When care is divided among many hands, the whole person can disappear between them.

The Lindsay Clancy trial brought an unsettling contradiction into public view. Clancy had received a great deal of mental-health care. She encountered psychiatric prescribers, therapists, emergency services, a specialized postpartum program and an inpatient hospital. Yet the complete, changing picture may have belonged to no one.

Modern healthcare is organized into encounters. One clinician evaluates symptoms and medication. Another determines whether the patient meets the criteria for hospitalization at a particular moment. A therapist understands what emerges in regular appointments. An inpatient team stabilizes the patient and prepares a discharge plan.

Each professional may act reasonably within a limited role. The patient and family, however, are not living through a series of separate encounters. They are living through one continuous illness.

Care coordination therefore requires more than exchanging records or making referrals. Someone must be responsible for understanding what has changed over time, reconciling different clinical interpretations, confirming that recommended care actually occurred and recognizing patterns that no single appointment can reveal.

That responsibility becomes especially important when the patient is least able to carry it. Someone who is severely sleep-deprived, depressed, frightened, cognitively disorganized or psychotic may still be expected to maintain medication lists, reconcile conflicting instructions, contact the correct professional and explain the evolving situation repeatedly. Family members often become unofficial case managers without the information, authority or guidance needed to perform that role safely.

The lesson is not that one clinician should control every decision. Complex patients need multiple forms of expertise. But a collection of experts does not automatically become a coherent system.

In my new essay for Writing From Here and Now, I examine the question that remains when a patient is surrounded by care but no one appears to hold the whole story: Who is responsible for knowing where the patient has been, what has changed, what everyone is watching for—and what happens next?

Read the full essay on Writing From Here and Now

This article and other informational content on this website are provided for educational purposes only. They are not a substitute for individualized professional care, do not constitute advice specific to your circumstances, and do not establish a therapist-client relationship.

About the Author

Anne Lindyberg, LMHC (Iowa), LCPC (Illinois), integrates the transformational family therapy of Virginia Satir with Deep Brain Reorienting (DBR) and the Alexander Technique. She specializes in helping adults with complex and developmental trauma create lasting emotional change through therapy.

This work is created on the traditional and unceded lands of Indigenous peoples; a fuller acknowledgment of the land, its history, and its peoples is available on this website.