I could treat at least 30% of my daily office visits by phone, but I would not get paid and would still be liable for the care. Often doing the physical on a routine patient for allergies or a sinus infection feels wasteful, including having to make sure the bullet points are done to get paid by the insurance company. Most of the EHR systems have a generic, and often not asked, Review of Systems. Much of the time the hospital and office notes are either to cover liability or to get paid through the archaic billing methods.
I have seen charts from 20-30 years ago. A patient with a sore throat would have a short note on a 4×6 card or ongoing sheet of paper in the chart, such as strept pharygitis, penicilling given. Nowadays you have to write a 20-30 line note to cover the SOAP format and to survive any insurance company audits. This increased documentation has not improved the care . Apparently in the mid 1990s, CMS/Medicare came out with a lot of rules for ROS and H&Ps. A lot of the work feels robotic.

The only way for primary care to survive is to refuse payment from a third-party. Let the patient submit for reimbursement.

Under these “lean” conditions our care is affordable and effective.