The Ultimate Patient Advocate

Posting my piece written for Sermo, as a guest blogger on the Sermo Blog, April 13, 2015. Click on the link here (The Ultimate Patient Advocate)to see the original post. 

Adding the quotes to set the tone, though, as I usually do. The graphic is also my own photography, as with all of the pictures on this blog. Enjoy!

“Only one rule in medical ethics need concern you — that action on your part which best conserves the interests of your patient.”Dr. Martin H. Fischer, German-American Physician and Author

“A physician shall, while caring for a patient, regard responsibility to the patient as paramount.”Principles of Medical Ethics, American Medical Association

“I pledge to pursue the practice of surgery with honesty and to place the welfare and the rights of my patient above all else.”Fellowship Pledge, The American College of Surgeons

Laurel, North Andover, MA

Advocating for patients is a core value in medicine, in patient care. Our legacy as patient advocates dates back to Hippocrates in 500 B.C.E., codified in the oath and teachings that have provided the moral and ethical foundation on which the profession has been built. Even the Code of Conduct for the American College of Surgeons includes as its first principle, “Serve as effective advocates of our patients’ needs.”

Physicians fundamentally care for patients, their families, our communities. We advocate on the small, individual scale for each patient, and we advocate on the large scale for the entire population of patients and society.

The physician is the ultimate patient advocate.

The entire purpose of my profession is to learn about humans—their biology and chemistry, their function in health, and dysfunction in illness and injury. We strive to understand the impact of health or illness and injury on the psyche and on social interactions. To learn about and discover treatments and interventions, and to provide compassion and comfort in applying them. To educate both patients and our society in order to prevent illness and injury, promote health. We are called to speak truth to power in order to accomplish these goals.

The foundation of all this is the relationship and trust between the physician and the patient. Central to this relationship, that trust is the role of the physicians as advocates for their patients.

But now the position of “Patient Advocate” has become ubiquitous among hospitals, insurance companies, and health systems. A Patient Advocate is a (lay) person/entity whose primary role is to protect the patient and their interests, but also to field complaints, advocate on behalf of the patient/family, and even go so far as to assist in decision-making regarding the treatment plan or course of care. They are supposed to help navigate the often complex and confusing healthcare system, and the interactions with doctors, hospitals and insurance companies.

Patient advocacy seems a noble pursuit, and often much needed. Patients and their families are distressed and vulnerable, even in good health; add illness, and the ability to navigate the system and the decision-making can be daunting if not impossible.

All well and good, but I wonder why there is this pressing need for an entire different profession, an additional layer, another buffer between the patient and the physician? Has the core principle of advocacy changed in my profession? Have we abdicated our responsibility, or is it something else? If it has not changed, if we have not abandoned our principles, what is it perceived as lacking?

As Voltaire (or Peter Parker/Spiderman’s Uncle Ben) says, “With great power comes great responsibility.” The powerful responsibility physicians have for the care of their patients remains, but the trust on which it is based has eroded. The bond between physician and patient — and between the medical profession and society — has become strained.

Individual patients, the general public, and the government have all become increasingly wary of physicians. Considerable effort and expense is employed to rein in the perceived power and control wielded by physicians, implying that there is little trust in the ethics, oaths, and codes that we have set for ourselves. Hospitals, healthcare organizations, insurance companies, and various branches of government and regulatory agencies, as well as licensing boards and health departments (not to mention lawyers) have bit by bit surrounded physicians and buried them under mountains of law and regulation, benchmarks and measures and protocols.

Health systems and insurance companies increasingly dehumanize physicians, treating the highly skilled and highly trained professionals like pawns on a chess board, faceless and interchangeable. Physicians drop on and off of “preferred provider” lists in arbitrary and capricious fashion, destroying any relationship and continuity built with the patient. Doctors are presented as interchangeable.

