A true story about traffic, modern medicine, the Philippines, and humanity's relentless pursuit of efficiency.
Yesterday morning, I had a doctor’s appointment at 10:00.
At 9:52, trapped in traffic, I made a terrible mistake.
I called the doctor’s office.
I was going to be ten minutes late.
That was it.
I wasn’t having chest pains.
I wasn’t requesting experimental surgery.
I wasn’t trying to donate a kidney.
I simply wanted to communicate one sentence:
“Tell the doctor I’ll be there at 10:10.”
I had no idea this would require the involvement of the Philippines.
I dialed the number.
Immediately:
“Thank you for calling. Please listen carefully, as our menu options have recently changed.”
Why?
Why are medical-office menu options constantly changing?
Who is sitting in a conference room every Thursday saying:
“You know what? Option 4 has had a good run. Move prescriptions to 7. Put billing on 3. And for God’s
sake, nobody should be able to reach the receptionist.”
The menu began.
Press 1 if you are a patient.
I pressed 1.
Press 2 for appointments.
I pressed 2.
Press 3 if you have an existing appointment.
3.
Press 4 if the appointment is today.
4.
Press 6 if you are calling about an appointment within the next 24 hours.
6.
At this point, I had pressed enough buttons to launch a missile from a submarine.
I was waiting for:
“If you are currently driving to our office while screaming at this recording, press 9.”
I would have pressed 9 so hard the Philippines would have felt it.
Then came the music.
Not music exactly.
Medical hold music.
The soundtrack of surrender.
It sounded like Kenny G had been sedated and placed near an aquarium.
Every 40 seconds, the music was interrupted by a reassuring voice:
“Your call is very important to us.”
No, it isn’t.
If my call were very important to you, SOMEONE WOULD ANSWER THE PHONE.
My call was apparently so unimportant that it had been deported.
Finally:
“Hello, sir. Thank you for calling. How may I assist you?”
A human being!
“I have a 10:00 appointment. I’m stuck in traffic. I’m going to be about ten minutes late.”
“Certainly, sir. May I have your date of birth?”
Why?
Did my date of birth affect traffic?
But fine.
I gave it to her.
“Can you verify your home address?”
I verified it.
“Telephone number?”
I gave it to her.
The telephone number.
I was calling her from.
“Email address?”
I gave her that too.
At this point, I was expecting:
“Mother’s maiden name?”
“Blood type?”
“First pet?”
“Name of your third-grade teacher?”
“Where were you on the evening of November 17, 1983?”
All because I was going to be ten minutes late.
She put me on hold.
The aquarium music returned.
Meanwhile, I continued toward the doctor’s office.
Several minutes later, she came back.
“Sir, I see that you have an appointment today at 10:00.”
Fantastic.
We had independently verified the existence of the appointment.
This was progress.
“Yes. That’s why I’m calling.”
“How can I help you with your appointment?”
“I’m going to be ten minutes late.”
“I’m sorry, sir?”
“Late.”
“Late?”
“Yes. I’m in traffic. I’m going to arrive approximately ten minutes after the scheduled appointment time.”
There was a pause.
“Would you like to reschedule your appointment?”
“No.”
“Would you like to cancel your appointment?”
“No.”
“Would you like to schedule another appointment?”
“No.”
“Would you like to change doctors?”
“NO.”
“Then how may I assist you?”
“I WANT YOU TO TELL SOMEONE THAT I AM TEN MINUTES LATE.”
Silence.
You could almost hear the request traveling through the undersea fiber-optic cables.
Atlanta.
California.
Hawaii.
Guam.
Manila.
Possibly Tokyo for verification.
Back to Manila.
Then eventually Atlanta.
She said:
“Please hold while I contact the office.”
CONTACT THE OFFICE?
That’s who I thought I called.
Apparently, I had accidentally called the United Nations.
By now, I was pulling into the parking garage.
Still on hold.
I parked.
Still on hold.
Got out of the car.
Still on hold.
Walked into the building.
Still on hold.
Got into the elevator.
Still on hold.
The elevator traveled six floors faster than my message traveled from the Philippines to the receptionist.
The doors opened.
I walked down the hallway.
I entered the doctor’s office.
And there they were.
Two receptionists.
Sitting behind a desk.
Actual human beings.
I could see them.
They could see me.
One looked up and smiled.
“Good morning! Can I help you?”
I held up one finger.
“One second. I’m trying to reach you.”
She stared at me.
