Bleak House Medicine: How Bureaucratic Fog Smothers Care

"Suffer any wrong that can be done to you rather than come here!" In Bleak House, Dickens's Court of Chancery is a foggy nightmare of endless forms and hearings. Today's clinics have their own version of that fog. Patient portals, online booking, and virtual visits promise "convenience," but often land squarely in the clinician's lap as new chores. Doctors may spend only 27 of 57 weekly hours on face-to-face care, with another 13 hours on orders and documentation, and 7.3 hours on administrative tasks. The result is care meant to be patient-centered but achieved at the expense of provider time, focus and morale. This hidden bureaucracy has real costs: delayed treatments, clinician burnout and even moral injury. Every "convenient" feature creates hidden work, and unless we clear that fog, the system simply burns out its caretakers.