execute
is an internal method that shouldn't be used from a feature. If you want to execute a step from another step you do have to underscore it. Spinach maintainers suggest extracting the logic in "I am a facility's administrator" and "I create a patient" step to another method, and calling this very method from other steps.
step "I create a patient as a facility's administrator" do
log_as_facility_admin
create_patient
end
def log_as_facility_admin
# something
end
def create_patient
# something
end