I stared at her.
Somewhere approximately 8,500 miles away, a woman was trying to contact the woman standing six
feet in front of me.
At that moment, I stopped being irritated.
I became fascinated.
I wanted to see how far we could take this.
Maybe Manila would email Dallas.
Dallas could open a support ticket.
The ticket could go to Phoenix.
Phoenix could escalate it to Tier 2.
Tier 2 could contact Atlanta.
Atlanta could print the message.
Then FedEx could overnight it to the building I was currently standing in.
Perhaps tomorrow morning, a man in brown shorts would walk through the door carrying an envelope:
URGENT PATIENT COMMUNICATION
The receptionist would tear it open.
“Joel says he’s running ten minutes late.”
And I could jump out from behind a plant and yell:
“I MADE IT!”
Eventually, the woman came back on the phone.
“Sir, thank you for your patience.”
Patience?
At this point, I deserved diplomatic immunity.
“I am sending a message to the doctor’s office informing them that you will be approximately ten minutes
late.”
I looked directly at the receptionist.
She looked directly at me.
I said:
“Excellent. Could you also put in the message that I’m standing in front of them?”
Silence.
“I’m sorry, sir?”
“I’m here.”
“At the doctor’s office?”
“Yes.”
“You have arrived?”
“Yes.”
“So you are no longer running late?”
And that's when I realized something extraordinary.
The system had solved the problem.
Not by communicating faster.
By taking longer than the problem itself.
I had called to report that I was going to be ten minutes late.
They kept me on the telephone long enough that I arrived.
Problem solved.
This may actually be the business model.
Then she asked the greatest question I have ever heard:
“Would you still like me to send the message?”
I almost said yes.
God, I wanted that message sent.
I wanted to watch it arrive.
I wanted the receptionist’s computer to ding.
I wanted her to open it.
I wanted her to read:
PATIENT REPORTS HE WILL BE APPROXIMATELY TEN MINUTES LATE.
Then I wanted to slowly lean across the counter and whisper:
“That’s me.”
Instead, I thanked the woman in the Philippines.
Because none of this was her fault.
She was perfectly nice.
She had simply been placed on the opposite side of the planet and given responsibility for
communicating something between two people who were now standing close enough to shake hands.
I hung up.
The receptionist smiled.
“Name?”
I told her.
She typed something.
“Okay. You’re checked in. Have a seat. The doctor will be with you shortly.”
Total elapsed time:
Approximately eleven seconds.
I sat down.
And I began thinking about what humanity has accomplished.
We split the atom.
We mapped the human genome.
We landed on the moon.
We built satellites that orbit the Earth.
We created computers capable of performing trillions of calculations per second.
Artificial intelligence can write software, compose symphonies, discover new drugs, translate languages
and detect cancer.
We have spacecraft traveling billions of miles from Earth.
We can have a video conversation with someone in Australia while sitting on a toilet in Atlanta.
And yet somehow...
we have completely lost the technology required for Susan at the front desk to answer a
telephone.
In 1975, this entire interaction would have gone:
“Dr. Smith’s office.”
“Hi, I have a 10:00 appointment. I’m running about ten minutes late.”
“Okay, I’ll tell him.”
“Thank you.”
Click.
Fourteen seconds.
Infrastructure required:
One telephone.
One telephone cord.
One Susan.
In 2026, we have dramatically improved this system.
Now it requires:
An iPhone.
A cellular network.
Voice-recognition software.
An automated telephone tree.
Seven menu selections.
A customer-service platform.
Several thousand miles of fiber-optic cable.
Multiple data centers.
International telecommunications infrastructure.
Identity verification.
A call center in the Philippines.
A woman in Manila.
A woman in Atlanta.
Possibly a satellite.
And twenty minutes...
to move six words across a desk.
The truly remarkable part is that somewhere, right now, there is almost certainly a corporate executive
standing in front of a PowerPoint slide.
The slide probably says:
PATIENT COMMUNICATION TRANSFORMATION INITIATIVE
Underneath it are several arrows, three circles and the words:
Streamlined. Integrated. Global. Patient-Centric.
And that executive is pointing at a graph going up and to the right and saying:
“As you can see, the new system has dramatically improved efficiency.”
Everyone in the conference room is nodding.
Someone from McKinsey probably charged $800,000 for the arrows.
And Susan?
Susan is still sitting at the front desk.
Six feet away from the telephone.
Which no longer rings.
Because apparently...
that would be inefficient