Healthcare Reimagined
Sit at a busy café in Paris long enough and something unsettling happens: nothing. The waiter doesn’t sprint. No one is shouting about table turnover. There’s no laminated sign behind the counter promising a “Server of the Month” bonus for fastest espresso delivery. And yet, miracle of miracles, the place runs smoothly. Orders arrive. Coffee is hot. Wine keeps flowing. The waiters and waitresses look… happy. Like, suspiciously happy. As if no spreadsheet is tracking how quickly they smiled at you.
These people are salaried. They’re professionals. They’re not hustling for tips like contestants on a reality show called
“So You Think You Can Serve”.
And somehow, despite the total absence of visible incentive programs, both the staff and the customers seem deeply satisfied.
What stood out was the lack of any tipping. In this café, I was presented with my bill and a credit card machine to make payment. Now primed to tip I was expecting to see the usual screen to add a tip. But here there was nothing. Zip, Nada. No screen and no awkward exchange while the wait staff hover around looking to either grab any cash left on the table or pull the receipt to capture the tip left by the patron. And to be clear, having spent much of the time people watching, this was the norm alongside zero pressure to vacate and free up the space.
America’s Obsession With Measuring Everything
Now contrast that with healthcare in the United States, where the system has decided that the only way humans will do good work is if we chase them with stopwatches and spreadsheets.
American healthcare runs on performance metrics the way Paris runs on butter (and based on my cooking class while there some very good butter in France!). Everything is measured. Everything is optimized. Everything is monetized. Physicians aren’t trusted to care for patients because they’re trained professionals; they’re managed like warehouse workers. Enter RVUs, Relative Value Units, which sound less like a healing concept and more like something you’d hear shouted on the floor of the New York Stock Exchange.
Doctors are told, explicitly or implicitly, to move faster. See more patients. Click more boxes. Generate more RVUs. If you linger too long listening to a patient’s story, you’re “inefficient.” If you take time to think, to explain, to reassure, congratulations, you’re now a productivity problem.
Imagine applying this logic to the Paris café.
- “Pierre, your table turnover is down 12%.”
- “Marie, you made eye contact for too long—non-billable time.”
- “Jean-Claude, your empathy per espresso ratio is unacceptable.”
Absurd, right? Yet in American healthcare, we’ve normalized this madness. We’ve decided that healing must be industrialized, timed, and audited to death. The result is physicians who feel rushed, patients who feel unheard, and administrators who feel thrilled because the dashboard is glowing green.
And just like that Paris café, the irony is painful: when you treat professionals like professionals, they tend to act like professionals. When you trust people to do meaningful work without dangling constant incentives over their heads, they often do it better.
Not faster, better.
The café works because the waiters aren’t terrified of falling behind some arbitrary metric. They know their job. They’re paid fairly. They’re allowed to be human. And the customers feel it. No one leaves angry because their croissant took an extra two minutes. No one demands to see the manager because the waiter paused to chat with a regular.
In American healthcare, we’ve built a system that confuses motion with progress. Speed with quality. Measurement with meaning. We keep asking why doctors are burning out, why patients are dissatisfied, and why outcomes don’t match the spending, and then respond by adding more metrics.
Maybe the problem isn’t motivation. Maybe it’s mistrust.
Maybe healthcare doesn’t need more incentives. Maybe it needs fewer stopwatches—and a little more café energy.
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