The Gap Between Visits

Why we've become obsessed with what happens when nobody has an appointment

The more people we talk to while building 76 Health, the more we think the hardest part of healthcare isn't the appointment. It's everything that happens after.

Over the last few months, we've spoken with patients recovering from accidents, managing chronic pain, dealing with migraines, and trying to navigate specialist care. What's been surprising is how rarely people complain about a single doctor.

Instead, they talk about the time in between: The referral that never got scheduled. The specialist who never received the records. The medication that caused side effects nobody expected. The lab order that disappeared somewhere between offices. The question that felt important enough to ask but not important enough to go to the emergency room for.

Most of healthcare's hardest work happens in those moments. Not inside the visit itself, but in the days and weeks that follow.

And somehow, we've built a system where the patient often ends up coordinating it all.

The part nobody talks about

A doctor's visit might last twenty minutes.

The space between two visits can last three weeks... Or three months.

For conditions like chronic pain, recovery from injury, migraines, and other long-running health issues, the visit is only a small piece of the story. Whether you get better or not is often determined by what happens after you leave the office.

Did the referral get scheduled?

Did the therapy actually start?

Did the medication work?

Did someone notice when it didn't?

Did the next provider know what the last provider recommended?

Those questions sound operational. But they're often the difference between progress and frustration.

How patients take on a second job

One thing we've noticed is that patients spend an incredible amount of energy connecting dots that should already be connected.

Forwarding records. Calling offices. Explaining the same story to new providers. Following up on referrals. Keeping track of medications. Trying to remember which doctor said what.

Healthcare asks patients to do a surprising amount of work at the exact moment they're the least ready to do it.

Not because anyone designed it that way. Because the system evolved around visits. Visits are billable.

The work in between usually isn't.

So the system gets very good at appointments and surprisingly bad at everything between them.

That doesn't mean doctors aren't doing their jobs. Most are working incredibly hard.

It just means nobody owns the space in between.

Why this matters

The cost isn't just financial.

It's exhaustion.

It's the feeling that getting better requires a second job.

It's sitting on hold with insurance.

It's wondering whether a new symptom is normal.

It's not knowing who to call when something changes.

It's telling your story over and over again.

Eventually, some people stop trying.

Not because they don't want to get better.

Because navigating the process becomes exhausting.

What's interesting is that the research largely agrees.

The pattern is remarkably consistent: when care is connected, patients tend to do better and costs tend to be lower.

The exact numbers vary.

The direction doesn't.

What better could look like

We've found ourselves coming back to three ideas over and over.

Continuity.

Someone who knows your story and is still around next week.

A shared plan.

Not six different versions of what's supposed to happen, but one plan everyone can work from.

And ownership of the in-between.

Someone whose job is to notice when things fall through the cracks before they become problems.

None of these ideas are particularly novel.

They're just surprisingly uncommon.

What we're trying to build

76 Health started with this observation.

Most patients don't need another app.

They don't need another portal. They don't need another place to upload documents. What many of them need is someone helping hold the thread.

Someone coordinating the people already involved in their care.

Someone making sure the next step actually happens.

We're still early.

We're working with a small group of patients and providers and learning every week. Some of our assumptions will turn out to be wrong. Some parts of the model will change.

But one thing keeps coming up.

The conditions we're focused on (e.g. chronic pain, recovery, accidents, migraines) aren't defined by a single appointment.

Because navigating the process becomes exhausting.

They're defined by what happens between appointments.

That's where progress happens.

That's where setbacks happen.

And increasingly, that's where we think healthcare needs to improve.

One final thought

Most patients assume this is just how healthcare works.

That you're supposed to keep track of the referrals.

Make the calls.

Follow up on the records.

Connect the dots yourself.

I'm not sure that's true.

I think we've simply gotten used to asking patients to do work the system should have been doing all along.

Sources referenced: The Lancet Low Back Pain Series (2018), published outcomes from Hinge Health and Sword Health, and American Physical Therapy Association research on early physical therapy and total cost of care.