Worse, at times it seems that these groups are driving a wedge in the physician-patient relationship. As a consequence, patient trust and confidence is shaken. It is not much of a leap for the relationship to be framed then as adversarial rather than cooperative. If a doctor is no longer seen as the patient advocate, then of course the void must be filled.

But Patient Advocates generally haven’t the medical training or expertise. They may be also beholden to the system or entity that employs them. The most common and available advocates are generally working for a hospital or insurance company, whose priorities may not entirely align with patient and physician. This is problematic, of course, because it is often the hospital or insurance company the physician must stand up to on behalf of her patient.

It is imperative that physicians continue to shape our evolving healthcare system and promote that which preserves and protects our relationship with our patients. We must insist that we not only take a seat at the table among “stakeholders” in the healthcare system, but show that we are the best and more uniquely qualified to lead the efforts. We must again claim that space between patient and physician and remind not just our patients, but all others that indeed we are their advocates. The physician who fails to serve as an advocate for their patient also fails to serve as a physician to that patient. We must fight for the time we need, fight against the distractions, shore up the trust that has been strained so mightily.

There is nothing in the description of a patient advocate that isn’t already part of what we as physicians commit to do for our patients. We are, therefore, the first and the last patient advocate, their most effective advocate, the ultimate patient advocate.

I advocate for physicians to continue to claim the time and space to be effective advocates for our patients; and to embrace this responsibility, and not abdicate it to others. Taking the lead to work with, but not be replaced by patient advocates.

5 thoughts on “The Ultimate Patient Advocate

  1. Thank you for this insightful and much needed perspective. We physicians need to step up and reclaim our rightful position as the primary advocates for our patients. The walls between our patients and us grow higher and thicker by the year. If we each take our best relationships and hold them up for one another to see, from both patients’ and physicians’ perspectives, then perhaps together we can start to influence our system for the better.

  2. Andrea Borondy Kitts (@findlungcancer) says:

    I very much appreciate this post. As a retired engineer who lost my husband to lung cancer about 2 years ago and now patient advocate and MPH student I firmly believe that docs and patients need to team together in a respectful relationship. The doc needs to respect the patient as much as the patient respects the doc. That being said, the patient bears a responsibility to do his/her part for education and compliance and transparency in the relationship. Only by renewing and strengthening this relationship will we be able to counter the many organizations successfully attempting to strip all decision making power away from physicians.

  3. Jessica says:

    I work for Dr. Chris Porter, owner and founder of OnSurg, a surgery education website which was created to improve surgical care worldwide by supplying free, open-access resources and fostering conversation. He recently come upon your work and has expressed interest in cross posting your content onto our website and Facebook. Is this something you would allow us to do? All of your work would be linked back to your blog/website.

    I look forward to hearing from you,

  4. Vic N says:

    Let me let you in on a fact: be a harmed patient and you will see how quickly everyone is NOT your advocate. We have learned “patient advocates” follow the risk manager/lawyers, they are not there for us.

    • Dr. Kathy Hughes says:

      There are a lot of people in the hospital, from case managers to patient liaisons to ombudsmen and many other titles, including patient advocate, who all claim a piece of patient advocacy. Not all
      of these positions are primarily about the patient or advocating in their behalf, as you have unfortunately observed, when the goals and missions don’t completely align (patient, hospital, physician).

      Even with complications and patient harm, doctors strive to care for the patient and most are committed to doing the right thing. It is a casualty of the current state of medical malpractice and litigation that efforts for meaningful apology and mediation/compensation programs are stymied, all of which impair the relationship between patient and physicians–and not just those directly involved, this salts the ground for all physician-patient relationships.

      It is too bad that you had such a negative experience. I have to be hopeful that physicians can work together with patients to not only create meaningful programs, practices and procedures to advocate for our patients, but also build programs to support both patients and physicians in the event of complications and patient harm. There really is a “second victim” scenario in those circumstances (the physician him/herself), both sides need to be able to communicate, and be supported.

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