Of all the phrases the divide British and American English, the one I dread hearing is leave it with me. It’s not a phrase I ever heard in the U.S., and now that I live in Britain I know life is about to spin out of my control when someone says it.

And yes, I do know life’s always out of our control, but we all like to believe, don’t we? We live for the comfort of that illusion. Even when we know we’re full of shit. Maybe especially when we know.

Or some of us like to believe. I like to believe.

Irrelevant photo: The causeway to St. Michael’s Mount, emerging as the tide drops. There’s a castle out there, hidden in the fog.

Suppose I need a referral from my GP to a specialist and I was supposed to be given an appointment by Wednesday and here it is the Tuesday after that Wednesday and I still don’t have the letter telling me when the appointment is. So I call to ask what happened. I’ve worked out an approach for this kind of situation. I’m polite and I’m relentless. I don’t demand, I don’t insult, and I don’t go away. This is easier to pull off when I’m advocating for someone else, but I can manage it for myself if I have to.

The receptionist says, “Leave it with me.”

Which means one of two things: 1. I will fix this so fast that whoever screwed it up will be dizzy for a week, or 2. I will make a note of this, bury it under a stack of paper, and forget you ever called, because your referral’s still a bunch of electronic blips in my computer but I don’t remember which file it’s in, or which computer, or what electronic means. Furthermore, I have worse problems than you. Don’t call back.

And I’m never sure which. Except for the don’t call back bit. I’m sure what that means.

I’ve learned to ask, “When will I hear from you?” so at least we’ve agreed on a date after which I’m free to make a pest of myself again, but until then I’m helpless. All my polite don’t-go-awayedness? It’s paralyzed by the leave-it-with-me beam of bureaucracy.

In the abstract, I could probably say, “No, sorry, I can’t leave it with you. Gimme my problem back,” but you know that bureaucracy beam? It’s like kryptonite. It keeps me from forming those words.

I did dodge the beam once, when a neighbor was having a medical crisis and D., who’s been a nurse, armed me with a magic phrase: That’s not acceptable. I listened to myself say it and wondered who I’d turned into, but in fact waiting wasn’t acceptable—it was a crisis—and since the phrase was magic it worked.

But you have to be careful with magic phrases. You can’t just spew that’s not acceptable in all directions and under less pressing conditions.

The leave-it-with-me problem stems, I think, from the British medical system’s paternalistic streak. The U.S. system is also paternalistic, but in a different way and—oh, you know how it is: When you’re not used to something, you notice it. The things you’re used to? They’re invisible. And the way they handle medical appointments here? I notice. If you need one, it will all be done for you and you’ll be told when to appear.

What if you can’t make it? You know, if you have to be in court that day or they’ll issue a bench warrant or you have some similar whim you might want to follow? At that point you get to step in and change the date or the time, but you have to wait to be given the wrong date and time before you can step in. And unless your condition’s a crisis, it’ll come by letter.

As far as I can figure out, this is true of both the National Health Service and private-sector medicine. Because that’s how it’s always been done and why change now just because the telephone’s been invented? And that other, even more modern thing, the inter-whateverit’scalled.

In the U.S., I can remember two systems for making specialist appointments. In one, I was given the name of a doctor and clinic (or a list of several) to call and I made my own appointment. In another, I stood at a desk while someone who worked for the clinic that was referring me made the appointment and could talk with me about whether I expected to be under arrest or in court at any given date and time.

In other ways, the NHS is more egalitarian than the U.S. medical system. I just read a nurse’s comment that “everyone is equal in the NHS; I find that amazing. In India, you can’t challenge a doctor, even if he is wrong. Here, a nurse can tell them straight away.” Unless things have changed since I last heard (and it’s not a topic I keep up on), challenges from nurses aren’t welcome in the U.S. yet.

But patients don’t seem to have claimed their power from the system, even if nurses have. So listen up, bureaucracy: I’m registering my complaint. Can I leave it with you?