Patient Advocacy—A Step in the right Direction

/, Consciousness/Patient Advocacy—A Step in the right Direction

By Deepak Chopra MD, Lizabeth Weiss, BA, Nancy S. Cetel, MD, Danielle Weiss, MD,  Joseph B. Weiss, MD

 

When the average American goes to the doctor, shows up at the ER, or enters the hospital, the risks and complexities of our healthcare system strike home vividly. Besides the expense of care and the intricate tests and procedures a patient faces, there is a widely under-reported risk of medical mistakes and “adverse events,” as they care called, which can range from minor to disastrous.

 

The new idea whose time has come is the patient advocate, someone who represents the patient’s best interest in any medical situation. An advocate might be a well-meaning relative who helps an older patient understand what’s going on, stepping in to do attendant tasks like picking up prescriptions and organizing medical bills. But more and more we see the need for an advocate who is professionally trained to buffer the mounting risks in a healthcare system where less and less time is spent between doctor and patient, raising the possibility of a wide range of bad outcomes.

The public has limited knowledge of the relevant facts:

  • Medical errors are estimated to cause 440,000 deaths per year in U.S. hospitals alone.
  • The total direct expense of adverse events is estimated at hundreds of billions of dollars annually.
  • Indirect expenses such as lost economic productivity from premature death and unnecessary illness exceeds one trillion dollars per year.

 

What the patient is all too aware of is the doctor visit that goes by in the blink of an eye.  A 2007 analysis of optimal primary-care visits found that they last in toto 16 minutes on average.  From 1 to 5 minutes is spent per topic discussed. Although a visit to a primary-care physician or specialist has increased to 20 minutes, a shift in a doctor’s workload in recent years, some of it mandated by law, finds more time being allocated to computer and desk work, such as entering data in the Electronic Health Record (EHR).

 

The actual face-to-face time with a doctor or other health care provider actually comes down to 7 minutes on average. Therefore, a patient advocate clearly has a huge gap to fill. The advocate can begin by simply observing the visit or procedure to make sure that simple mistakes and errors in communication don’t occur. Many of these are unavoidable byproducts of nurses changing shifts, hospital doctors on rotation, etc.

 

But in an aging population, the advocate’s efforts become even more critical. An advocate can take time to take a detailed patient history, something often lacking in our rushed system. They can translate information into the patient’s first language as needed, calm nerves in the stressful and unfamiliar surroundings of a hospital or clinic, and thereby bring to the fore the questions and answers that need to be transmitted. In the stress of a medical event, it’s very common for patients, particularly the elderly, to be so flustered and anxious that they forget to ask important questions or give important information.

 

Not everything is potentially positive if patient advocates become a standard part of health care. If they have their own agenda because their employer is a hospital or insurance company, the patient’s best interests may not be uppermost. One anticipates antagonism between the advocate and the doctor, who isn’t used to third-party input and values his autonomy. And if the advocate isn’t calm, professional, and common-sensical, adding another anxious person in the examining room would be a detriment.

 

Still, we feel that the benefits far outweigh the potential downside. The key is for advocates to be accepted as a positive extension of the existing system, not an opposition party.  A concerted effort to standardize a curriculum and certification for advocates is now being developed. It needs all the support it can get. The creation of an educated, licensed workforce of professional advocates can and should be an integral part of improving the safety and efficacy of our national health care. With your eyes now opened, you’ll see how great the need is the next time you need to see the doctor.

 

Deepak Chopra MD, FACP, Clinical Professor of Medicine, University of California, San Diego, Chairman and Founder, The Chopra Foundation, Co-Founder, The Chopra Center for Wellbeing

 

Lizabeth Weiss BA, Research Associate, The Chopra Center for Wellbeing, Assistant Director, Rancho Santa Fe Senior Center

 

Nancy S. Cetel, MD, President and Founder, Speaking of Health and specialist in women’s health and reproductive endocrinology.

 

Danielle Weiss, MD, FACP Clinical Assistant Professor of Medicine, University of California, San Diego, Medical Director & Founder, Center for Hormonal Health & Well-Being

 

Joseph B. Weiss, MD, FACP, Clinical Professor of Medicine, University of California San Diego.

 

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1 Comment

  • It is wonderful to see that there is a recognition of the importance of a patient advocate who works on behalf of the patient. However, this is not a new concept. As a Registered Nurse who was trained in the 70s, the essence and commitment to that role was at the foundation of everything we were taught in Nursing school. We were not taught that we were subordinate to the physicians but collaborators in the care of the patient. Perhaps, rather than recreating a new role and education, we should rebrand the role of the Registered Nurse! And along with that identify a mechanism to pay for that advocacy. Home health nurses have a tremendous opportunity to support the outcomes for patients with chronic illnesses and prevent unnecessary hospitalizations which are expensive and potentially life threatening for the elderly. There are opportunities for Medicare to become more creative in their approach to supporting advocacy for the elderly, and controlling the cost of their healthcare and the outcomes of their wellness. As it exist now the only control for cost is the death of the insured. In the hospital environment there is no separate billing for the bedside RNs’ care and advocacy, the bedside nurse is expertise and care is lumped in with the room charge. So quite honestly even the hospital nor insurance companies recognize the education and expertise that the bedside nurse brings to the outcomes of the patients care. There are many RNS across this country and the world who take seriously their role as patient advocate. Altho they may work in a hospital, an outpatient clinic, in home health, or for an insurance company, they remain vigilante in their advocacy for the patient. I am not saying very nurse receives this type of education nor does every nurse resonate with this role but it really is the role they are qualified to fill and should be filling in the healthcare environment. There are many seasoned experienced nurses who don’t need additional letters behind their names to qualify them for this role. They are out there in every patient care environment, we just need to bring recognition to the role they should be filling through rebranding and financial recognition for the role in the billing of services rendered! Just like we bill for a Physician, an NP, a PA, PT, OT, ST. RNS are also licensed but nowhere are they recognized in the healthcare payment system as an active contributor to the patient outcomes.

    Constance Dias 26.02.2017

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