Mitchell Motooka, MD, FACP

Ambulatory Primary Care, Hawaii Permanente Medical Group
Program Director Emeritus, Kaiser Permanente Hawaii Residency Program
University of Hawaii Internal Medicine Residency, 1987–1990
University of California San Diego School of Medicine, 1987

On July 31, I will hand in my yellowed and faded ID badge, an end to 36 years as a primary care physician, faculty member, and physician leader—for some of that time, I was Program Director for our Internal Medicine Residency. I can’t say that it seems like only yesterday, but it certainly doesn’t feel like what I thought 36 years would.

1990 was a world before hospitalists, and we took overnight call for the hospital after a full day in clinic. We rounded on our patients 365 days a year (no 1 day off in 7 or 1 week on/1 week off), but we were less encumbered then. In the management of diabetes, for example, we had only 2 classes of medicine—insulin and sulfonylureas. The landmark UKPDS and DCCT trials, which would show that tight glycemic control lowered the risk for complications, were yet to be published. We had no electronic medical record with its in-basket or smart and not-so-smart phrases. The only way a patient could access the physician was by scheduling an in-person appointment—there were no video or telephone appointments and there was certainly no e-mail. Lab and x-ray results were printed out and delivered to our offices once a day. Our pandemic was not COVID-19: it was AIDS. And in the span of my career, what was once a death sentence has been rendered a chronic illness.

How will health care evolve over the next 36 years? No doubt it will be shaped by the specter of artificial intelligence. But, fundamentally, a physician’s job description in 2026 is no different than it was in 1990. It still comes down to the individual physician applying human intelligence and a human heart, providing care, and making a difference in the quality of life for those exceptional people who have chosen you to be their doctor.