BY: JULIE ANDREWS
Ms. Andrews is director, patient
and physician relations, Georgetown University Hospital, Washington, DC.
Patient advocates are people who
must not lose sight of the patient and the family despite the herd of elephants
stampeding through the halls of our organizations. We struggle on a daily basis
to balance potentially conflicting missions. Despite these distractions, we
need to stay focused on the patient and gently remind coworkers why they chose
their noble professions. Health care providers are simply honored guests in
the lives of patients and their families, and as such they must earn patients'
respect.
We advocates act as liaison among
patients, staff, and physicians. Our job is to recognize and remove institutional
barriers in order to provide high-quality care. Our goal is to help patients
and family members push the envelope: to question care decisions, be included
in care delivery, and challenge bureaucratic rules.
As we make our daily rounds, we
look for people in trouble. We look for unattended elders left in the emergency
department by nursing homes, unattended children, repeat admissions, patients
with sickle cell anemia, and patients who are dying. We look for those with
cultural and language barriers, those with poor prognoses, and those with a
history of noncompliance. Most often overlooked are the quiet elders. When I
ask a typical quiet elder how he is, he says, "How are you, my dear?"
They are silent people who may be in trouble.
We ask everyone to be on the alert
for high-risk patients, to be an advocate, and to question the ethics of all
our actions. As patient advocates, our goal is to work toward our redundancy.
We ask everyone to have the courage of their convictions, such as advocating
on behalf of a patient being discharged prematurely. When a patient's rights
are not being honored, we must step in. Our role is to address all topics we
are afraid to discuss — the elephants in the room — no matter what they
are. Whining and abdication of this responsibility are unacceptable.
A third-year medical student once
came to see me and said, "As you make your rounds Miss Andrews, I would
really appreciate it if you were to see this very difficult family — they
are elderly." So I met them: a patient with a chronic disease and a caretaker
with a chronic disease. The young student had gone into the room and had clearly
offended this couple. The student's interpretation was that they were very
difficult, and he passed them off to the next shift. So I went back to the student
and said, "Well, Peter, I would be delighted to see this couple. But I
really need you to come with me." "Oh," he said, "That's
not what I had in mind." When I took Peter back to see the couple, they
were mortified to see him again. I introduced him and said he had something
to say. I hoped to God that he knew why I had brought him back. Finally, after
a dreadful pause, the student found it in himself to say the needed words: "I'm
sorry." He will do well in medicine.
In advocacy, the precise nature
of the animal in the room doesn't really matter, in my view. The patient
is the focus, and that is nonnegotiable.