A medication was recommended to me a week ago. It still has not reached me. I prescribe medications for a living. I know where an order can stall: awaiting a signature, sent but never received, delayed by an authorization, or routed to a pharmacy without stock. I know whom to call and what to ask.
None of that has moved my prescription. There is no one covering the service, so it will move when the system allows it to move.
I am a best-case patient. I know a prescription can disappear between a clinician, an electronic record, an insurer, and a pharmacy without anyone noticing it has stalled. I know to keep looking. A week is not what this system does at its worst. A week is what it can do under favorable conditions: an informed patient with access, professional knowledge, and the ability to identify where the process may have failed. That is the timeframe worth examining. Not the disaster case. The favorable one.
I see what happens outside those conditions when I assume care for patients with complicated treatment histories. They may arrive on regimens developed over years by several prescribers. The medication lists say what was prescribed, but not why, what failed before it, or what happened when someone last tried to reduce it.
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By the second appointment, I may discover that a patient has been without one medication for weeks. Not because the patient chose to stop it. Not because a clinician discontinued it. The prescription simply lapsed during the transition. The patient did not know the gap was theirs to catch. They assumed that if it mattered, someone would be watching. No one was. This is usually structure, not negligence.
The prescriptions followed patients from one practice to the next. The reasoning did not. The handoff moved the medication lists but lost the stories, leaving patients no way to know which parts carried the clinical weight.
That is what makes my week-long wait unsettling. I know my medication is still somewhere in the process. Some patients may not know that theirs have stopped moving at all. The difference is how much of the failure each of us can see. The name for this is not simply delay. It is unowned care.
The clinician assessed, the insurer approved, and the order was entered. Each person completed a task and released it to the next part of the system. Yet the outcome, the medication reaching the patient, belonged to no one. Care fell into the space between completed tasks, where everyone had acted but no one remained responsible for knowing whether the process worked.
The burden then shifted to the patient. It lands hardest on those least able to carry it because the system asks patients to overcome, as a condition of treatment, the symptoms for which they are seeking care.
The patient with depression must make six phone calls. The patient with anxiety must repeatedly begin uncertain conversations. The patient with executive dysfunction must coordinate organizations that do not communicate. We have built a system that can make recovery a prerequisite for treatment. When patients cannot meet that demand, the resulting gaps may be labeled nonadherence.
I would like to believe I see this only from the patient’s side. I do not. As a clinician, I have inherited regimens whose rationale was unclear, continued treatments because changing them without adequate history created more risk, and moved quickly through renewals by relying on the existing plan. Each action can feel like continuity. Sometimes it is also momentum, the plan passing from one set of hands to another without anyone reclaiming responsibility for why it exists or whether it still serves the patient.
This failure does not happen only in careless hands. It moves through conscientious clinicians, pharmacists, staff members, insurers, and health systems. It is reproduced through ordinary actions that resemble diligence: forwarding the request, renewing the prescription, completing the task. The record shows activity. The patient may still have no medication.
The next time a prescription leaves my hands, I need to ask who owns what happens next. My delay is manageable because I know it exists. Patients between handoffs may not know their treatment has stopped moving. The failure is not that they did not chase it. The failure is that no one was responsible for noticing they had been left in the gap.
A health care system can record every completed action and still miss the only outcome that matters: whether treatment reached the person who needed it. I know how to work this system as well as almost anyone, and it still takes me a week. Stop building the final step for patients like me.
I am the one who will probably be fine.
Alexandro Vasquez is a board-certified psychiatric nurse practitioner, assistant professor in the Department of Graduate Nursing at Winona State University, and founder of Clear Path Psychiatry PLLC in Eagle Lake, Minnesota. He specializes in adult outpatient psychiatric evaluation and medication management, with a clinical focus on high-functioning adults, treatment-resistant presentations, and rural access to psychiatric care. He provides services in person and via telehealth throughout Minnesota and holds a faculty appointment at Winona State University’s PMHNP track.
His clinical and academic work centers on closing the gap between symptom onset and treatment engagement in underserved populations. He is the author of “Why high-functioning adults are delaying psychiatric care.”
