And How Inept We Are as New Recruits

American healthcare stinks and the airlines stink. You might think they are treating us badly because they only want our money, and for us to shut up as they fleece us, but I have another hypothesis. I suggest that healthcare and airline companies are aligned because they have elevated us to the role of employees, people who should be able to participate in the business, take of themselves, and relieve these person-oriented organizations of any burden of care. Here are the reasons why both the American healthcare industry and the airline industry are in lockstep making us into employees, without our permission or a paycheck:

Both expect the consumer to come in already knowing what’s what. For healthcare, it’s about Dr. Google because doctors no longer look at or touch a patient and they expect youto tell them what’s going on and suggest what it means. Doctors used to hate that patients looked up their condition online but now they direct us there. I recently had a blood test result during my annual physical (where the doctor did not touch me and barely looked my way, instead keeping his eyes glued to the computer screen) that included a serious result. Instead of calling me and discussing the result or suggesting I come in so we could address this new development in person, my so-called primary care physician wrote to me on Mychart and offered me three websites to consult. When I asked two specific questions in my reply, he didn’t answer them, and I have never heard from him again. So, I looked at the websites while also looking for another doctor.

In the same way, we used to have travel agents who handled our flight plans and understood where we were going and how to get there. They checked various routes on their mysterious platforms and made suggestions. But now, we are at the mercy of “aggregators” (whatever those are) and must sit at a computer and wrestle them to the ground day after day until we find a flight that might work. These aggregators also cough up alternatives that change every second and we are expected to have the expertise of a weatherman, geographer, cartographer, aeronautical engineer, pilot, and clairvoyant with the patience of a saint and perseverance of an explorer and choose the “best” flight. Then we must sit quietly, sometimes for months, as the airlines change all our choices for reasons known only to them and their algorithms. We should know better, but we don’t because we might be playing an airline scheduler at home but not privy to their secret ways.

Both the healthcare system and the airlines want nothing to do with customers. Healthcare used to be modeled after the family doctor who came to your home because someone was sick. Healthcare was as person-friendly and socially intimate as it gets. But that norm has transformed into a raging monster with multilayered levels of bureaucracy. Healthcare is now a health destroyer that cackles hysterically at the very idea that a doctor once upon a time came to call. Airlines also used to be customer-oriented with stewardesses bathing us with kind words to soothe our fears about flying and changing into perky outfits to offer a cart full of fun drinks. They waited on us, remember? Now they tell us to shut up and put up while we fasten our seatbelts under their Arctic stares. After all, we should be grateful that they deign to allow us on the plane. Also, they hate being there so we, the new untrained and unpaid employees, should hate it too.

Both organizations are supposed to serve the general public, and the word “public” used to mean something. It meant everybody — the tired, the hungry, the sick. The slow, the stupid, the scared, the smart-asses. Now they don’t seem to know what the public means. These days riding a city bus is more public-oriented than any hospital that rejects people on Medicaid or any doctor that has decided to make his practice a “concierge service” for privately paying patients. Airlines are also masters of imposing a caste system on their customers. They make us lineup at the gate in separate rows according to wealth and accrued points. We are branded by our class for all to see. On the plane, they hang dividing curtains to remind people where they belong. No crossing those class barriers even to pee. And so, they have tried to wrangle what used to be a wandering mob of public consumers into humble, grateful junior employees who gladly accept their station in life while flying.

Instead of providing an efficient, smooth, supportive experience, the health care system and the airlines also now want us to be on our toes, frightened, all the time, like new hires. Healthcare relies on a mysterious labyrinth that includes costly tests, a broad range of facilities such as clinics, urgent care places, hospitals where doctors operate and have offices, more offices, in-house labs, across-town labs, hospital labs, and a dizzying range of people that do something as we are handed off one to another like a relay baton. There are doctor’s assistants, nurse practitioners, techs of so many sorts, many many receptionists who hate their jobs, billing people, and some person in scrubs who takes your vitals and you never see again. This person could be a vet tech for all we know. Being handed from one person to another means you never know what is going on as you are spun about, anxiously facing one stranger after another like in a house of mirrors. And in this one, you have to repeat your story over and over, always ramping up your fight or flight response in this dizzying horror movie. The airlines also enjoy scaring us to death with their planes that fall apart midair, the detritus left behind by passengers of an earlier flight — what is that? Puke? Toenails? Somebody’s homework? And there is the pilot who never explains why the plane is bouncing around, and customer service that hates every single one of us and wishes we’d die in a plane crash. And so, they pull us into their web of dizzying systems in an attempt to blame all this craziness on the customer, the rookie employee, who is at fault for using their services.

