THE 60%
Field Notes from the Working Majority
FIELD NOTE NO. 007
WHO OWNS THE NEXT STEP?
A healthcare visit can end with a plan and still leave someone with a problem.
Get the bloodwork done.
Schedule the imaging.
Call this specialist.
Come back if it gets worse.
All reasonable recommendations. Often exactly the right ones.
Then the visit ends.
The employee goes back to work with a phone number, an order in the patient portal, or a piece of paper folded inside a jacket pocket.
Now someone has to figure out what happens next.
Which facility accepts the insurance? Does the test require approval? Will the specialist call, or is the patient supposed to call first? Can the appointment happen outside working hours? What will it cost?
None of those questions necessarily belongs to the clinician who made the recommendation. None of them necessarily belongs to the insurance company either.
So they belong to the person who is sick.
We have been thinking about how much healthcare depends on that person becoming the project manager.
They make the calls. They repeat the story. They track down records. They wait for one office to send something to another. Sometimes they ask a spouse or family member to help because the calls have to happen while they are working.
If the next step takes three phone calls, an afternoon away from work, and a new online account, it becomes easier to understand why it may not happen.
Not because the person does not care.
Not because the recommendation was unclear.
The rest of life simply kept moving.
Healthcare tends to measure completed events. The visit occurred. The referral was placed. The test was ordered.
The space between those events is harder to see.
It is also where a surprising amount of care gets stuck.
The word “referral” sounds like movement. Sometimes it is only permission to begin another search.
This is especially noticeable for people whose workdays leave very little room for administrative problems. A teacher cannot step away from a classroom every time an office calls. A driver cannot navigate an automated phone menu from the road. A construction worker may not hear the phone at all.
By the time the workday ends, the office they need may be closed.
Nothing dramatic happened. There was no obvious failure.
The next step just stayed on the list.
We spend a lot of time asking how quickly someone can get into healthcare. It may be just as important to ask whether they can keep moving once they are there.
Because access to one appointment is not always access to the care that comes after it.