An essay by Eric Goldfarb, an information technology executive and patient advocate, opens with a story that feels almost too absurd to be true. I have written nine books of medical satire and thought I had seen it all, yet his experience shows that parts of our system still defy belief.

After Goldfarb’s eighty-eight-year-old father died, Goldfarb reviewed the hospital bill and noticed a charge for a pregnancy test. He paid the bill but questioned the charge. Initially, he was told a refund would be issued. Later, he was informed the charge was correct. When he continued to push for an explanation, he was told to check his father’s online patient portal, MyChart, even though his father was dead and the account was no longer accessible.

It is easy to see why this story made people angry. One reader urged Goldfarb to publicly name and shame the hospital, while another suggested suing. But a physician highlighted an important medical point: Human chorionic gonadotropin (hCG), the hormone used in pregnancy tests, is not limited to women. It can also be ordered for men as a marker for certain cancers, such as some testicular tumors. That fact changes how we view the story. Without access to the medical chart, none of us can determine whether the hCG test was ordered in error, mislabeled on the bill, or medically appropriate.

Goldfarb’s belief that an older man should never undergo that test is emotionally compelling, but it does not capture the full medical picture. This uncertainty makes the situation even more disturbing and fuels satire. If there were a legitimate medical reason for the test, why could no one explain it to the family? That is the question that should concern doctors and health care leaders most.

Goldfarb’s essay is not really about a single lab test. It is about what happens when responsibility is spread so thin across a health system that no one seems to own the problem as a whole. His story includes much more than a disputed charge. After brain surgery, his father was apparently being prepared to go home less than 12 hours later, even though, according to Goldfarb, he could not stand and was clearly not ready. It was a weekend. The doctor signing the discharge order was not part of the usual team. The family had trouble finding anyone who could clearly explain the plan. In the end, the discharge was halted, and a better plan was put in place.

Later, the family received a follow-up appointment notice even though his father had already died. A physician who had promised to be the “captain of the ship,” Goldfarb says, never returned. The billing dispute was passed from one representative to another, then to a review team, and finally to the online portal, which the family could no longer access. Years later, Goldfarb wrote to the hospital’s chief executive, sent supporting documents, and said he again received no reply.

Each of these events could, on its own, have an understandable explanation. That is exactly the point. A large hospital can usually explain any single incident. But families do not live through individual events in isolation. They live through the entire chain.

Hospitals are very good at breaking work into discrete steps. One person places an order. Another performs the test. Someone codes it for billing. Another person generates the bill. Someone else reviews complaints. Another answers messages in the portal. A different clinician enters the discharge order. A scheduler arranges the follow-up visit. Each step can be assigned, tracked, and checked off. But who is responsible for asking, “Does this all make sense when taken together?” Very often, the answer is no one, because that question does not belong to any single task in the workflow.

In my work within health care systems, I have seen how easily “doing the process correctly” gets confused with “doing the right thing.” A task can be carried out exactly as designed and still produce results that are clearly wrong, deeply confusing, or even unsafe. The box is checked. The ticket is closed. A section of the performance dashboard turns green. Meanwhile, the patient or family is left wondering whether anyone ever stepped back to look at the entire situation.

Goldfarb calls the missing element “noticing.” A nurse who senses that sending a patient home feels unsafe can change what happens next. A billing clerk who hesitates over an unusual charge can save a family months of hassle. A doctor who sees that a family is overwhelmed can pause to explain, in plain language, what will happen before the family leaves.

But simply noticing is not enough. True leadership requires taking ownership. Someone needs to stay on the problem until it is resolved. Someone must clarify mixed messages. Someone has to say, “I’m not sure why this test was ordered, but I will find out and get back to you.” Someone has to recognize that sending the grieving family of a deceased patient to a locked online portal is not a real solution, even if the portal is the official channel for questions.

This is where we need to resist the urge to blame individuals. Goldfarb himself describes kind nurses and others who tried to help. In most broken systems, people are not uncaring. They are busy and working within structures that reward completing tasks more than understanding them. This isn’t a front-line issue; it is a leadership issue.

The answer is not to jump straight to public shaming or lawsuits every time. Those reactions are understandable when families feel no one inside the system is listening. But the deeper question is why families so often feel they must go outside the organization (to social media, the press, or the courts) before someone inside finally takes responsibility.

Health care leaders often talk about being patient-centered and about safety, experience, trust, and accountability. Those promises mean very little if a hospital cannot clearly answer a simple question from a grieving family. Sometimes the honest answer will be, “We made a mistake with this charge.” Other times, it will be, “The test was medically necessary, and here is why.” Either is better than flat certainty without any explanation.

There is also a message for physicians. As medicine relies more on electronic orders, automated billing, patient portals, computerized decision tools, and artificial intelligence, more actions will be triggered by systems that no single person can fully see. That makes human oversight more important, not less. The problem is not just that computers can be wrong. People can be wrong too. The greater danger is that everyone assumes someone else has already checked.

At the end of his life, Goldfarb’s father needed medical care. His family also needed something our health system should be able to provide without years of effort: a clear explanation from a real person willing to take responsibility for it.

Maybe the hCG test was ordered by mistake. Maybe it was exactly the right test for his condition. Either way, someone should have been able to explain why. A health system should never be more confident it is right than it can make its actions understandable to the people it serves.

Arthur Lazarus is a physician-author whose work spans narrative medicine, physician leadership, artificial intelligence, health care ethics, medical culture, and fiction. He has published more than 500 articles and essays across scientific journals, professional publications, and online platforms.

He is the author of numerous books on narrative medicine, AI in medicine, career development, and the changing moral landscape of health care, as well as fictional series including Rounds Never End, Sick and Systemic, and Real Medicine, Unreal Stories. His writing explores the forces reshaping modern medicine while preserving a central commitment to story, meaning, judgment, and the human relationship at the heart of care.

He shares updates on LinkedIn.