I went back to see patients recently. I’m not going to name the clinic. It doesn’t matter. The problem is everywhere.
You know it. I know it. We’ve been talking about it for years.
But here’s the truth: this isn’t a new bug in the system. It’s the system’s operating condition. We call it click creep.
Ambient Scribing Won’t Save Us
Let’s look at the shiny new toy. Ambient AI scribes. They listen to your visit and draft the note. They are supposed to fix documentation fatigue.
In theory, yes.
In practice? You can automate the writing and still drown in clicks. These are two different beasts. You can have the smartest AI assistant in the world and still spend more time clicking buttons than looking at the patient.
So how does the clutter actually build up? It’s not malicious. That’s the trap.
Every single addition feels reasonable in isolation. A prompt for one more screening question. A mandatory field for a quality metric. A “next best action” suggestion that makes clinical sense on paper.
None of these are the enemy. The enemy is the stack.
Add enough individually defensible clicks together and you get something collectively indefensible. You end up with fields that no single person designed, and no one fully understands. The volume becomes unfathomable.
And it gets worse because it compounds.
Click fatigue is real. Clinicians stop clicking thoughtfully and start clicking reflexively. We just get through the screen. The data we are so busy harvesting becomes garbage. Low reliability. Low value.
So what do we do? We build workarounds. We copy-paste old notes. We use “smart defaults” to skip ahead. We create elaborate machinery to capture information that no one actually reads.
The irony? I lead an organization. I have to confess: we ignore most of the data we collect.
We add the field. We never check if anyone uses it. Somewhere between the boardroom good intention and the annual compliance report, the loop breaks. We collect the data but lose the insight.
Patients Are Tired Too
This isn’t just a burnout problem for doctors. It’s bleeding into your living room.
I saw my own primary care provider the other day. Before I even sat down, I was handed five pages of questions. Many were new. Some were repeats.
We had a great visit. We talked about what mattered. My blood pressure. My sleep. The stress of life.
Almost none of that conversation touched those five pages.
The documentation failed the encounter. The encounter didn’t fail the documentation. But it sure felt like it.
The Ratchet Effect
So how do we fix the Grand Declicking?
We need a purge. A deliberate, aggressive cut-down of the fields we ask you to fill out.
But you can’t just hack away at the EHR. You need to understand why it got this messy in the first place.
Click creep is not an accident. It’s a ratchet.
Every field in your electronic health record was added by someone who thought it was necessary. Almost no one who adds a field has the power to take it away. Addition is easy. Deletion is political.
The cost of adding a field is diffuse. It’s spread across thousands of clicks by thousands of providers. It’s three seconds here, two seconds there. Nobody feels the pain individually.
Deletion is hard because it requires someone to stand up and say: “We are safe without this.”
In most hospitals, no one owns that job. So the ratchet only turns one way: up. More data. More clicks. More noise.
Governance Over Technology
The Grand Declicking isn’t really a tech problem.
It’s a governance problem.
Don’t get me wrong. Ambient AI will keep getting smarter. It should. But better tools on top of bad governance just produce more sophisticated clutter.
The computer doesn’t decide what to ask you. Humans do. Which means humans can decide to stop.
True declicking requires authority. We need someone with the explicit power to remove fields, just as we have given everyone the implicit power to add them.
We need to treat every field as a liability until proven to be an asset. Default to “off.” Make teams justify why a question needs to exist. Retire the ones that can’t.
Here is the hard rule we need to adopt: If we are not using the data, do not collect the data.
It sounds simple. It is uncomfortable.
Because it forces us to admit that a lot of what we record is vanity metrics. It’s theater for accreditation, not care for the patient.
The Cost of the Click
Every field I click that no one reads is a small theft.
It steals time. Specifically, it steals the seconds I should be spending listening to the person in front of me.
Multiply that by one provider. Then by a thousand. Then across the country.
You get a healthcare system that is excellent at documentation and increasingly poor at attention.
We can’t automate our way out of this. Better notes won’t bring back the lost moments. The fix requires courage. It requires saying that the data you could collect is not worth the price you have to pay.
The ratchet can go the other way. But only if we choose to stop turning it.
