Having a Health Care Advocate

Did you know that you about as likely to have a bad outcome in the healthcare system as you are to lose your luggage at the airport?

In the field of systems analysis, British psychologist James Reason examined industrial accidents in multiple industries and concluded that catastrophic safety failures are almost never caused by isolated errors committed by individuals but more as a result of multiple, smaller errors due to system flaws.  He then developed the “Swiss cheese model”.  This model states that each hole in the layer of cheese is an error and if enough errors or holes line up then harm reaches the patient. The other conclusion he came to is that humans make errors.  Regardless of how much someone is rewarded or punished or we strive for perfection, in a system run by humans, there will always be errors.

In the healthcare system, we can automate as much as possible but given that most of the care has to be directly provided by another human, errors will happen.  The smarter system is one that is designed to catch errors before they reach the patient resulting in harm.  When in spite of best intentions, a patient is harmed, a “root cause analysis” is usually done to see why the system failed and the error happened. Was it due to system failure, human staffing error or failure to develop safe conditions.  In healthcare, we are always looking to improve care and reduce harm.

That being said, what do you do now that you are a consumer?  How do you protect yourself to make sure you are not harmed through the use of the healthcare system?  I personally always encourage my patients to have an advocate for their health and safety.  What does this mean?

According to the Agency for Healthcare Research and Quality under the U.S. Department of Health and Human Services, “A health advocate is a family member, friend, trusted coworker, or a hired professional who can ask questions, write down information, and speak up for you so you can better understand your illness and get the care and resources you need – giving you a peace of mind so you can focus on your recovery.”

Anytime I have to give a patient serious information about their health, I ask them to bring someone with them.  Two sets of ears are always better than one and it has actually been studied and shown that the on average only about 50% of information given to a patient can later be recalled.  Having someone with you will increase the amount of information that may be recalled or understood.  If you don’t have someone available, ask if you can record the visitor or put someone on the phone for you.

Second, you should ask questions about your health.  Sometimes, however, it becomes apparent to me that my patient may not even know what they should be asking.  I will try to pay attention to those cues when I see them and try to focus on information I know my patient will want to know and need.  Having an advocate who is knowledgeable in health care to prompt questions for you can be a great help!

Next, I suggest you write it down.  My patients will often take notes about what we discuss. I try to go the extra mile and give them a written plan in their visit summary of what we discussed, what was ordered or changed, and what referrals were made, to whom and how to contact them.  Unfortunately, not all providers do this although they should be!  Don’t be afraid to ask for this information.  Too many times I find patients become intimidated and don’t ask the questions they have!

Ask for more information or handouts to reinforce what was discussed.  We all learn by different methods, some are auditory learners while some are visual learners.  Having the information discussed in an alternative form will increase the likelihood of you understanding what the provider was trying to tell you.  Plus, I guarantee when you get home, your loved ones are going to say “what did the doctor say” and your most common response is going to be “I don’t know” or “I can’t remember”.  If you have a visit summary, your notes or a handout, it will reinforce the information recall but repetition in information.

Lastly, have that advocate there for you to act as your safety shield.  Anytime you are receiving health care, risks will happen. Falls do happen in hospitals.  Patients are tethered to IVs or monitoring systems making it difficult to get out of bed, to the bathroom or about in the room.  Having someone there to assist you or call for nursing help when needed will reduce that risk.  Anytime you are given a medication, ask what is being given and what it is for.

In most cases, your advocate will be someone who you trust and respect and has your best interests at heart.  In a perfect world when seeing specialists, your advocate would be your primary care provider.  Don’t be afraid to ask for them to communicate with a specialist directly if you have concerns about the treatment plan.  Remember, you are always part of the team in making decisions about your healthcare!

Pura Vida!

Karen Radley, MD

Please share this with your loved ones to show you care and are watching out for their wellbeing!