Throughout my career developing women’s health programs, I’ve seen organizations invest tremendous effort into improving clinical outcomes, streamlining workflows, and expanding access to services. These are, of course, essential priorities. But I’ve also seen how easy it can be to overlook something fundamental: the unique experience of the individual receiving care.
Too often, behavioral health support is reactive. We recognize a patient’s emotional needs once their distress becomes visible, begins affecting their well-being, or impacts treatment. We then frequently respond with a referral, adding steps to an already complex care journey.
But emotional needs rarely emerge overnight. They can develop around predictable moments in care, sometimes long before a patient reaches a point of crisis.
This has shaped one of the central questions I ask both myself and our partners when designing behavioral health programs: How can we build consistent, scalable systems that operate proactively while still responding to each person as an individual?
Some of the most meaningful lessons I’ve learned about answering that question haven’t come from operational reports or strategic planning sessions. They’ve come from the experiences of the people around me.
As we recognize Breast Cancer Awareness Month this October, three experiences stand out
Lesson #1: Emotional support should begin before patients reach a crisis
In 2014, shortly after I’d started working at John Muir Health, I witnessed something that has stayed with me throughout my career. A group of sophomores from Carondelet High School — my own alma mater — organized a project to write encouraging letters to women receiving care at our breast health center.
The students delivered more than 200 handwritten notes, addressed simply, “Dear Sister.” The project became a tradition that continues today, connecting young women in the community with patients facing breast cancer. Their efforts even received local news coverage.
What struck me wasn’t just their compassion. It was their understanding of when that compassion was most needed.
Breast cancer programs often devote considerable attention to survivorship, including the challenges of rebuilding confidence, navigating changes to one’s body, and adjusting to life after treatment. And yes, these are critically important needs. But these students were thinking about women who hadn’t reached that point yet: women who had just received frightening news, were facing difficult treatment decisions, and were living with uncertainty about what comes next.
They recognized something that healthcare systems can sometimes overlook — facing an uncertain future can be even more emotionally complex than recovering from what you’ve already endured.
And patients shouldn’t have to reach a breaking point before we recognize that they need help
Applying lesson #1: Proactive, milestone-based behavioral health interventions can help healthcare teams identify patients’ emotional needs early, before they escalate or interfere with treatment.
For health systems, that means considering where emotional needs are most likely to arise throughout a care journey and building appropriate touchpoints into established workflows. A diagnosis, a treatment decision, the beginning of chemotherapy, or preparation for surgery can each represent an opportunity to check in, assess needs, and connect patients with support.
Rather than relying exclusively on patients to recognize their own distress and ask for help, we must create systems that make identifying those needs a consistent part of care without adding to providers’ existing burden
Lesson #2: Clinical recovery doesn’t mean the emotional journey is over
Breast cancer has touched my own family. Multiple people close to me have undergone double mastectomies, and I’ve witnessed the physical and emotional complexities that can accompany treatment and reconstruction.
For some, the challenges of reconstruction have been particularly difficult, creating uncertainty about their bodies and how they see themselves. These are deeply personal experiences, and no two women navigate them in quite the same way.
But one of the most memorable lessons came from something much smaller.
During my mother’s radiation treatment, clinicians placed tiny blue tattoo marks on her skin to help guide the delivery of radiation. They served an important purpose, helping ensure treatment was both accurate and consistent.
Years later, those dots are still there.
My mother survived cancer, but she still comments on her little blue marks when she puts on a swimsuit or a dress with a lower neckline. They make her self-conscious. They’re a visible reminder of an experience that, medically speaking, is behind her.
From a clinical standpoint, those dots may seem insignificant compared with the importance of successful cancer treatment.
But to my mother, they aren’t insignificant. They may be small, but she’s always aware of them.
Her experience has reminded me that we can’t always predict which aspects of treatment will have the greatest emotional impact on an individual. Something a clinician sees as a routine part of care may carry a very different meaning for the person living with its consequences.
And surviving a disease doesn’t automatically resolve the distress associated with the experience
Applying lesson #2: Whole-person care must recognize that emotional needs are individual and may persist long after clinical treatment ends.
This has practical implications for how we design behavioral health support within oncology programs.
We need consistent opportunities to assess emotional well-being, but we also need to give patients the space to tell us what matters to them. For one person, that might be anxiety about recurrence. For another, it might be changes in relationships, body image, or confidence. For someone else, it might be something as seemingly small as a few blue dots.
