I’m a pastry chef.

I’ve got a mariage élégant tomorrow, and I’m crushed. Panicked, I hire you as a temporary assistant. You’re just starting, and as far as you know XXX powdered sugar is something smutty, but desperate times call for desperate (dry) measures.

I lay it all out for you:

  1. The success of this wedding is a matter of life and death.
  2. While completing your work, don’t trust anything you read on the internet, because baking tips on the internet come from rubes and margarine eaters.
  3. I am an expert, but I am very busy and my time is very valuable. If I’m interrupted too much, it could bring the whole thing down. Check in only when you think it’s absolutely necessary.

You get started and you’re doing pretty well. I’ve given you the Betty Crocker-level tasks while I handle the art. But as you’re mixing up some icing, doubt starts to creep in. It just seems a little... grainy. But I’m currently finalizing plans with the bride.

I told you not to bother me unless it was a total emergency. You’d look online, but you can picture my sneer. You ask around the kitchen. Someone gives you a remedy they got from their grandma. The panicky girl next to you says you absolutely must come find me. Someone else says that it tastes fine, you’re just overreacting.

I’ve ruined your confidence and you have nowhere to turn. You’re beholden to my expertise, but I’m unwilling to share it on my terms.

“Don’t confuse your Google search with my medical degree.”

I see it all the time on “healthcare twitter.” And on crappy Etsy mugs. I’m reminded constantly that in healthcare, a medical degree is the one source of truth. It’s not just a droll phrase on a t-shirt, it’s a pervading belief.

There’s skepticism about retail medicine. There’s warnings about getting flu shots at the drugstore. There’s a reductive distrust of anything found on the internet.

Therein lies a paradox. Because healthcare policy wonks are drinking coffee out of mugs that say “The way to control costs in medicine is reduce unnecessary visits and procedures” It’s not catchy, but these people are very literal.

I’ll lay it out for you again (stripped of the metaphor):

  1. We tell patients that early detection and preventative medicine are vitally important.
  2. We tell patients to only go to the doctor if they are truly sick.
  3. We tell patients all the information online that might help them know whether they are sick or not is unreliable, potentially dangerous and that they’re worthy of our derision if they trust it.

So which is it?

I ripped the phrase from Jeffrey Veen (I think), but design makes it easy for people to do the right thing. Is healthcare making it easy for patients to do the right thing when it comes to primary care decision making?

I’ve had a primary care physician look me in the face during a checkup and ask me why I was at the doctor if nothing was wrong. “Come back when you’re getting close to 40. Men don’t need yearly checkups.” I’ve also had a doctor politely but firmly remind me who was in charge when I shared some information that I’d read online about a condition from which I was suffering.

We can’t have it both ways and expect patients to be anything but confused. I’ve never been less sure when I should and shouldn’t go to the doctor—and I once walked around for two weeks with a collapsed lung.

Was your icing really grainy? We’ll find out when it’s served. Are you confident you always make the right decision when considering a trip to the doctor? The stakes are pretty high.