The Accumulation of Good Intentions – How we accidentally outsource work to the very people we’re trying to serve.  

Last week I had several frustrating interactions with companies that are relying more heavily on  AI. These were businesses I’d had smooth relationships with for years. Unfortunately, getting  transferred to a human often wasn’t any more helpful. They seemed to be working from the  same script. In the end, I felt like I had worked harder to solve my problem than they had. 

 Many organizations aren’t simply replacing people with technology—they’re quietly shifting more  of the work onto their customers. 

 None of my issues should have taken more than fifteen minutes. Instead, each consumed  nearly an hour with menus, transfers, repeated information, and waiting on hold. 

 Healthcare has been doing this for years, one small burden at a time. Collectively, those  burdens have turned patients into administrators of their own care. 

 It’s not any single sign that exhausts us. It’s their gradual accumulation. 

 As we’ve been redesigning our clinic at Unorthodoc and building a nonprofit model that we hope  other communities can replicate, I’ve realized that I want to move in the opposite direction. 

 Whatever you think of Amazon as a company, it has demonstrated what relentless friction  reduction looks like. Once you’ve decided what you want, the purchase, shipping, and return  process nearly disappears. 

 I don’t want to borrow their philosophy. I want to borrow their discipline. 

 In our world, reducing friction isn’t about making it easier to sell. It’s about making it easier to  care. Removing  needless  actions preserves human energy for walking beside the wonderfully  complicated people who trust us with their lives. 

 Here, reducing unnecessary friction becomes an act of respect. 

 Whenever we’re considering a new policy, form, workflow, or technology, I’d like our first  question to be simple: 

 Whose life gets easier if we do this? 

 Sometimes the answer will be us. Sometimes it will be our patients. The best solutions serve  both. We simply need to be intentional about where we’re placing the burden. 

 As physicians, we’ve learned to practice DEprescribing. We don’t keep medications simply  because they’ve always been there. We ask whether each one still provides more benefit than  burden. 

 Our practices deserve the same discipline. Every layer of complexity should periodically justify  its continued existence. 

 Healthcare is complicated, and some complexity protects patients, physicians, and the practice  itself. But every burden should be intentional—and as thoughtfully designed as possible. 

 Our goal isn’t simple efficiency. Our goal is to make it easier to be in relationship with us. 

 Direct Primary Care physicians often tolerate being on call for our own patients better than most  of our medical colleagues because relationships change the experience. The interruption means  something because the person means something. Counterintuitively, that makes caring easier. 

 Relationships are our infrastructure.  They’re the foundation upon which everything else is  built. 

 Modern healthcare has invested enormous energy in optimizing for billing and system efficiency  while sidelining its most important resource: relationships. 

 As we continue refining our own practice—and as others build theirs—I hope we’ll resist the  temptation to solve our operational problems by quietly outsourcing them to our patients. 

 If we keep relationships at the center of every operational decision, I believe we’ll make better  choices—for our patients and ourselves. 

 What decision best protects your relationships?  

What unnecessary friction is competing with them?