In , Eli Terry, a Connecticut clockmaker, began to realize that the soul of a machine was not found in the artistry of its gears, but in their sameness.
Before Terry, a clock was a singular event-a bespoke marriage of hand-filed brass and carved wood. If a tooth on a gear broke, you couldn’t just order a replacement. You had to find the man who made it, or someone equally skilled, to forge a new piece specifically for that one eccentric mechanism.
Terry changed that by pioneering interchangeable parts. He realized that if you made ten thousand identical gears, the clock ceased to be a masterpiece and became a product. It was a triumph of efficiency that eventually paved the way for everything from the Model T to the smartphone in your pocket.
Interchangeable Efficiency vs. Bespoke Soul
But humans are not clocks. We are not assemblies of interchangeable gears that can be swapped out or billed in isolation without compromising the integrity of the whole.
01
The Fractured Lens
I was thinking about Eli Terry this morning while I sat in my car, gripping the steering wheel until my knuckles turned white because some guy in a silver Audi decided that my blinker was merely a suggestion and stole the parking spot I’d been waiting for.
It was a small, sharp act of social friction-a moment where the communal flow of the parking lot was sacrificed for a singular, selfish gain. It made me irritable, the kind of irritability that makes you look at the world through a fractured lens. And that’s exactly how a modern medical bill feels.
The Post-Operative Ledger
I recently saw a transcript for a patient’s post-operative debrief. She had spent with a specialist, a session she remembered as a single, tearful conversation about her fear of never running again.
But the itemized bill she received later told a different story. According to the ledger, she hadn’t had a conversation; she had experienced a “Level 4 Evaluation and Management Visit,” a “Brief Emotional Assessment,” and a “Post-Surgical Site Review.”
The hour had been dissected into three distinct billable units, each with its own CPT code, its own price tag, and its own clinical silo.
When you split an hour into units, the hour stops making sense. It ceases to be a therapeutic encounter and becomes a sequence of transactions. The coherence of the experience-the way a patient’s mention of their sleep quality might actually be the key to their chronic back pain-is lost when the doctor is forced to categorize every thought into a box that the insurance company recognizes.
The Myth of Clinical Efficiency
I’ll admit that I used to be a fan of this kind of granularity. As a podcast transcript editor, I live for the “cut.” My job is to find the dead air, the “ums,” and the “ahs,” and excise them to create a “cleaner” experience for the listener.
I used to think that efficiency in healthcare should look the same way. I once argued, quite loudly at a dinner party, that if we could just strip away the “fluff” of the medical visit-the small talk about the weather, the digressions about a patient’s grandkids-we could see more people and lower costs. I thought lean manufacturing principles could be applied to a human body.
I was wrong. I was deeply, fundamentally wrong.
In podcasting, if I cut the breath before a difficult confession, the confession loses its weight. If I edit out the stutter that happens right before a guest admits they failed, I’ve deleted the most honest part of the interview.
The Tragedy of the Billable Unit
The tragedy of the billable unit is that it ignores the emergent property of the hour. In systems theory, an emergent property is something a complex system has that its individual parts do not.
A gear doesn’t have the property of “telling time.” Only the clock does. A “consult” doesn’t have the property of “trust.” Only the unhurried hour does.
When a practice optimizes for revenue capture by billing for every discrete action, they are essentially taking the clock apart to sell the gears and then wondering why nobody knows what time it is.
This is why people are increasingly frustrated with the “conveyor belt” model of care. You walk in with a complex problem-let’s say it’s a mix of brain fog, joint pain, and a stubborn weight gain that hasn’t budged despite a caloric deficit.
In a fragmented system, you might get to talk about the joints before you’re told to book a separate appointment for the weight. The brain fog? That’s a different referral.
By the time you’ve seen three specialists, no one has looked at the underlying inflammatory process that links all three. The system has billed you for three “units” of care, but you’ve received zero units of resolution.
The Rebellion Against the Ledger
At the White Rock Naturopathic Clinic, the approach is an intentional rebellion against this fragmentation.
Dr. Tom Grodski has spent nearly in the Surrey and White Rock community operating under a different set of physics. When a patient walks through those doors, the goal isn’t to see how many codes can be attached to the visit.
