Sep 15 2014

Chutzpah! Know When It Crosses the Line

chutzpahOne of my favorite words:  Chutzpah!  Pronounced “hoots-pah.” A Yiddish word translated as “shameless audacity” or “supreme self-confidence,” as in (according to Merriam-Webster) “personal confidence or courage that allows someone to do or say things that may seem shocking to others.”

….  and sometimes a trait required by the most effective of health and patient advocates.

  • Do you have chutzpah?
  • And more importantly, do you know how and when to use it?

I ask this because I think there are appropriate times, and inappropriate times, when an advocate needs to showcase his or her chutzpah.  Lately I have experienced both, and I wonder how that translates to its use for clients.  I know some of you experience it, too.

Having chutzpah, and being able to use it, means you have enough confidence in what you are asking for that you believe you are entitled to, or possibly deserving of the outcome you request.

An example: your elderly client is in the hospital, sharing a room, and a single room comes open across the hall. You know your client would be much happier in that single room, so you ask to have him moved. Of course, they have already determined that someone else who is private pay is going to get that room, but you make the case (just enough of a stink) and ultimately your client finds himself alone in that single room.  Yes, you demonstrated your chutzpah. Now your client is happier.

Another client-related example might be when that same client gets the bill for that single hospital room, which wasn’t approved by Medicare, and for which you now argue with the billing department to have the extra charges removed from his bill.  After all, you believe it was crucial to his ability to heal.  And, oh, by the way, you’ll do your best to be sure he doesn’t need to return to the hospital within that 30 day window, meaning they won’t lose money on his readmission. <<wink wink>>

That’s chutzpah!  But – does it cross a line? Is it more like bribery? or blackmail?  or….  ?

That’s the big question.  Where is the line? And is it appropriate to cross it?

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Sep 08 2014

Babbling Will Get You Nowhere

rejectionMargaret needs help for her aging father who lives 600 miles away from her. She wants to find someone to accompany him to doctors appointments, someone who can review and organize his medical bills as they arrive, and someone who can discuss his medical needs on a three-way phone call (Dad, Margaret and an advocate) once each week.  Dad is happy with the idea and is willing to pay for the service.

The “perfect” client, right?

Here’s how I know Margaret’s story:  She sent an email to our “info” email address at AdvoConnection, asking for the best way to find an advocate.  We sent our automatic reply that explains how to use the patient’s zip code, and the services needed to find the right person in the AdvoConnection Directory.

Margaret replied that she had already done that, and had called the only advocate listed in her father’s location.  However <quote> “All she did was babble on about herself and her own medical problems. She dissed a couple of doctors in ____ (the name of the town) including Dad’s doctor who is a family friend!  I don’t want to work with her. I need someone else.”<unquote>


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Aug 25 2014

Happy Birthday to Us! AdvoConnection Turns 5

birthdaypeopleDateline:  September 1, 2009
The AdvoConnection membership organization was launched on this date in an effort to find people who could help patients navigate their medical journeys.

Happy Birthday to Us!  (Yes – “us” – because the AdvoConnection Membership Organization was the original name of Alliance of Professional Health Advocates!)

My how times have changed!  (And yet, they haven’t changed much at all… )

The original site was only intended to be a directory – sort of for patients and advocates – and 30 people stepped forward to be included. (We had been collecting email addresses of interested parties since early 2007.) Many are still members of the organization today – charter members! – meaning they have been successfully providing services to patients for at least five years. (I hope that gives some of you newer folks some hope :-) )

My how healthcare times have changed too! (And yet, they haven’t changed much at all… )  I remember that when we launched, some pundits thought we would be no more than a short-term solution… After all, healthcare reform was approved just a few months later. That was going to fix the system! 

But of course, it not only didn’t fix the system, but if anything, it only makes what our members do even more important than ever before.

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Aug 18 2014

You’re Not Charging Enough, and It’s Hurting Our Entire Profession


  • What is it worth to find someone who can save your life?
  • What is it worth to find someone who can provide quality to a life that has little or no quality because of health problems?
  • What is it worth to find someone who can save you tens of thousands of dollars, or to prevent you from going bankrupt?
  • What is it worth to find someone who can alleviate your fear, and provide peace of mind?


I can tell you what it’s worth based on what I read in the press, in the APHA Forum, in my email and based on feedback from many of you:

On the high end, it’s worth about $350 an hour.

But on the low end, every day, many of you behave as if it’s worth is $0. Nothing. Zero. Nada. Zip. 

