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The Systems Don’t Serve Us

July 10th, 2022 by dk

I had a simple medical appointment on Monday morning, but nothing about it was simple. As I waited for multiple staff people navigating unexpected complexities, I found myself asking aloud whether our systems serve us. It seems increasingly to be the other way around. We’ve become slaves to our systems.

Medical care usually starts with payment procedures. Although there’s a great deal of money changing hands, almost none of that money ever touches the hands that are doing the actual exchange. The clerk alerted me that my insurance coverage had changed. (That must be what was inside the envelope that arrived two days ago.)

That envelope contained a card with a number on it. The card is important, but the number is essential. Payment cannot be processed without that number. Without my awareness, the money-changing hands changed hands. The clerk ably navigated the interlocking systems to find my new number and update my records.

I don’t know when doctors began keeping organized records about their patients. Who first summarized those records with a generic, singular label? I wonder whether there are any actual charts included in my Chart. These thoughts occupy me while the clickety-clack reconnects the interlocking systems.

“I’m not used to being a difficult patient,” I confess as she clickety-clacks.

“No, not at all,” she insists. “You didn’t do anything wrong! Just next time bring your new insurance card,” identifying what I did wrong. She can’t do her job as easily without that card. She still managed, but difficultly. Maybe I apologized to the wrong person. There were three people waiting patiently in line after we finished.

Waiting in the examination room, I heard a nurse in the hallway tell her colleague that she would “duck in and quickly take [my] vitals.” I told her I’d prefer to keep my vitals, but if she must take them, please do so quickly. It was a joke, but she didn’t laugh. She was busy scowling at a monitor. (Could “difficult” have been added to my Chart that quickly?)

“I’m sorry,” she said, still looking at the monitor. “The computer system is super slow today.” She could take my vitals without the computer system, but then where would she put them? It’s not like there’s anything resembling a paper folder anywhere that contains my Chart! She needs the system more than she needs me. It has her vitals.

“It’s worse than usual today,” she explains. “They upgraded our systems last night. That’s the problem.” Well, yes — that, and the misuse of the word “upgrade.” But I don’t say that out loud. I don’t want any difficulties added to my Chart.

Two technicians and two apologies later, the doctor walks in with a smile. He has good news. Everything is healing more rapidly than he expected. I no longer have to wear a plastic boot to protect the broken bone in my foot. (I plan to keep limping, so that people will still feel sorry for me, at least until my next x-ray, in a month.)

Do I have any questions? “Yes. If everything is getting better and I have no pain, do I really have to come back for another exam and x-ray?”

He smiles at my naiveté. “Well, the legal answer is yes.” More systems, operating out of sight, like strings on marionettes. “If you decide to cancel that appointment, that’s up to you. And you wouldn’t be the first to do that. But we’ll get you scheduled for it.”

I’ll bring my new card. Maybe this “upgrade” will be that by then. I hope none of these difficulties make it into my Chart, whatever that is.


Don Kahle ( writes a column each Wednesday and Sunday for The Register-Guard and archives past columns at

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  • 1 Alu Taloa Jul 10, 2022 at 2:42 pm

    You and Scott Adams concur that systems are the key to the level of [dys]function we endure. As you convincingly demonstrate, even in an ostensibly for-profit medical clinic, there’s room for improvement. Scott says, taking it another step, that the fatal flaw of the left in designing any system is they invariably forget human motivation. “We didn’t expect when we were shoveling mountains of money into PP “loans” and “unemployment” benefits, there might be waste, fraud and criminal abuse”. On the other hand, he thinks the fatal flaw of the right is the mind-set: “If I did it, anyone can”. Which, of course, is just as blind to all the externialties, let alone individual differences, as is the left’s shock, every time the Bible proves human nature hasn’t changed whatsoever.