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Always Have Someone with You in the Hospital

Why You Need a Personal Health Care Advocate


Why You Need a Personal Medical Advocate

by Dr. Abigail Schildcrout

The number of government regulations regarding health care is exploding. The Affordable Care Act is well over one thousand pages. The extent of rules delineated by HIPAA and its subsequent related legislation is mind-boggling. Doctors are trying to understand and fulfill “meaningful use” requirements of electronic medical records, and trying to make sure they click an adequate number of boxes on their computer during your visit so that they don’t get charged with fraud and fined thousands of dollars for submitting a bill to Medicare that is not coded at the level reflected in the computer documentation.

A typical primary care physician has thousands of patients in his or her practice, and sees scores of patients each week. The population is aging, and the Affordable Care Act adds millions of people to health insurance rosters. Reimbursements to physicians are decreasing. Physicians who do not want to take on more patients are forced to do so in order to keep their practices afloat. As the number of patients in their practices is multiplying, the time most physicians are able to devote to any individual patient is decreasing.

More and more doctors are becoming employed by hospitals or giant groups, and their employers are telling them how many patients to see, who to refer to, and what treatments or tests to order or not order.

A physician serving as a personal medical guide and advocate can bridge the chasm of knowledge between a person and their doctor.

Patients are frustrated. Doctors are frustrated.

In days past, doctors would tell their patients what to do. We describe that today as “paternalistic medicine.” The more modern approach is one of patient autonomy, where a well-informed patient makes his or her own decisions related to medical care and treatment. In a perfect world, doctors would all have time to teach their patients and help them make informed decisions. In the real world, doctors do not have this time. Far too often, patients are left with the choice of blindly following a recommendation or of finding their own information and making their own decision, whether it is well-informed or not. A physician serving as a personal medical guide and advocate can bridge the chasm of knowledge between a person and their doctor, so that the person can work as a partner with their own doctor, optimizing their medical care, and making the choices that are best for them.

Doctors expect their patients to do what they tell them to do. This is most likely to happen when the patients understand why their doctor is telling them to do something, when the doctor understands the patient’s concerns about her advice, and when the doctor and her patient have the same goals. When you have a physician serving as your personal medical guide and advocate, you have someone who will help you and your doctors understand one another. You will have the strongest possible team working towards your health and medical goals.

Your doctor will tell you, “Your biopsy came back positive for cancer. I’ll give you a referral to Dr. Jones, the oncologist we generally refer to.” A physician serving as your medical advocate will research where cutting edge research is being done on the type of cancer with which you have been diagnosed. She will help guide you towards second (or subsequent) opinions before you start down a particular treatment path that may be difficult to change later. She will speak with you about your personal goals regarding your condition, and will help make sure that your wishes don’t get lost in the tumult of dealing with a serious diagnosis.

Your personal medical guide and advocate can educate you so that you are best able to make informed decisions as you go along. To the extent possible and that you desire, she can include your family members and/or others close to you in your discussions. If you desire, she may be able to arrange to accompany you to appointments with your primary care doctor and/or specialists.

Your doctor will tell you, “You have pre-diabetes. We don’t need to put you on medication yet, but watch what you eat and I’ll see you back here in three months.” Your medical advocate will sit with you, explain what diabetes is, what its natural course is, what treatments you might expect as the condition progresses, and how you might be able to alter or delay its natural course. She will review your eating and exercise habits in detail, and at your request will look in your refrigerator and pantry to see where changes in grocery purchasing could make a difference in your health. She can go with you to local grocery stores and help you fill your cart with items that will help you attain your health goals.

Your doctor will tell you, “You need to lose some weight.” Maybe she’ll give you a specific number of pounds. Maybe she’ll tell you how many calories you should eat each day. She’ll tell you to come back in a year for your annual visit. A personal medical advocate will sit and talk with you about your eating habits and activity level. She will review food diaries with you. At your request, she may look in your refrigerator and pantry, and advise you on what changes in grocery purchasing could help you in your quest to reach a healthier weight. She may go shopping with you, teaching you how to fill your cart in the healthiest possible way for you and your family. She will help you figure out where your roadblocks are to healthy eating, and will help you navigate around those roadblocks. She will look with you to find your obstacles to healthy activity and exercise, and will strive to make healthy activity not only workable for you, but an enjoyable part of your life.

Your doctor will tell you, “Your blood pressure is a little high.” Maybe he’ll tell you to come back in a few weeks or a couple months to check it again, and that if it’s still high, he’ll start you on medication to lower it. What can you do in the meantime? Your medical advocate will sit with you, review your general medical history, weight, eating habits, activity level, medications, and family history. Together, you’ll see if there are changes you can make that might lower your blood pressure without medications. She can help you formulate a plan to review with your doctor, and maybe you’ll be able to safely avoid (or come off of, if you’ve already started) medications.

The person can then work as a partner with their own doctor, optimizing their medical care, and making the choices that are best for them.

You set up an appointment with your lawyer to discuss a will or trust. He asks you if you’d like him to draw up Medical Advance Directives as well. What are these? Your lawyer can explain what these documents mean legally, but how do they affect your care in actuality? A doctor serving as your personal medical guide and advocate can sit with you and your family members, discuss your overall wishes regarding medical care, and explain how the existence of certain advance directive documents is sometimes misinterpreted by hospital personnel and medical professionals. She will work with you and your family to teach you how to avoid the misinterpretations, and help you formulate specific questions for your lawyer and your doctor so that you will be more likely to have your wishes honored, whether for more aggressive or less aggressive care.

Your personal medical guide and advocate will listen frequently and carefully to you, assessing and reassessing your understanding of your medical situation, assessing and reassessing your goals, charting and recharting paths with you, helping you navigate roadblocks, and keeping you in the driver’s seat. She is your copilot, guiding you through your medical maze, whether it’s a long or short one, complicated or fairly simple, on your own or with ones you love.

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From Dr. Schildcrout:

Dr. SchildcroutI'll give you the time and attention that your doctors can’t give you, and in so doing, give you the tools to get the most out of your appointments, conversations, and relationships with your doctors.

I am here for people who want help taking charge of their own or their loved one’s health. I will teach you, guide you, and coach you. I will help you communicate skillfully within the medical world. You will become knowledgeable, savvy, and tough as you become your own best advocate. You will understand your doctors better, so that you can maximize what you get out of your office visits, and you will understand how hospitals work, so that you can get safe, optimal treatment when hospitalized and after you leave the hospital. I will be at your side, either figuratively or literally, guiding you, stepping in when necessary to break through medical red tape, and communicating directly with doctors and other medical personnel when necessary or preferable.

I care, and I am here for you.

To discuss how Practical Medical Insights can help you, Call Dr. Schildcrout at 248.439.9123 or e-mail today.

Practical Medical Insights and Dr. Schildcrout will not serve as or replace your own physicians.