Healthcare isn’t immune to this. If anything, it’s especially vulnerable because so much care depends on multiple people doing different jobs at different moments.

Take intimacy and cancer. Ask almost anyone on the care team whether it matters, and you’ll hear broad agreement. Most people recognize that changes in sexuality, relationships, body image, and identity can have a profound effect on quality of life.

The uncertainty begins when the conversation shifts from Does this matter? to Who is responsible for making sure it doesn’t get missed?

An oncologist assumes a social worker will have more time to explore it. A social worker waits until the physician has introduced the topic. Survivorship assumes it came up during treatment. Rehabilitation focuses on physical function. Nurses are balancing countless competing demands. Absolutely none of those decisions are unreasonable on their own.

However, the patient experiences something much simpler → To put it plainly: no one asks.

This is why I think we sometimes frame the challenge too narrowly. We spend a great deal of time talking about communication skills and helping clinicians feel more comfortable having these conversations. That’s important work, but confidence alone doesn’t create consistency.

Organizations also need a pathway. Who opens the conversation? Who follows up if concerns are identified? What resources are available? When is a referral appropriate? Who owns the next step?

Those aren’t just workflow questions. They’re implementation questions.

Awareness is an important beginning, but awareness doesn’t tell a care team how responsibility moves through a system. Until that’s clear, patients are still relying on chance. They receive intimacy-informed care if they happen to meet the right person at the right time.

I think that’s the next conversation. Not simply how to help more clinicians talk about intimacy, but how to design care so those conversations have somewhere to go. They’re implemented and even embedded in an organization.

This is one of the questions shaping my work right now. I’m less interested in convincing organizations that intimacy matters than I am in helping them design practical systems that make support more consistent, more visible, and less dependent on chance.

In summary: Awareness tells people what matters. Implementation determines whether it actually happens.