicine in a digital fog, where every patient has a dozen doctors, and every doctor is now responsible for everything. That’s not teamwork. That’s chaos.
I’m happy to do my part. But don’t assign me work (and, I’ll add, legal risk) without my knowledge or consent. Especially not in the name of “whole care,” when what’s really happening is no one’s clear on who’s in charge.
Until that changes, I’ll be doing what too many of us are doing: frantically triaging my inbox, trying not to miss something I didn’t ask to receive.
Somehow, I had become part of her "whole care" team in the electronic medical record (EMR), and suddenly, I was being held accountable for results I hadn’t asked for and decisions I hadn’t made.
