I walked through a beautiful hallway the other day, the kind hospitals and clinics seem to favor now, polished floors, warm lighting, and old oak paneling on the walls. It looked less like a medical building and more like the lobby of a boutique hotel. At the end of the hallway sat a receptionist who was having a bad day. Or maybe she was just doing her job. She glanced up briefly and asked what I needed. I explained the reason for my visit. Without looking particularly surprised, she told me the next available appointment was 6 months away. 6 months. I thanked her politely and walked back down the hallway, still surrounded by the oak paneling.
Medicine today often feels less like a profession and more like a bureaucracy. If you have ever spent time at the DMV, you know the feeling. You move carefully through the system, trying not to do anything wrong, trying not to sound impatient, hoping that someone behind the desk might help you navigate the rules. Patients learn quickly that the safest strategy is to be agreeable. Do not look irritated. Do not sound angry. Do not question the process too strongly. Afterward, you may receive a survey asking how your visit went. You answer honestly, perhaps even courageously, thanks to the anonymity, and then nothing happens. Phone systems are no better. You press a series of buttons to find the correct department, wait on hold for 20 or 30 minutes, and eventually reach someone who may or may not understand the problem you are describing. If medicine resembles the DMV, pharmacies sometimes feel like the asylum run by the inmates.
But imagine something different for a moment. Imagine medicine run like a good business. Not a soulless corporation, but the way a great restaurant operates. When you walk into a good restaurant, people greet you. Someone helps you find a table. The menu tells you what things cost. If there is a delay, someone explains why. The staff understands that your experience matters. For years my practice had a small subtitle on its materials: psychiatry as it should be. We tried to focus on the small things, returning calls quickly, keeping appointments on time, creating an atmosphere where patients felt welcome rather than processed. It was not complicated. It just required attention. 20 years ago, if you called a clinic because something felt wrong, you usually reached a human being before you reached a recording that said, “If this is an emergency, please hang up and dial 911.”
Today the recording often comes first. That message leaves many people wondering: Is this an emergency? For someone like me, the answer would probably still be no, even if I had the uneasy feeling that my abdominal aorta might be rupturing. Many patients hesitate for the same reason. They worry about overreacting or wasting someone’s time. The system teaches caution. One of the oddest features of modern medicine is that prices remain almost entirely invisible. Imagine walking into Walmart where nothing had a price tag. You put items in your cart, take them to the register, and hope for the best. That is essentially how medical care works. You arrive at a clinic or hospital with little idea what anything will cost. You may not even know exactly who will see you. You proceed on faith. And while you are doing so, you try very hard not to offend the receptionist.
So why the oak paneling? When I was a child, hospitals were the ugliest buildings in town, fluorescent lights, linoleum floors, the unmistakable smell of antiseptic. No one expected them to feel luxurious. Today many clinics resemble hotels. Marble floors. Polished wood. Architectural touches designed to create an atmosphere of calm professionalism. Perhaps those things serve a purpose. When you are choosing a physician, someone who may influence how much pain you experience or how long you live, you usually have very little information. No clear price. No detailed comparison of skill. Often not even a clear understanding of what will happen once you walk through the door. All you really have to go on are signals. The building. The atmosphere. The way the place feels. Sometimes, it seems, all we really have to go on is the oak.
Jeffrey Junig is a psychiatrist and addiction medicine specialist with a longstanding interest in the intersection of neuroscience, clinical care, and the systems that shape modern medicine. He is affiliated with the Medical College of Wisconsin and has spent much of his career working with patients affected by substance use disorders.
Dr. Junig has written about addiction treatment and clinical practice for many years, including his long-running Suboxone Talk Zone, which began in 2007 and now continues on Substack. His essays explore medicine, neuroscience, and the often unexpected ways in which health care systems influence patient care and physician decision-making.
He publishes ongoing commentary and essays on Unscripted Practice. A full list of his academic publications and professional background is available on his website.
