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Recently, my dental clinic sent me a notice to pay, two weeks before the due date. Then they sent me another notice about one week before. This time I called: “I’m supposed to pay this when I come in for my follow-up visit. Why am I getting notices?”
“It’s our software,” she said. “We can’t do anything about it.”
A few weeks earlier, I had a medical test. I talked to the doctor about it afterwards. “No problems.”
Two weeks after the test, I got a snail mail letter from the hospital, addressed “Dear Sir or Madam.” It said that the test results needed to be discussed ASAP with the provider.
What happened? Did the machine have a bad day so we needed to recalibrate the results? If it’s ASAP and urgent, why send a snail mail instead of a text message?
When I queried through my portal, a nurse answered cheerfully: “The letter was sent by snail mail because it was intended for the small percentage of patients who weren’t on the internet. Just ignore it.”
So why did these examples really annoy me? I flashed back to my psychology classes, where we studied Stanley Milgram’s famous experiment about willingness to obey.
Briefly, subjects were instructed to deliver painful shocks to a “learner” who failed an assignment. Of course, the whole thing was a set-up: shocks were fake and the “learner” was an actor trained to emit howls of pain on cue. But subjects believed they were following “orders” of the white-coated experimenter. Would they comply?
It turns out that 65% of the subjects were willing to inflict what they thought were painful shocks; 35% refused. The experimenters concluded that large numbers of people will obey what they think are legitimate orders.
One of those who refused was a Dutch engineer. He said something like, “I am an engineer. I know this level of electric shock will be fatal. I won’t do it.” His background made him question the meaning of the whole scene.
So what does this have to do with my stories?
In the modern medical world, nobody inflicts painful shocks on anyone else. But as patients, we are often asked to “obey,” i.e., be compliant. That covers everything from taking recommended tests and medicines to tolerating a noisy TV-filled waiting room to accepting mistakes, both medical and non-medical.
When the front desk says, “The problem is our software,” many – probably most – people will accept that story. We forget that to many people, software is a mysterious unknown created by the same forces that give us hurricanes and tornadoes. When they hear, “It’s the software,” they nod knowingly and empathize with the practice.
I’ve been working with software for the last 20 or 30 years. I work in a coworking space with people who write software. I know software is just lines of code created by imperfect humans and that some software is better than others. I know that software shouldn’t drive an organization’s strategy: you choose or modify software to meet your goals.
So, like that engineer in the experiment, I didn’t buy the explanation. I developed a strong distrust of the practice and began looking elsewhere.
In the case of the letter, my degree and research were all in services marketing. I’ve consulted and written about marketing communications. So I am aware that for a relatively small cost, you can hire a professional to write a clear letter with no questions; the letter could explain that it’s primarily intended for people who don’t do portals or internet and everybody else can ignore it.
Even better, why doesn’t this prestigious, well-funded organization hire a coder to write a program to send letters only to that one small segment? Solopreneurs use mailing systems like KIT that can segment their audience; why can’t they?
Actions like these lower trust, and trust is associated with medical noncompliance as well as other concerns. If you want to reach the least technologically aware segment, why make things more confusing for everybody else?
I once got the run-around about a billing mix-up and (after a letter to the hospital president) was transferred to someone who was actually helpful. She told me she hears all the time from patients who work in quality control and wonder why the hospital can’t do better – people who didn’t fall for the story that “We can’t do anything about this.”
A lot of my friends can’t understand why I get so angry and mistrustful with simple mistakes. But I’ve been conditioned by my background and education. I don’t see these as isolated incidents. I see them as signals of how the organization puts energy into creating a positive experience and how much they really respect their patients.
