Of course it couldn’t. But it couln’t make them any worse.

So, last weekend I’m driving to pick up my daughter at her friend’s house, a friend who lives nine miles away. I fire up the GPS on my phone; estimated drive time of seventeen minutes.

The route is mostly back roads, and as soon as I reach the ‘backest’ of the back roads I am informed, “GPS signal lost.” Speaking my mind to the recording, I continue to drive. And drive. And you know the rest. I head to places with higher elevations, find a signal, and am directed to roads that even I know have nothing to do with where I am headed.

I pass a flock of Eurasian Wigeons; a species that frequents the west coast of America–I started my drive in the Philadelphia suburbs.

My route is again transferred to another back road, and so forth and so on. I reach the backest of the back roads I am informed, “GPS signal lost.” After speaking my mind to the recording, I continue to drive. And drive. And you know the rest. I head to places with higher elevations, find a signal, and am directed to roads that even I know have nothing to do with where I am headed.

I am talking to myself, and yelling at drivers who look like they know where they are going. Chipmunks on the side of the road point at me, and double over in laughter—I hope they choke on their acorns. After an hour and two minutes, I arrive at the house, upon which my phone chirps, “You have arrived.” I started screaming epitaphs at the chipmunks, one of whom looks like Alvin.

An hour and two minutes is four minutes longer than I spent the other day trying to schedule an appointment with a large east-coast health system. The person with whom I spoke the longest seemed to have a pulse equal to that of a hibernating bear, and had he been a household pet he would have been put down purely for aesthetic reasons.

I find it helpful to trace everything back to a seminal point, a point like just prior to when the random swirls of gases in the chartless universe got together and formed the earth; or not, depending on which side of the Darwin bed you sleep.

From the side of the bed on which I sleep, the seminal point for healthcare consumerism can be traced to the phone. If the people manning your health system’s phones cannot meet the caller’s basic needs and solve the problems of its callers, very little else matters because the callers will call somebody else.  GPS signal lost.

Hammers, like phones, are very evolved tools. They haven’t changed since they were invented. (Niether has consumerism, but then again, I may be boased.) And why would hammers change? Nails haven’t changed. Nails have been the same forever. Therefore, a hammer’s necessary features were worked out long ago. A heavy metal head, and a handle. All you need, and nothing you don’t. And for hammers to be effective they only need a single user.

Phones are also very evolved tools. The primary difference between a hammer and a phone is that if you do not have capable people on both ends of the phone call, both phones are useless.  GPS signal lost.

And this is relevant to healthcare because?  Because the way healthcare access exists today, 100% of it occurs by phone. GPS signal lost.  Try to access your health system online–GPS signal lost.

And this is relevant to healthcare because?  Because the callers may be patients, and if you cannot meet their needs, care suffers. Or, the callers may be trying to buy healthcare from your system, and they cannot.  And that is sort of the reason your system built a big room and bought a bunch of phones.

Transferred calls, dropped calls, callers placed on hold, being told my call would be recorded for quality purposes—an illusory promise of something unseen. When I heard the recorded voice inform me of that tidy bit of news I yelled back, “Wouldn’t I actually have to speak to someone to make recording my call worthwhile?” The entire scheduling process—I am overstating the concept as there was no process, just a series of random interactions. By the time the process had concluded I had developed nictating membranes over both eyes and my thought process had recessed to the lizard part of my brain.

Maybe the process was designed to wear people out, to get them not to call back. Sort of like the customer experience models used by payers.

Just to be clear, there are no catastrophic consumerism or patient access failures. The failures people suffer through are made up of a series of small things that accumulate and become big things, much the same way that individual snowflakes become an avalanche.

Here is how real people—patient people and consumer people—figure out how to call a given health system. They go online; they see a number, cross their fingers, and dial. They do this process again and again until they either give up or until they declare themselves cured and no longer need to purchase healthcare.