Both systems push patients and customers to be the decider when we have no idea what is going on. Doctors now often ask if we want this test or that one, this medication or that one, as if we, too, had gone to medical school. In the same way, the airlines also often put us in the driver’s seat, especially when they have screwed up and we don’t even know how to drive. If a flight is canceled, they sometimes offer choices like a different flight twelve hours later or a snooze on the airport floor and a flight the next day that includes two additional stops on the way. It’s up to us, the new employees, to decide what to do, but how would we know? I was once sitting on the floor at Newark airport, at midnight, vomiting repeatedly into a face mask after an international SwissAir flight was canceled (after a 5-hour delay). A clerk finally noticed me sitting there in the very long line of 300 passengers (perhaps it was the continual gagging) who were trying to figure out what to do because the airline was doing nothing. The agent brought me a box of Kleenex and suggested I go find a hotel, at midnight, by myself somewhere in Newark. And I would need to pay for it. He also instructed me to keep the receipt (as if I were an airline employee on a business trip) and maybe the airline would reimburse me (for their fault). I shook my head “no.” When he asked, in a sarcastic tone, what I wanted to do, all I could think was, “I want to fly to Europe, you dolt.” Instead, I kept saying “I just want to go home” (see, I did make a choice) and he reluctantly put me in a taxi back to Philadelphia and handed over a voucher to cover the two-hour ride. The next day, I started all over again and eventually got to Europe by being my own travel agent, once again.

In both the healthcare system and the airlines, we are treated as recalcitrant, noncompliant, stupid employees. No one pities you when you can’t navigate Mychart or even worse, never heard of it. We are badgered by reminders of appointments by text and email and God forbid you don’t respond, or horror upon horrors, don’t own a cell phone. The doctor can make you wait for an hour in the waiting room but if you are 5 minutes late, the staff reminds you, in the way parents talk to acting-out teenagers, of the many many reminders that were sent by text and email. As an employee of the healthcare system, you are expected to arrive on time, fashion your day around the appointment, and not ask too many questions like, “Where is the doctor?” or “How long till she gets here?” because she is the boss and you are a low-level employee, so shut up. When we get to the airport, it’s the same. We must check ourselves in and print our boarding passes if we haven’t already done so at home (What? You don’t have a printer at home or don’t know how to download a “mobile pass” onto your phone because, as an airline employee, you should know better). If that mobile pass is not available on your phone because the battery has run out due to a delayed flight, that’s on you as well and not the airline. And if you have trouble with the self-check-in at the airport, that, too, makes you an idiot because an employee should know better. The disapproving looks and sighs by the one real employee near the kiosk communicate that they can’t believe we don’t know how this system works, because good employees have learned the system.

During an actual procedure or flight, we are also now considered trained and self-actualized employees. Don’t you know that the paper gown must open at the front? Don’t tell me you didn’t fast for this blood test (although no one told you to). You, an employee, should know better. You’ll be changing your own dressing, lavaging your own wounds, removing your own gauze, deciding your level of pain, and medicating yourself. And don’t complain about it or badger any healthcare provider with questions. Figure it out for yourself because they don’t have the time or the mindset to deal with an employee who acts so helpless. Once at the airline gate, it’s the same. We are supposed to know intuitively why a plane is delayed, why the gate has changed at the last minute, and not complain that the seat we bought was overbooked. Stop asking questions. You should know all this already. While boarding the plane, we must also sling our carry-on into the overhead and are expected to know which way the bag should fit into the compartment although every plane model is different. We often get chastised by flight attendants for not knowing all this since we are all now on the job.

The healthcare system and the airlines are also both unreachable, like a boss who is too busy to bother with a rookie employee. It’s now pretty much impossible to speak to a real live human when something crops up in both of these organizations. I dare you to try to get someone on the phone when a lab test goes wrong, or a bandage falls off, or you have a billing problem. It recently took me three and a half hours and seven calls to my doctor’s office to fix a blood test coding problem that was their fault, but it was suddenly my job to figure out what happened and to fix it. On one of those calls I was told by a switchboard person that I could not speak to the front desk of the practice because, “They are busy, and we have a protocol.” You know, of course, the joy of being told you’ll be on hold for 3 minutes which turns into 20 minutes. You know all about hanging up and trying again. You know about sobbing during one of these impossible calls hoping someone on the other end will take pity on you for your perceived lack of knowledge about the healthcare system. By the time I finally got someone who could solve my problem (o.k. it was fixed once, but not well enough, and I had to start all over again with the calls), I had been fasting for 16 hours and was lightheaded and woozy. I was also chastised by the receptionist at the lab for not knowing this new doctor’s phone number off the top of my head as she sat there staring at my electronic chart and could have looked it up herself. As punishment, she stared at me until I fiddled with my phone to find it. In the same way, if you try to call an airline, they now often charge you to speak to a real person. They charge you! You are expected to solve all problems online, and it’s your tough luck if you can’t. The status of “new employee” now means we have no right to speak to anyone who might be able to solve an issue. We are underlings, unpaid volunteers, interns as it were. We should learn everything by watching and listening, if only we knew where to watch and who to listen to and had the time outside of our real jobs to do this. And don’t ever dare to think you might get a refund for some mistake the airline makes. You can try, but you will never hear back because you are on notice for just asking.

