Without Communication, Coordinated Care Is Still Just Care

by | Jan 12, 2016

Back in October, I tore my left calf in the middle of a marathon. Like any crazy runner worth his weight in energy gel, I still finished the race, even if it meant limping around for the rest of the day and driving myself to urgent care when I woke up the next day with a purplish-red mark on my leg. This marked my first foray into the medical system (aside from my annual physical) since I whacked my head on a beam in my basement several years ago and needed staples in my head.

More than two months and nine physical therapy visits later, I’m back to running – albeit at a slower pace and for shorter distances than I’m used to, but luckily with no staples anywhere on or in my body. The whole ordeal provided me a nice introduction to care coordination – and illustrated all too well just how immature the process remains.

I made sure to visit an urgent care facility affiliated with my primary care provider’s network. (It’s one of the large ones in Boston.) The physician who saw me, as well as the discharge nurse, noted that my records would be passed along to my PCP. I’ve yet to hear from my PCP – but, in his defense, an otherwise healthy young man suffering a minor injury with a slow but straightforward recovery process likely (and rightly) ranks low on his priority list.

To the credit of my health system, the record of my urgent care visit appears in my portal, too. This I learned the hard way, though; no one at the clinic told me to look there. I’m willing to bet I’m in a small minority of patients who can find a) the URL for the portal, b) the password for the portal and c) records within the portal. This lack of communication hardly presents the same severity as an open care gap, especially given my condition, but it does show that volume-based health systems care more about seeing the next patient than fully empowering the current patient.

From there, I went to an orthopedist referred by the urgent care physician. No record of that visit appears in my portal. Nor, for that matter, do any of my subsequent visits to physical therapy. In other words, my record is incomplete. Absent any sort of longitudinal care plan, one could easily get the impression that I went to urgent care and ignored doctor’s orders instead of seeking the most appropriate treatment for my condition so I can run the Boston Marathon for the first time this spring.

No one is at fault here. The urgent care physician was honest, the orthopedist direct, my therapist thorough. I have no complaints about the care process at all. The problem is that – contrary to what any slide deck from a vendor, government agency, professional group, or healthcare organization will tell you – there is no solid line between caregivers of this type. There is no precedent for them to communicate, just as there is no precedent for anyone at urgent care to tell patients before they hobble out the door on crutches to check their portal.

Sure, a financial incentive may motivate any of those caregivers to share a note that says, “Hey, Brian’s recovery is going well.” So, too, might a Direct-based messaging system that integrates with whatever software program those caregivers use most during the course of their day.

However, until the healthcare industry recognizes that its care management problem is, above all, a systemic communications problem that fails to capture and document the verbal and nonverbal care narrative, a truly coordinated care process remains rare – as rare the injured runner who actually waits to go for his first jog until his physical therapist says it’s OK.


  1. Romain Doutriaux

    Powerful insights, Brian. If we are not able to share in a secure way our health records, we can’t expect any continuum of care. And no continuum of care means no care. Hope your calf is doing better.

    • Brian Eastwood

      You’re exactly right, Romain — and you touched on the ability of patients to share records, which I didn’t even mention.

      The calf is feeling better, thank you. I’ve been able to relegate the crutches to the back of the closet and am back to running four days a week. I’m slower than I was before, mind you, but I’m aiming for long-term recovery and strength over short-term gains.

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