I never expected to spend my retirement navigating a health care system that increasingly requires patients to do the work once handled by the system itself. But that is where we are. The modern patient must track their own records, coordinate their own referrals, chase their own authorizations, and solve problems that once belonged to the infrastructure. It is a strange inversion: the more complex the system becomes, the more responsibility shifts to the individual.

My recent experience preparing for a routine outpatient procedure made this reality impossible to ignore. The process began with a simple question: What do you need from me before surgery? The answer should have been straightforward. Instead, it triggered a cascade of tasks that felt less like medical preparation and more like assembling a tax return.

I was asked to provide medication lists, specialist notes, imaging reports, and lab results, all items that already existed in the system, scattered across electronic health records that refuse to speak to one another. Each office had a portal. Each portal had a password. Each password had expired. I reset them, logged in, downloaded PDFs, and uploaded them somewhere else. I became my own courier.

Then came the preoperative clearance. The procedure itself is routine: a cataract lens replacement. What makes it less routine for me is that it is being done on my only good eye. The other eye is centrally blind from macular retinoschisis. That fact doesn’t change the surgical plan, but it changes the stakes. It changes how carefully I track every instruction, every document, every preoperative requirement.

The cataract surgeon wanted medical clearance from my cardiologist, not my primary care physician. That was appropriate. I have mild concentric left ventricular hypertrophy, and while it has never caused symptoms, it is the kind of finding that makes a surgeon want a second opinion before anesthesia. My cardiologist agreed and ordered an echocardiogram, an abundance of caution that was warranted. The test was normal enough to proceed, but the process revealed something larger: Even when the medicine is straightforward, the system around it is anything but.

The most revealing moment came when I tried to confirm whether the surgical center had received my preoperative labs. They had not. I sent them again. They still had not. I finally drove to the lab, obtained a printed copy, scanned it myself, and emailed it to the surgical center. The problem wasn’t technology. The problem was the assumption that the patient would fix whatever the system failed to do. This is the DIY health care odyssey: a journey through a system that expects patients to compensate for its own inefficiencies.

The absurdity becomes clearer when you consider the stakes. This is not scheduling a haircut. This is preparing for anesthesia. The system should be airtight. Instead, it relies on patients to close the gaps.

I found myself thinking about the families I cared for during my career, parents juggling work, childcare, and the emotional weight of raising a child with developmental or behavioral needs. I did the coordination for them, and I did it well. They didn’t have the time or the bandwidth to chase down records, reset portals, or troubleshoot communication failures. Yet the system now expects patients to do exactly that. The burden has shifted, quietly and without acknowledgment, from institutions to individuals.

The final step in my own odyssey came when the surgical center asked me to bring a printed copy of my medication list “just in case.” In case what? In case the electronic record failed? In case the fax machine jammed? In case the system that prides itself on digital integration couldn’t retrieve the most basic information?

I printed the list.

The procedure itself would be simple. The preparation was not. And that is the point. The complexity of modern health care no longer reflects the complexity of the medicine. It reflects the complexity of the system.

Patients now serve as their own care coordinators, archivists, and troubleshooters. They are expected to bridge the gaps between offices, platforms, and protocols. They are expected to anticipate failures and compensate for them. They are expected to do the work quietly, without complaint, because the system has normalized the expectation.

I went into surgery on Thursday morning. The postoperative instructions were clear. The recovery was straightforward. And the experience left me with a simple conclusion: The system works only because patients do the work the system no longer does for itself.

The surgery was uncomplicated and successful, primarily due to my own care coordination.

Ronald L. Lindsay is a retired developmental-behavioral pediatrician whose career spanned military medicine, academic leadership, and national advocacy for dignity-centered neurodevelopmental care. His NIH-funded work with the RUPP Autism Network helped define evidence-based approaches to autism and related developmental disorders.

He directed the LEND Program at The Ohio State University and founded JBLM CARES, a $10 million autism resource center for military families. His writing spans clinical scholarship and long-form fiction. He is the author of The Mercy Directive and the six-novel Cassandra series, a completed political and medical fiction saga tracing the rise of the Cassandra system from its origins to its national and international legacy. His forthcoming memoir, The Quiet Architect, examines how conscience and structure collide in modern medicine.

He shares updates on LinkedIn.