Estimated reading time: 6 minutes
Mrs. Alvarez sits in the waiting room with a purse full of appointment slips. They’re soft at the edges, creased from weeks of being handled and rehandled. Inside the purse is a worn photo of her newborn grandson. It isn’t decoration; it’s something steady to look at when the day begins to tilt.
She keeps the purse close — a small, protective grip shaped by years of navigating a system where missing a five-minute window can mean waiting another month. She once told me she arrived late to an endocrinology visit — not by much — and it took most of a month to untangle the consequences. She said it quietly, as if lateness were a moral failing rather than the natural result of trying to keep six different specialists satisfied.
Cardiology on Tuesday. Nephrology on Thursday. Endocrinology next week. Orthopedics, when they call. She recites the list like a prayer, or maybe a warning.
She doesn’t have one doctor.
She has six — none of them wrong, all of them incomplete. None of them really knows who she is, how she feels, what keeps her up at night.
Once she walks out of their offices, she becomes a different patient in each chart.
Six different stories, none of them quite matching — and she’s the only one who knows which one is actually true.
It isn’t neglect.
It’s just the shape medicine drifted into while no one was paying attention.
How the Body Ended Up in Pieces
Medicine didn’t begin fragmented. For a long time, physicians worked from the whole person — pulse, posture, voice, story. All of it counted. All of it meant something.
Then, long ago, Paris and Berlin changed the rules.
Laennec listened to the chest, then opened it.
Bichat separated organs into tissues.
Virchow went smaller still.
We gained clarity — the kind that saves lives. But something else shifted too, almost without anyone saying it out loud. Instead of asking, What is happening to this person? we found ourselves asking, Where is the lesion?
Good question. Necessary question.
Just not the only one.
By the early twentieth century, the profession looked more like a map than a calling — borders, territories, experts guarding their ground. Knowledge deepened, but ownership narrowed. And patients slowly became divided by the same anatomy that was meant to save them.
When Everyone Does the Right Thing – and the Patient Gets Worse
Fragmentation rarely announces itself. It doesn’t explode or collapse. It frays — small things first, the kinds of things patients apologize for but shouldn’t.
A cardiologist increases a statin. The numbers improve. The chart looks clean. Meanwhile, Mrs. Alvarez stops walking to her mailbox because her legs burn. Neurology rules out neuropathy. Physiotherapy recommends stretching. No one connects the pain to the pill.
I’ve seen that walk — the small, tentative steps of someone who used to move quickly but now studies the ground as though it might betray them.
An endocrinologist intensifies insulin. A1c improves. Weight rises. Heart failure worsens. Diuretics increase. Electrolytes drift. Nephrology enters the picture.
None of this is wrong.
It’s just disconnected — everyone solving the right problem, just not the same one.
Psychiatry adds an SSRI. The mood lifts. Sodium falls — a predictable collision with her other medications. Confusion follows, then a fall. Someone writes “frailty” in the chart, as if that closes the case.
This isn’t malpractice.
It’s system momentum — a series of good intentions moving in different directions.
The Missing Center
People often call this a coordination problem. I’ve never liked that phrase. It makes the situation sound administrative, as if the whole thing could be fixed with a scheduling upgrade.
But this isn’t about timing.
It’s about responsibility.
Someone has to hold the patient’s story in one hand — not as a clerk, not as a referral hub, but as a physician who sees the whole arc, not just the single chapter they were assigned.
Generalists once did this.
The internist who balanced competing risks.
The family doctor who knew the patient before illness multiplied.
The geriatrician who understood the quiet art of subtraction.
These roles still exist, but the system doesn’t lean toward them. There’s no billing code for knowing a person. No metric for noticing the thread that ties their life together.
Multidisciplinary meetings help — for an hour. Then the room empties and each specialist goes back to their lane. And the patient is left standing there, holding all the loose ends because no one else has the full picture.
Can Technology Fix This?
Artificial intelligence promises integration. And maybe it will offer some. Machines are good at spotting patterns and catching interactions we overlook.
Technology may catch patterns we miss, but it doesn’t carry responsibility.
It doesn’t sit beside a patient who’s exhausted from repeating their history.
It misses the tiny things — like the tremor in the hands unzipping a purse.
Information isn’t our bottleneck.
Accountability is.
What Patients Cannot Carry
Mrs. Alvarez can live with heart disease. She can live with diabetes. She can live with chronic kidney disease. She has been living with all of them for years.
What she cannot keep doing is carrying the seams between them.
Specialization didn’t fail; it simply reached its limit. Modern medicine now produces more knowledge than any one person can hold — scattered across disciplines that often speak different dialects.
The future of medicine won’t be shaped only by new discoveries.
It will be shaped by whether anyone is still willing to sit long enough, listen long enough, and hold the entire person in mind without slicing them into categories.
A patient isn’t a set of organs.
Or a list of issues arranged in order.
Real people don’t sort themselves that way, even if our system does.
A patient is a whole life — lived all at once, rarely in the clean lines we prefer.
And someone — some physician — must be willing to take responsibility for the whole, even when the system does not know how to reward that.