Insurance companies make both systems a nightmare, and they suck us into their dastardly web and we are expected to navigate it all as if we worked there. We all know how insurance companies, acting as middlemen, have inserted themselves into every corner of healthcare, and what a tangled mess that has become for doctors, staff, and patients. It once took my doctor six repeated copies of a prescription over three months to get it filled because some unknown pharmacist employed by the insurance company kept changing what the doctor wrote. During my 3.5-hour blood test adventure, I was directed to the emergency room at one point to get them to draw my blood. But when they called me into the inner sanctum, I stood up and left. I was worried that my insurance company would be charged for an emergency visit (costing what? $1,500 with an added $500 facility fee?) and that they wouldn’t pay since I had made the mistake, and maybe I would have to cough up the money — for a simple blood draw. I recently filled a script for a skin ointment, then was refused the designated refill because insurance companies, I’ve since heard, now commonly let you get a first medication and then ask for pre-approval for the refill. Huh? When I then asked the dermatologist’s office for preapproval, they replied that they did not, across the board, do preapprovals for anything. And we understand why — it must be maddening, and time-consuming to deal with these insurance companies. Another doctor’s office said they employed a full-time person to deal only with preapprovals. Who are these people who know nothing about us that can now override the decisions of medical professionals who hold our charts? I assume they, these mystical hidden medical judges, graduated last in their med school or pharmacy school class and were unable to get a decent job in the healthcare system. What a nice, corrupt, power trip for them. After this nutty runaround, I offered to just buy this tube of ointment with my own money and was told by one pharmacy that it would be $250. After looking online (yes, I’m now an employee of a pharmaceutical company) I found one site that only charged $35. I went with that. Some doctors now refuse to accept insurance because they can’t take it anymore, just like the rest of us. And the poor people who have no insurance? Well, they will be dead soon, in the richest (and the most dysfunctional) country on earth.

You can’t trust the airline business anymore either and so many people take out travel insurance. Good luck with that. The fine print, the caveats, the Byzantine rules, the exceptions, often mean that if your trip is delayed, canceled, changed, or whatever, you are not covered. And the airlines won’t come to your defense because they, too, are trying to shirk the responsibility for ruining your flight or vacation, leaving you with no clothing, camping on the airport floor, or staying overnight in a city you never heard of that is not even on the route to you destination (all on your own dime that you will never get back). What you do get is months and months of phone calls arguing your case, being ignored by the insurance companies and the airlines, and replacing your packed goods all by yourself. Because, as an employee of the airline or a travel insurance company, you should know better and take this all with grace.

Both organizations also think of all this mess as giving people “agency” (translation=responsibility) in their healthcare or their travel plans. But none of us have asked for that while planning a trip or coughing up blood. Instead, the agency that we really get is sitting patiently, silently, while some computer fucks with our vacation plans, or while a physician stares at a computer screen rather than seeing or touching a patient who is sitting 12 inches away.

In the “before times” we would call our doctors when sick, get an appointment, show up, be looked at, and the provider would give advice, maybe require a test, or hand out a prescription. We’d go home and hopefully get better. In the “before times” we planned a trip and got on a plane, even looked forward to the flight. That’s all over now. In both health care and airlines, individuals who are not professionals, not employed, educated, or trained in the ways of these systems (meaning us, your average citizen) are now expected to know how it all works like an insider and run the show, even when we don’t have a clue what is going on. As a result, all of us have become junior doctors and pharmacists, baffled and inept travel agents. And we are whiney in our new roles which makes it even worse for everyone involved. So, the real employees turn away from the rookies and sigh in exasperation when all we want is a diagnosis or a solid flight plan to get away from all of this.

Ironically, we pay them for the pleasure of working for their company, like summer interns. Except that these particular internships go on forever.

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