In good health: Advocating for the patient

By Marc A. Singer

Issue of June 4, 2010 / 22 Sivan 5770

In my nearly 25 year career of caring for patients, I have witnessed medicine evolve in its science, management, and in the patient-doctor relationship. As the patient population has morphed — due to both advanced age and the acuity of illness, demands on everyone involved in patient care have escalated. It is evident that much like we have physician extenders — in the form of Physician Assistants and Nurse Practitioners — we also have patient extenders. They help the patient in various aspects of their care.

Non-Medical

As patients are less able to care for themselves due to illness, their needs are certainly greater. Visitors can do for patients what patients cannot do for themselves — ranging from common things, like food (if permitted), to amenities, to things that will more directly help the patient’s care (again, with the approbation of the medical team). As staffing in a hospital is sometimes at a premium, I would suggest you ask the staff what you can do to help them take care of the patient. It may be something as simple as walking with the patient, washing or shaving them, or just getting them out of bed. Above and beyond providing care, the advocate can be the voice of the patient, in varying roles — from pointing out a possibly overlooked abnormality, or alerting the staff to a patient’s distress.

And Medical

Oftentimes, patients are unable to speak for themselves. This is where the people around the patient can play a pivotal role. So much of what physicians base their decisions on is rooted in the patient’s history. If the patient cannot convey that on their own, because they physically cannot, or there is a language barrier, or even if the patient is distracted by pain, the patient and the medical staff will depend on someone other than the patient to provide this needed background. This includes medical history, medications currently prescribed, and allergies. I have seen patients come in with typed lists, or even laminated cards containing this information (in the not distant future these will be supplanted by a computer chip that everyone will carry with their entire medical history. But until that is commonly available...).

Medical information is a two way street. Patients may not hear, comprehend or retain everything they are told by the medical staff (this becomes especially true if bad news is conveyed). It is therefore equally useful for the patient to have someone there who can help the patient process the information. This person can help fill in the gaps for the patient at a later time, when the medical team may not around to do so.

Watchdog

No one is perfect. Mistakes are made, and health care providers are only human. Fortunately, mistakes are few and far between. Nonetheless, everyone needs to be alert for the possibility. We have all heard stories of the wrong medication given, or administered at the wrong time. The wrong patient is transported for the scheduled test, or the story that makes headlines: the wrong side of the body (arm, foot, etc) undergoes the surgical procedure intended for the other side! We all need to be mindful of these possibilities. And, while on the topic of what we need to watch for, remember that hospitals harbor bacteria. These microbes are more virulent and resistant than those found in the community. Moreover, they are easily transported from one patient to the next. Hand washing is paramount in preventing this, and we need to be watchful that everyone coming in to examine or even touch the patient washes their hands first.

Spokesperson

I must differentiate between acting as the patients’ spokesperson versus advocate. These are separate and distinct roles. As discussed above, there are circumstances when the patient cannot express his own wishes with regard to their medical care. Ideally, s/he would have previously designated someone who would be able to convey those decisions on behalf the patient. That is the role of the health care proxy, to whom the medical staff can turn to convey the patient’s desires regarding their medical care.

The health care proxy is different than a patient advocate. Oftentimes, patients cannot speak up for themselves. They need to express their thoughts and concerns regarding their medical care, to voice their questions or request alternatives to the care they are offered. This advocate is the one who speaks up on behalf of the patient.

Most physicians these days can accept being questioned. I would suggest this not be done in a challenging, confrontational manner. As to how to interface with the staff, I would remind the advocate of two very important facts: Not only is the medial provider not obligated to speak with anyone but the patient, they may not even be legally permitted to discuss the patient with anyone not designated by the patient (this is proscribed by the HIPPA act, which provides for protection of patients’ privacy).

My personal advice as to how advocate is based on common sense. First, only one person should act as the patient’s representative. Nothing can be more upsetting than being called by several different family members with the same set of questions or suggestions. Second, be patient. Realize that though your friend or relative is your paramount concern, there may be many other patients and their advocates vying for the doctor’s time and attention. I would suggest trying to set a time to speak with the physician (either in person or by phone) that is mutually convenient. It is good to be researched and focused. In the age of the internet doctors and hospitals know that everyone has access to a vast amount of medical information. Some doctors may be threatened by someone coming in with printouts from the Journal (either Wall Street or New England - both report the latest medical breakthroughs), so remember that you are advocating on behalf of someone else, and this is best accomplished in a non-confrontational manner. Personally, I sometimes expect a discussion to ensue with a member of a patients’ family. After all, an informed consumer...

And please remember the patient is just that, a medical consumer. We research other products that we use — from household products, to cars to schools. Why should something as important as medical care not be treated in the same manner? There is no greater compliment to a physician than knowing that s/he is chosen and recommended, rather than being used by default.

Providing medical care is a team approach. It is just that in the modern era, the team is ever- expanding.

Dr. Marc Singer, M.D., F.A.C.C., practices internal medicine and cardiology on the North Shore of Long Island. He is on staff at Long Island Jewish Medical Center and North Shore Hospital in Manhasset. He wrote this article while advocating for his father, Chaim Menachem ben Malka, in need of a complete recovery among Cholei Yisroel.

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Calling All Teens: Learn CPR

By Jewish Star Staff

The American Heart Association is calling on a new audience — teens.

“We are reaching out to teens to create the next generation of lifesavers,” said Michael Sayre, M.D., chairman of the American Heart Association’s Emergency Cardiovascular Care Committee. “Teens can learn how to save lives and play an important role by setting an example for their friends, families and neighbors about the need for CPR (cardio-pulmonary resuscitation) and AED (automated external defibrillator) training — and they can encourage the adults in their lives to learn CPR.”

During CPR Week, the association will increase awareness about CPR and automated external defibrillators (AEDs) so more people will know the simple steps to save a life if someone suddenly collapses from cardiac arrest.

Anyone – teen or adult – can help the association reach its goal by playing the “Be the Beat” educational game or watching the Hands-Only CPR video at cprweek.org.

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Photo courtesy UJA

The UJA-Federation Long Island South Shore Healthcare Professionals dinner was held on April 29 at Temple Hillel of North Woodmere. (l-r) Neil Smith, M.D., Eric Lippman, M.D. Eric Thall, M.D., and Neil Berman, D.D.S.