And in most cases, you don’t realize that is what you are doing.

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Aug 11 2014

The One Thing That Will Cause Your Private Advocacy Practice to Fail

Here are samples of some inquiries I have received from people wanting to be advocates. See if you can guess what they all have in common:

I want to help Medicaid patients find doctors who will take their insurance.

We plan to help children with mental health issues find the help they need.

I want to help young girls who find themselves pregnant find the social services they need to get them through their pregnancies.

I want to work with churches and senior centers to help their members and attendees understand their medical care.

I want to help lymphoma patients with shared decision-making about their treatment.

I want to help children in _____ County who have neurological disorders. (The county named is in a poor, rural part of a southern state.)

One thing they have in common is that everyone of them has a noble and worthwhile mission. They have developed missions that come from each inquirer’s heart.  There is no doubt there will be people who need them and who they can help.

But that one thing they have in common is also the one thing that will cause them to fail in private practice, too.

How so?

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Aug 04 2014

The One Thing You Must Do to Grow Your Advocacy Practice (and Take a Vacation, too)

workingbythepoolThe answer to this notion of “the one thing you must do” boils down to trust, although maybe not in the way you’ll expect…

I say this to you, with the keen awareness of the fact that trusting isn’t something I do well.  Having spent the first half of my life as Pollyanna reincarnated, then having been burned by too many people I DID trust along the way, including an ex-husband, an ex-business partner, and the notorious reason for all this empowerment and advocacy work of mine – the doctors who I trusted to help me whether my mysterious odyssey in 2004 - I hope you’ll understand that trusting isn’t exactly my long suit. Pollyanna, as represented by Trisha Torrey, long ago left the building.

So, whereas in the first half of my life, when anyone I met was trusted by default, that’s far from true in these past few decades. It is a huge struggle for me to trust anyone enough to relinquish any sort of control I have over important, personal situations. I can count the people I do trust with those situations on one hand.

That means this post, about the one thing you need to do to grow your practice (and take a vacation) is a bit like the pot (me) calling many of you kettles, black. Yes, I know this advice will be a tough pill for some to swallow, and I truly do understand that many of us need (what amounts to) a 12-step program to make it happen.

So what is that one thing?

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Jul 21 2014

Mentors and SIGs – Our Best Resources Yet

tshirtWhen APHA and AdvoConnection were launched in 2009, the resources that existed for starting and growing a private, independent advocacy practice were few and far between.

There weren’t many advocacy experts, because with only a few exceptions, there just weren’t many people with the track record to call themselves experts. Certainly there were experts in different useful topics; for example lawyers or insurance people who could take what they knew and apply it to advocacy. So we took advantage of those experts’ good graces to build the first foundations for practices going forward. We still rely on them, and appreciate their help, today.

Now fast forward to today.

These 5 years later we have dozens of experts in almost every aspect of starting and growing an advocacy practice, in the advocacy work itself, in patient education, and more… Early adopters who have ‘been there, done that” – and would be happy to show off their T-shirts. Real advocates. Real success stories!  Even among those who haven’t launched their practices yet, we have almost every topic imaginable represented among our APHA members – people who can speak to the expertise they have brought to advocacy, and what they have learned along the way.

Now we’ve made it easier for you to find them – and for them to help you.

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Jul 14 2014

The Real Cost of Selling One’s Soul


I heard from a friend that he recently sold his start-up business after years of building it to do just that.

Wow!  I was so impressed!  “Take a break!” I replied. “I can only imagine how much work that was and how much money you must have made!”

Yes, he told me. It was a LOT of work and he is exhausted. But, he confided, he really didn’t make much money in the sale.

What?? I was flabbergasted… Then I learned why. It seems that he and his partners, in order to raise the money they needed to make their business so enticing and salable, had given away most of the company to investors – first angels, then later venture capitalists – so that by the time they sold it and all those investors took their chunks of the profit, there was little left for the original idea guys who had started the venture. (ouch!)

It got me to thinking.

Over the years, I have been approached by businesses that want to “support”my work. The first time it was a pharmaceutical company that wanted to pay me to speak to patients diagnosed with the diseases their drugs treated, teaching those patients about empowerment principles, and (oh, by the way) about the great work their company was doing. The offer came very early in my patient empowerment career and I was really hurting for income. I was so hurting that I didn’t know if I could keep doing the work I wanted so badly to do! Their offer was extremely tempting. I gave it some serious thought…

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