In need of a letter certifying that I do not suffer from a disease of international concern, I headed out to my primary care practitioner last Monday.
Knowing how busy most doctor’s offices are these days, I decided I’d make it easy on the staff by bringing a) a copy of the WHO’s International Health Regulations (IHR) regulations on diseases of international concern b) a list of the diseases currently covered under this rubric and c) explicit instructions about the elements such a letter must include (i.e., letterhead of the practice, stamp of the practice, doctor’s signature etc.).
They assured me that they were familiar with this procedure and that it would be no problem.
And when I mentioned that it would be great if they could do it in both English and Spanish, I was assured that would be no problem either as there was a Spanish-speaking provider on staff who could write it up in that language.
But again, in the interest of facilitating things, I provided them with a copy of this very type of certification letter written for me some time back by a doctor in Spain. This “letter,” such as it was, consisted of one sentence of 27 words in Spanish and a couple more than that when rendered into English.
Given that there were two staff members present, and that one of them was scrolling on her phone, I figured it would be a simple matter of one of them quickly writing up the letters, checking my file to see if I had any of the diseases of international concern (I had been there a week previous for my annual checkup) and catching my doctor (or one of his colleagues) between patients for a quick signature.
However, when I asked the woman in front of me how long it would take, she replied, “Three to five business days. That’s the procedure. We’ll call you when it is done.”
When I told them that I needed it for an appointment first thing on the following Monday in New York and that if I didn’t have all the documents, it would be months before I got another one, they just repeated the mantra that it would be done toward the end of the week, probably late on Friday.
On Friday, at 1:45 I received a call saying the letter was ready for pickup. Relieved, I entered the office, checked the letter quickly, and headed out. Upon rechecking it at home, however, I realized that it had not been signed by the doctor, which was one of the first requirements on the list of directions I had handed them on Monday.
So back I went to the office and explained to them it would be inadmissible for the bureaucratic procedure in question without that signature. By this time it was getting toward 3:15 in an office scheduled to close at 5:00.
After listening to me and saying nothing, she ran off to talk to her manager.
When she got back she said, “I’m going to put an order in for it,” and began typing into her computer looking for the page where she could “put in an order” for something that could literally be done in 2–3 minutes. I said somewhat incredulously “Put in an order at this point?” and repeated the idea of typing the letter anew and grabbing one of the doctors between appointments.
After another trip to the invisible manager, she returned saying I could leave and that they’d call me when and if the issue is resolved.
An hour later I received a call saying everything was arranged and that I could come and pick up the letter.
With a smiling face, she handed me the 27-word letter. But there was only one problem. It was signed not by a doctor but an APRN (advanced practice registered nurse). When I explained that the directions clearly said that it needed to be signed by a doctor and that the foreign government agency I was taking it to was notorious for rejecting documents that did not conform exactly to their requirements, a confused frown returned to her face.
She asked me to sit in the waiting room and ran off to the manager again. It was now 4:45 in the afternoon, 15 minutes before closing time.
About 10 minutes later, the heretofore invisible manager emerged, and with a smiling face, assured me that the issue would be resolved shortly. And so it was.
At 4:55 she emerged with the letter signed by the only remaining MD at the office, grabbing her, I presume, as she emerged from one of her sessions with a patient.
In other words, the issue had been finally resolved by the very unalgorithmic, but highly practical and personal manner I had proposed four days earlier.
So, what’s the moral of the story?
Before getting to that, I should perhaps say what it is not; the idea is not to point out that the nice people at the office are all irretrievably stupid... at least not yet.
Rather it is to demonstrate a phenomenon that is rampant in culture that we seldom talk about openly, never mind decry with all the fury that it deserves.
It is the story of how a managerial elite possessed of generalized contempt for the bulk of their fellow citizens and a slavish adherence to an extremely narrow, algorithmically-generated notion of “efficiency” has created scores of so-called idiot-proof systems that dehumanize and demoralize those who work in or engage with them.
And while these systems are wildly successful at walling off the corporations that design them from the need to listen to and mindfully serve those who buy their goods and services, they are not, as my little story above shows, even efficient in any meaningful sense of the term.
Those of us of a certain age who have worked in office settings all know (or knew) that person, that wonderful person with a vibrant personality, quick intelligence, and top-notch social skills to whom you could always turn to get things done in a pinch.
She—and yes, it was usually a she—knew where all the bodies were buried and the strengths and weaknesses of every person in the house, something she would leverage to make things happen in the most unobtrusive and efficient way possible, pulling those she worked with out of tight spaces again and again along the way.
It pains me to say this, but it seems these linchpins of workplace culture are in extremely short supply today.
And it’s not, as many people assume, because we lack people with the aptitude to perform in this impressive multimodal manner in our society.
No, it is because, despite all the HR-generated rhetoric proclaiming the opposite, the people who design and run the systems within which we work are often true nihilists for whom the magical and life-giving processes of human relations, and what some students of psychological development call “human becoming,” mean next to nothing.
Caught in the “measure-grab-and-control” tyranny of the algorithmic mind, they cannot even begin to imagine how those they see as lesser than them, might, if left to their own devices, be capable of generating greater efficiencies than their vaunted oh-so-rational systems... and usually with a heaping portion of increased human joy as part of the bargain.
Worse yet, they do not realize that putting people in systems that assume they are stupid will, in the long run, make those who have intelligence (and what person doesn’t?) truly and profoundly stupid, sad, and ultimately unresponsive to anyone or anything in the long run.
Is that what the managerial elite truly want? Or is it that their imaginations are already so impoverished by fantasies of algorithmic perfection that they truly do not understand the wave of spiritual destruction they have set in motion and feed daily?
I honestly wish I knew.
