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This paper examines usability issues in Mixed Reality (MR) systems from a Cognitive Systems Engineering (CSE) (Hollnagel & Woods 1983; 2005) perspective with the purpose of finding an alternative approach to usability in MR-systems. A qualitative user study has been performed at a Swedish hospital where professionals have tested an MR prototype providing instruction of the use of advanced medical equipment. The results indicate that the participants in this study do not consider the MR system as a traditional computer based manual, but rather as an interactive personal instructor. The fact that users work through the MR system rather than with the MR system raises some fundamental design issues regarding usability and the perspective on usability. This suggests that there may be a need to utilize a different approach for usability concerning MR systems, instead of transferring traditional human-computer usability guidelines to the MR domain.