The goal is to maintain the coherence of the hour. Whether it’s hormone balancing or regenerative medicine like PRP, the treatment isn’t treated as a standalone “unit.” It’s part of a longitudinal narrative.
If you’re a professional in your 40s or 50s living in the Fraser Valley, you’ve likely felt this fragmentation in your own life. You are managed, but you are not heard. You are coded, but you are not understood.
This is what happens when medicine follows the Eli Terry model of interchangeable parts. It assumes that one “patient-unit” is the same as the next, and that the “doctor-unit” just needs to provide the “service-unit” to achieve the “health-outcome-unit.”
Building the Single Picture
But health isn’t a product you can assemble on a line. It’s a state of being that requires a root-cause investigation. When you look at the work being done at a place like White Rock Naturopathic Clinic, you see the value of the “whole.”
They use functional lab testing and sophisticated integrative therapies not as disconnected add-ons, but as tools to build a single, comprehensive picture of why a body is out of balance.
They understand that you cannot fix a thyroid issue without looking at the gut, and you cannot fix the gut without looking at the stress response. It’s all one system.
I think back to the guy who stole my parking spot. His mistake-and the mistake of the fragmented healthcare system-is the belief that we exist in isolation. He thought his of saved time was more valuable than the invisible contract of the parking lot.
The energy spent repeating stories, managing portals, and reconciling conflicting advice is the most expensive part of the bill.
The billable-unit model thinks that capturing $20 more for an “extended assessment” is more valuable than the sixty minutes of quiet observation that reveals a patient’s hidden autoimmune trigger. Both are wrong because they fail to see the cost of the friction they create.
When you fragment care, you create “patient friction.” The patient has to repeat their story five times. They have to manage five different portals. They have to reconcile five different pieces of advice that may or may not conflict.
This “tax” on the patient’s energy is never recorded on the itemized bill, but it is the most expensive part of the transaction.
The Value of the Drift
In my work editing transcripts, I’ve learned that the most important information is often found in the “drift.” It’s when a guest goes off-topic and starts talking about their childhood dog that they finally relax enough to tell the truth about their current business failure.
If I were billing by the “on-topic unit,” I would cut that drift. But if I want the truth, I have to keep it. Modern medicine needs more “drift.” It needs the space where a doctor can watch how a patient moves, listen to the cadence of their voice, and notice the subtle hesitation when they say they’re “feeling fine.”
You can’t bill for a “nuance observation,” so the system tends to ignore it. But in a physician-led integrative practice, that nuance is the entire point.
We have spent the last century trying to turn the medical visit into a factory floor, thinking that if we could just standardize the parts, we would solve the problem of human suffering. We’ve reached the limit of that logic.
The “itemized soul” is a failed experiment.
The next time you look at a medical bill and see yourself reflected as a list of codes, remember that those codes are just the gears. They aren’t the time. They aren’t the healing. And they certainly aren’t you.
Healing happens in the spaces between the codes, in the unhurried conversation, and in the refusal to be dissected for the sake of a ledger.
Beyond the Ledger
When I finally got into the grocery store after losing my parking spot, I was still simmering. I was rushing, trying to make up for the “wasted” three minutes. I bumped into an elderly woman’s cart.
Ordinarily, I would have muttered a quick “sorry” and kept moving-another transaction, another unit of my day. But I stopped. I looked at her. I asked her how her morning was going. We talked for about the price of hothouse tomatoes and the weird weather we’ve been having in BC lately.
By the time I left the store, my irritability was gone. The “wasted” four minutes of non-billable, non-productive conversation had done more for my nervous system than any “efficient” shopping trip ever could.
It was a reminder that the most valuable things in life-trust, community, and health-cannot be itemized. They can only be experienced in their entirety.
The goal of a true healer is to protect that entirety. Whether it’s through hormone therapy, allergy desensitization, or just a really long, thorough initial consultation, the objective is to put the patient back together, not to find new ways to take them apart.
We deserve a healthcare system that treats the hour as sacred, a space where the fragments are finally allowed to become a whole again.