A patient advocate should have the negotiation skills of a diplomat, the curiosity of a child, the protectiveness of a mother and the courage of a freedom-fighter. Dr Aniruddha Malpani
The poor patient’s plightEkta is a 60-year old widow, who has diabetes, impaired kidney function and angina. Her family physician is under the impression that her cardiologist is tracking her health – after all, he has referred her to him because he is the specialist, and he is happy to defer to his expertise. Her cardiologist believes that Ekta’s care is being monitored by her family physician, as he feels that this is the responsibility of the primary care physician. And the nephrologist has no clue what the other two are doing! You can imagine how high the probability for medical errors is in this kind of situation, when the left hand does not know what the right hand is doing! She is a disaster waiting to happen.
In a perfect world, doctors would talk to each other, and everyone would be on the same page. In real life, however, doctors are extremely busy. They have a tough time dealing with their ever-increasing workload and rarely have the time to communicate with their patients, or with the other treating physicians. This results in poor coordination, and the patient’s care often suffers due to the number of specialists she has to see. This means it’s become the patient’s responsibility to constantly be on their toes when it comes to taking care of their health.
The patient advocate comes to the rescueEkta finally found a patient advocate, who acts as her protective shield from medical errors. He is her knight in shining armor, because it’s his job to handle everything from accompanying her to the busy specialist’s clinic, to updating her medical records. Her patient advocate is her “go-to person”, who helps her navigate the complex healthcare maze.
Patient advocates can be pillars of strength for patients during a very challenging phase of their lives. A patient advocate can be either a :
* Self advocate: If the patient has an adequate amount of medical knowledge and if her health permits, she can be her own advocate
* Informal advocate: A family member (spouse, sibling, parent or friend) assumes the role of a medical advisor
* Professional advocate: A social worker, nurse or any other health professional employed either by the hospital or the family, to act on behalf of the patient. Progressive health insurers now provide patients who have a complex chronic illness with a case manager, who acts as their patient advocate
A good advocate should have earned the patient’s trust; must understand her medical problems; and be assertive. He should be able to take a firm stand – after all, his job is to speak up for his patient! An advocate needs to be well-informed, and should be able to discuss treatment options with the doctor, on behalf of his patient. Patient advocates protect patients from medical errors by guarding the patient’s rights. They can:
* Provide insight into how the healthcare system works, and what to do when it doesn’t
* Facilitate access to leading doctors, if a second opinion in needed
* Help the patient to speak up when things aren’t going as expected
* Cut through the hospital red-tape
* Make sense of medical research
* Ensure that the medical team puts the patient’s interests first
The patient advocate’s role during your hospitalizationWhen you are hospitalized, you’re not on top of your game. A patient advocate becomes your friend, philosopher and guide, who watches over you while you are in the hospital. In the past, this role was performed by your family physician (who sadly seems to have become an endangered species today). Your patient advocate functions as your guardian angel, and his most important role is to ensure that there is no slip-up in the care that you receive.
* Your advocate needs to coordinate care with the various specialists in the hospital, each of whom seems to be in charge only of the organ system which belongs to his particular superspecialty! It’s important that he have the phone numbers of all the doctors who are caring for you, so he can get in touch with them directly, in case he has any questions.
* He should make friends with the nursing staff; they provide the actual hands-on care and are responsible for administering your needs. They have the answers to most of your questions, and are much more accessible than your doctors.
* He needs to be present at the change of shift duty, during the handoff or transition, when the nurses who are going off duty update those who are coming on duty. Passing the baton can be fraught with hazards, and he needs to make sure it is not dropped during the handover.
* Before you leave the hospital, your advocate should meet up with the hospital’s discharge planner – usually the nurse on duty. She can furnish important information about local resources and referrals to other medical professionals. If you require continued care at home or at a rehabilitation center, your advocate will assist with the transition. What makes doctors wary of patient advocates?
The term advocate sounds adversarial, and doctors often get defensive when they have to deal with one. They can create hurdles in the patient advocate’s path and this negativity harms the patient’s care. This is why some advocates prefer calling themselves “patient champions”.
His training and experience enables him to understand what the patient is going through, and he is in the right position to ensure that her unique medical needs are being properly met. The medical staff should understand that it’s the advocate’s job to monitor and oversee a patient’s care, so that the patient gets the care that the doctor has prescribed. They are both on the same side–the patient’s! It’s crucial for the advocate to remain polite, positive, encouraging, and appreciative; and to cooperate with every member of the medical team, so that he creates a win-win for everyone.
At times, he may need to be firm, even demanding, but that cannot be an excuse to be impatient, short-tempered, rude or confrontational. If he wants his patient to get the best medical care, he should take care to be patient himself!
A patient advocate is a very valuable resource that patients and their loved ones can turn to, so they can deal better with their medical challenges. Because a patient advocate can help improve the patient’s experience with the healthcare system, he should be recognized as an essential service provider in our healthcare system. You can learn more about what a patient advocate does in our book, Patient Advocacy-Giving Voice to the Patient at http://www.slideshare.net/malpani/dr-malpani-patient-advocacy