The goal isn’t to assume every person will experience the same challenges. It’s to create consistent, reliable opportunities to understand and address the challenges each is facing
Lesson #3: The healthcare experience itself can influence emotional well-being
A friend recently shared an experience that offered another important perspective.
She has particularly dense breast tissue, which can make breast cancer screening more complicated. As a result of her individual circumstances, she undergoes regular mammograms and supplemental MRIs.
These screenings are an important part of managing her health, but they haven’t always been comfortable experiences.
She described how clinicians have coarsely and repeatedly commented on how difficult her breast density makes the screening process. I doubt those comments were intended to be hurtful. From the clinician’s perspective, they may simply describe a technical challenge.
But that’s not necessarily how they’re received.
Over time, those comments have left my friend feeling self-conscious about her body and uncomfortable with a process she knows is important for her health.
As someone with a family history of breast cancer who also undergoes additional screening, I understand that these appointments can carry their own emotional weight. The last thing a woman needs is to feel that something about her body makes her a difficult patient — or even just different.
It’s a reminder of the broader expectations women navigate around their bodies, their appearance, and how they’re perceived. Those pressures don’t disappear when someone enters a clinical setting.
Even when medical care is appropriate and technically effective, the experience surrounding that care can affect a patient’s confidence, trust, and willingness to engage
Applying lesson #3: Patient-centered care requires thoughtful communication and attention to how clinical interactions affect patients’ dignity, confidence, and engagement in their care.
This lesson extends beyond behavioral health referrals or formal therapeutic interventions.
It raises important questions about how we prepare patients for procedures, explain clinical findings, discuss sensitive concerns, and create opportunities for patients to express discomfort or ask questions.
A compassionate care experience isn’t separate from effective healthcare delivery. It’s part of how we help patients feel comfortable participating in their own care
Turning individual lessons into better care systems
These three experiences have reinforced something I believe strongly: we cannot design effective healthcare programs by focusing exclusively on diagnoses, procedures, and clinical outcomes.
But we also cannot build scalable programs around individual anecdotes alone.
Health systems need consistent workflows, evidence-informed clinical protocols, clear responsibilities, and measurable outcomes. Those structures make reliable care delivery possible across large patient populations.
The opportunity is to use those structures to deliver something deeply personal.
We should standardize the opportunity for support, not the patient’s experience of it.
Each of these stories points toward a practical design decision.
The Carondelet students reinforced the importance of timing. We can establish proactive behavioral health assessments at meaningful milestones, identifying emerging needs rather than waiting for visible distress.
My family’s experiences reinforced the importance of personalization. We can build consistent assessment and follow-up processes while allowing the patient’s individual concerns, preferences, and experiences to guide appropriate interventions.
My friend’s screening experience reinforced the importance of communication and patient choice. We can design workflows that encourage sensitive conversations, help patients feel heard, and make it easier to raise concerns throughout their care journeys.
In my work at Iris, these are the kinds of considerations I bring to designing behavioral health integration programs with our partners.
Rather than treating behavioral health as a separate service that patients must navigate after a need is identified, we seek to incorporate appropriate support directly into existing care pathways.
That includes identifying meaningful intervention points, establishing clear clinical workflows, integrating behavioral health clinicians alongside medical care teams, and creating coordinated pathways from assessment to care.
The objective is to make support more proactive, accessible, and responsive without adding unnecessary complexity for patients or clinical teams.
And it requires recognizing that consistent protocols and personalized responses are not competing priorities. They’re what make effective integration possible at scale
Better care begins with understanding the person
Breast Cancer Awareness Month is an important reminder of the value of screening, early detection, treatment advances, and survivorship support.
But I also think it’s an opportunity to consider everything patients experience between and beyond those milestones.
I think about the women who received those handwritten letters, facing a future they couldn’t yet see.
I think about my mother, who is grateful to have survived cancer but is still self-conscious about her little blue dots.
And I think about my friend, who continues to show up for screenings, even when the experience leaves her feeling uncomfortable in her own body.
These stories are different, but they share something important: behind every clinical encounter is a person whose needs, concerns, and experiences may not be immediately apparent.
We can’t anticipate every emotional challenge a patient will face. And we shouldn’t assume everyone moving through the same clinical pathway will need the same type of support.
What we can do is build healthcare systems that consistently make room for those differences.
For me, that’s the defining characteristic of thoughtful behavioral health integration: crafting programs that expand access to services while recognizing emotional needs earlier, responding more personally, and supporting patients throughout their journeys.
The goal isn’t to make every patient’s journey the same. It’s to make sure every patient has the same opportunity to be seen, heard, and supported during their unique journey.