Patient Access: What Would Happen If Euclid Spoke French?

Hindsight is a wonderful thing; the smart people try to get theirs in before it is needed.

Here is some timely hindsight.

Let’s take a look back at high school.  Among my studies were French and Math—I was way better in math in part because we were not graded on our pronunciation.  I was in class for three years of French.  We learned phrases that may come in handy if we are ever invaded by Quebec; Je vais aller à la bibliothèque (I am going to the library) and, la plume de ma tante (The pen of my aunt).  That is why I studied math.

I have worked in twenty countries, and my mind has remained sharp during the intervening years.  In countries other than Canada, New Zealand, and England, my brain quickly lets me know something is amiss—people are not speaking English.  They are speaking a foreign language, it tells me.  I know a foreign language, it tell it.  I knew intellectually when I was in India, and Austria, and Argentina that people were not speaking English or French. But the message was slow getting from my brain to my tongue, so when those people spoke foreign to me, I replied in foreign to them.

Lest you wonder, trying to tell people in Mumbai about my aunt’s pen did not entice them to esteem me.

The thing is, we go with what we know, and we hope that will get the job done.  Or at least we hope we can score a few bonus points by giving the impression of having tried.

I think that may be part of the reason many health system executives decided to build call centers.  The discussion in the cafeteria over a slab of Lucy’s Meatloaf and a side of mash, may have gone down something like this:

CFO:   Did you know thousands of people call us every day?

COO:  What kinds of people?

CFO:   All kinds; patients, mothers, home health agencies.

COO:  What should we do about it?

CFO:   It’s above my paygrade.  What if we bought a bunch of phones and found a big room and put a bunch of people in the big room and paid them to talk to those people?

La plume de ma tante.

Back to my mathematical journey.  I was a mathematician for the few months between the end of college and the beginning of grad school.  A remarkable feat when you consider that the dean of the math department, having failed to talk me into changing majors for the good of the university, gave me his calculator, telling me, “You need this more than I.”

There was this guy Euclid who was pretty good at math, and he did not even own a calculator.  In fact, he postulated a few axioms from which he then derived all of the same geometry we use today.  Over time, triangles do not evolve into squares in the same way PBS would have you believe we evolved from fish.

One of the Euclidian mathematical proofs is that the shortest distance between any two points is a (say it with me) straight line.  Euclid did not prove the shortest distance between these two points was a straight line, he proved that the shortest distance between any two points was a straight line.  That is pretty cool when you consider there are a lot of points floating around out there.  Clearly, if he had to prove it for every pair of points in order for it to be true, there would be no proof.  Instead, he had to construct a mathematical argument that was valid to the exclusion of any two points.

I bet every single person working in healthcare believes Euclid and his idea about the two points.   The thing is that Mr. Euclid never met our healthcare system.

Healthcare’s two point believers are big on things happening in a straight line.  They have to be.  We go with what we know—la plume de ma tante.

People call.  We should talk to them.  Buy a bunch of phones.  The shortest distance.

In healthcare there are no shortest distances.  The distance between any two points, A and B, is at best a meander if you are the person trying to access the health system.  It is a journey filled with little side trips. Side trips unwanted by the callers.  Most of the time multiple calls are required to get from A to B. On some of the side trips callers listen to a recorded voice.  One some calls they get to do that more than once.  They learn about waiting.  They learn how to ask the same question of multiple people.

And sooner or later callers start asking themselves the question, “What is so special about getting to B anyway.”  They decide to stay at point A, and nothing is going to budge them.

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