Volume 40 Number 5 | October 2026
Summary
Using a relatable medical laboratory scenario, Darby Naheedy examines how poorly designed systems create unnecessary “extraneous cognitive load” that drains attention and contributes to fatigue. She argues that laboratory professionals often spend valuable mental energy navigating inefficient workflows rather than practicing clinical science, and encourages labs to identify and reduce these hidden barriers to improve wellbeing and performance.
How Poorly Designed Systems Steal Cognitive Allowance
Darby Naheedy, DO, MLS(ASCP)CM, ASCLS Patient Safety and Diagnostic Stewardship Committee
Alex’s Story: Alex grabbed their starched lab coat off the hook and donned it, one sleeve at a time, just like any other day.
At the morning huddle, Alex was told a coworker had called in sick. It was one of the hematology supervisors. The other hematology supervisor was in a meeting for a few hours that morning, so Alex would be covering both chemistry and hematology.
No problem. That’s exactly why procedures exist.
Alex logged into the hematology workstation and fired up the middleware. What was that login again? They entered their password. Incorrect.
Two more attempts and a password reset later, Alex was finally into the system.
What was next? Morning QC, of course.
Alex started looking around for the laminated QC card that the supervisor had taped to the cabinet during onboarding last year. It wasn’t where it was supposed to be. Alex knew they ran two of the three QC levels but couldn’t remember which two, when they were due, or which analyzer to use first.
Alex thought about reaching out to the second hematology supervisor—the one in the meeting—but hesitated. Was it email? Text? Epic chat? They remembered being told there was a preferred way to contact the supervisor during meetings but couldn’t remember what it was. Rather than interrupt the meeting, Alex decided to look up the procedure instead.
“The first step toward reducing unnecessary cognitive load is recognizing when our attention is being spent on the system rather than the science.”
After logging into MediaLab and searching for nearly 10 minutes, it became evident the procedure had never been uploaded. Five, maybe seven more minutes passed before Alex found the 20-page procedure in a binder. After finding the single sentence they needed, Alex loaded the QC onto the analyzer and started the run.
Shortly afterward, an alarm sounded in chemistry. The analyzer alarmed. A reagent was empty. No big deal. Alex walked to the refrigerator, grabbed a new reagent, and loaded it onto the analyzer.
Now, where was low inventory documented again? Was it the whiteboard? The communication binder? The shared spreadsheet? Alex couldn’t remember. They made a mental note to ask second shift when they came in.
Back in hematology, Alex was pleased to see the QC had passed. They sat down at the computer and started to enter their password, but before they could, the phone rang. It was a clinician calling for specimen collection information for a microbiology test.
Alex was a little caught off guard. After all, they were covering hematology, not microbiology. Still, they unlocked their workstation, only to discover MediaLab had timed out again. After helping the clinician, Alex paused. Where was I?
Oh, right. QC. Alex manually entered the QC values, clicked submit, and looked up from the workstation just in time to see the hematology supervisor returning from the meeting.
“Good morning, Alex. How has hematology been?”
“It’s been good. I just finished running QC and logged the results. No issues with levels one and three!”
“One and three? Why did you run those?”
“Well … that’s what the procedure says,” Alex replied, glancing toward the binder.
“Oh!” the supervisor said with a chuckle. “No one uses that procedure anymore. We have a new one.”
Work that Isn’t the Work
Let’s stop for a moment. If you’re feeling a bit uncomfortable, or if this is sounding a bit “too real” for you, that’s precisely the point. Unlike a financial tax, this cost never appears on a spreadsheet. It appears as fatigue, frustration, interruptions, workarounds, and the lingering feeling that you’ve been busy all day without accomplishing what you set out to do.
For being a narrative about a laboratory professional starting their shift at work, there was a severe lack of actual clinical science going on. The discomfort felt is not because of a misinterpreted CBC or a missed critical value. It’s because before being able to perform any clinical tasks, the morning had been spent remembering passwords, searching for information, recovering from interruptions, and compensating for outdated systems.
None of these events, by themselves, are particularly significant. And while they may be exaggerated for illustration, few laboratory professionals would struggle to recognize pieces of this story. The details between us change. The pattern does not.
What you’ve just observed is cognitive load—specifically, extraneous cognitive load. Although Alex’s experience is likely familiar to many readers, the terminology describing it may not be.
Cognitive load refers to the mental effort required to perform a task. Some of that effort is intrinsic—it is inherent to the work itself. Solving a difficult antibody identification, interpreting a blood smear, or troubleshooting an analyzer all require mental effort. That is the work laboratory professionals are trained to do. It is why we entered the profession.
Extraneous cognitive load is different. It is the mental effort imposed by workflows and systems rather than the work. Examples include searching for information, navigating outdated procedures, remembering unnecessary details, or compensating for poorly designed workflows.
For laboratory professionals, extraneous cognitive load is an invisible tax: the mental effort spent compensating for systems, workflows, and processes that should be carrying more of that burden themselves.
Reading the Fine Print
We all know it’s there, but hardly anyone looks at it.
Unfortunately, a challenge with unnecessary cognitive load is that it often goes unrecognized. This occurs for a variety of reasons, though most are founded in lack of accessible context for why taxing systems are implemented in the first place.
Newer employees may feel out of place questioning why workflows are the way they are—not wanting to make waves before asking the why questions—the questions that should be asked.
Established employees adapt to poorly designed systems by finding workarounds. Experienced laboratorians often develop effective workarounds over years of practice. Over time, those workarounds can become so familiar that the underlying workflow is no longer perceived as burdensome. Improving the system, to them, may be perceived as extraneous cognitive load, ironically.
Additionally, when mental resources are already stretched thin, it becomes difficult to distinguish between the work itself and the effort required to navigate the system surrounding it. Many laboratory professionals finish the day mentally exhausted and attribute that exhaustion to laboratory medicine, when a substantial portion of their cognitive effort may have been invisibly taxed—spent searching, remembering, recovering from interruptions, and adapting to antiquated workflows that don’t serve their original purpose.
Seeing What’s Invisible
Our cognition is a finite, limited resource, and unlike equipment, staffing, or budgets, cognitive resources cannot simply be replenished in the middle of a shift. Every unnecessary mental demand competes for a laboratorian’s limited cognitive resources. Each time a person must compensate for poor system design, attention is diverted away from the work that only a trained laboratory professional can perform.
The next time you find yourself searching for a procedure, reconstructing context after an interruption, tracking information across multiple systems, or relying on a workaround that “everyone just knows,” pause for a moment. Ask yourself: Is this part of the work? Or is this part of the invisible tax?
We cannot improve what we cannot see. The first step toward reducing unnecessary cognitive load is recognizing when our attention is being spent on the system rather than the science.
Darby Naheedy is Resident Physician, Anatomic and Clinical Pathology | PG-2 at the University of Vermont Medical Center in Burlington, Vermont.