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I recently wrote about the wretched experience of trying to access a medical referral by using a medical portal that required various security gyrations, which in turn would grant me access to yet another portal with a fresh set of requirements before I could have a look at the actual referral.
Alas, the first portal’s requirements proved too much, and I had to abandon the effort because I can only spend so much time coming up with a password that requires 16 characters, an Egyptian hieroglyph, the maiden name of my third-grade teacher’s mother-in-law, an unpublished Hemingway manuscript, and one character not currently recognized by any code known to man, before going full Lizzie Borden on an iMac.
Besides, my doc needed some information from a previous doctor in another city, and I happened to have stumbled on the contact information for that doctor. So I looked at a couple of paper documents, scanned them in and emailed them to the guy and asked him for more information that I could provide to my current doctor. The result? Silence.
So I contacted my healthcare network via telephone and asked them to send me their referral via US Mail. They agreed in less than 10 seconds. Then I copied the documents I have and physically took them to my current doctor’s office. Done.
Which raises the question: What causes a digital system to be so enigmatic that a carrier pigeon would be more efficient, and yet the system continues to evolve to a level of complexity that passeth all understanding?
Now, for those of us who are savvy enough to utilize some sort of digital assistant (Grok, Perplexity, ChatGPT, etc.) to help navigate the digital labyrinth, a peculiar pattern emerges:
Healthcare → administrative system → digital portal → difficulty navigating portal → digital assistant needed to navigate digital portal → healthcare.
We hear on the news someone’s supposition that AI may eventually wipe out the human race. Meanwhile, we’ve constructed a system in which technology is no longer merely assisting access. Technology has become a puzzle palace that is a prerequisite for access.
This danger doesn't require malevolent machines. It arises from perfectly well-intentioned institutions that progressively remove human alternatives because each increasingly difficult portal looks efficient when viewed in isolation.
“Put the forms online.” Sensible.
“Let patients track referrals online.” Excellent.
“Move communications into the portal.” Convenient.
“Reduce telephone staffing because everyone can use the portal.” Ah.
“Require authentication through another service.” Hmm.
“Send the user back to the originating provider because System A doesn't recognise what System B transmitted.” Welcome to Dante’s Hell; please take a number.
Look, I’m reasonably well educated, persistent, comfortable with computers, capable of making telephone calls and visiting offices, and now capable of asking an AI assistant to help untangle digital bureaucracy. And I still couldn't get through that wretched portal.
So what happens to the 87-year-old widow? The cognitively impaired veteran? The poor person with an old phone and intermittent internet? Someone with limited English? Someone working two jobs who cannot spend three hours discovering why System A doesn't recognize System B?
This raises a more consequential question: Does administrative complexity merely inconvenience people, or does it actually cause attrition? Because if a given percentage of people eventually abandon benefits, referrals, appeals, treatment, or applications because the machinery becomes too difficult to negotiate, then hasn’t “digital efficiency” already produced a substantive real-world outcome?
Look at my own case, in which physically carrying paper copies of old medical records into the neurologist's office is the most efficient option because the interconnected 21st-century information systems won’t reliably accomplish what a manila folder and a pair of shoes can.
This isn’t merely a case of an old man momentarily contemplating the delicious cathartic release of taking an axe to a desktop computer. Perhaps the relevant question ought to be: at what point did people become responsible for being compatible with the system, rather than the system being responsible for serving the people?
Discussion (25)
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This is priceless - I can relate to all of it, and have been there and done that, I am sorry to say. I keep paper files too.
And after having a ten minute conversation with a bot over the phone (unbeknownst to me at that time) whose name was Mike, I now have to ask if the person I'm speaking with is real or a robot.
Mike sounded like a real person and created a work ticket for me, and repeated everything back so perfectly, and even sounded annoyed when I asked one too many questions - that was my only clue, the perfection. As I ended the conversation, I asked if he was real or a robot, and Mike said he was an AI assistant there to help with my concerns......
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The motivation behind all of this is that the decision makers believe that it will lower costs and/or increase net revenue.
Any claim about empowering the patients or clients is secondary.
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We recently had an issue with my husband's blood sugar app. It is supposed to connect wirelessly with his monitor. Three days ago it stopped connecting. Four days ago it worked fine. Replaced the batteries in the monitor. We tried to pair the device again. Didn't work because we didn't know we had to press the connection button that would give us a place to enter the code. More fooling around. Delete the app. Reinstall the app. Delete the device. Reinstall the device. Find the place to enter the code. Re-pair the monitor with the device. Restart the phone. And on and on. Sent a message to the app help desk. No response. We are two college educated individuals, he spent his career in healthcare. Doesn't matter.
We had also discussed what people who are not able to understand all these steps would do. I guess the same we did. Give up on it. The monitor has an internal logbook. So there is really no need for the app in the first place. My husband just keeps a running tally on his computer. A little more work, but a lot less frustration when things just up and quit working.
Also reminds me of the new stove I did not buy. You had to set up a wireless connection in order to turn on the air fryer from an app on your phone. You could not turn it on from the stove itself.
Apps are taking over the world!
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It's almost comedic, except that the consequences can be pretty rather dramatic.
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The problem arises when people give up, or simply can't navigate the digital obstacle course. What then? Is that simply cost of this brave new world where convenience is becoming increasingly inconvenient and the consequences can be irreversible?
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