On Coordination

One of the more interesting features of modern healthcare is how much responsibility falls on the patient.

This is easy to miss because healthcare is often described as something done for patients. We talk about diagnoses, treatments, procedures, and outcomes.

Less often do we talk about coordination.

Yet for many patients, coordination is the work.

A physician recommends a test.

The patient asks:

"How much will it cost?"

The physician often doesn't know.

"Will my insurance cover it?"

The physician often doesn't know.

"Which facility should I use?"

Again, the answer may not be clear.

The patient leaves with a recommendation but without many of the answers needed to act on it.

At that point, responsibility shifts.

Someone must determine coverage, understand costs, schedule appointments, navigate referrals, and connect information across multiple organizations.

Increasingly, that someone is the patient.

Years ago, while consulting on Medicare-related initiatives, I spent time researching trust and decision-making in healthcare. One finding appeared repeatedly: people trust their doctors.

When faced with uncertainty, patients often look to physicians not just for medical expertise, but for guidance.

The challenge is that healthcare isn't organized around that expectation.

Clinical decisions happen in one part of the system.

Coverage decisions happen somewhere else.

Pricing information exists somewhere else entirely.

The patient is left to connect the pieces.

This matters because healthcare researchers have spent decades studying why patients fail to complete recommended care. Medication adherence remains one of the most persistent challenges in healthcare, with roughly half of patients with chronic conditions not taking medications as prescribed.

The reasons are complex.

But many of the barriers researchers identify aren't medical.

They're operational.

Cost.

Confusion.

Communication.

Coordination.

The ability to navigate a fragmented system.

That's why I've become increasingly skeptical of explanations that place responsibility entirely on the patient.

When people don't follow through, we often ask:

"Why didn't they do it?"

A more interesting question may be:

"What did we ask them to navigate in order to do it?"

The answer tells us something important about the patient.

But it may tell us even more about the system.