I was quite surprised in a conversation recently with an advocate who is not (yet) a member of AdvoConnection. OK. That’s putting it mildly. I was actually stunned.
“Why do people feel well served by you?” I asked him.
“Because I have a beeline into all the good doctors,” he replied.
When I asked him to explain further, he said it was because he knew the best doctors to recommend and which ones to tell patients to avoid.
[Pause. Letting that sink in…]
In conversations with both long-time advocates, and lawyers, too… and honestly – what makes common sense – is that a patient advocate or care manager should never (I mean NEVER!) make a recommendation about a doctor.
Here’s why:
Suppose you do make that recommendation – and the patient sees the doctor – and something goes terribly wrong. (Now – don’t tell me nothing’s going to go wrong. We all know better than that!) The fact that you were the professional who recommended that doctor will come back to bite you in the backside either as word-of-mouth that could destroy your reputation, or as a lawsuit, which won’t do much for your business or your reputation either.
Now suppose you recommend AGAINST a doctor. We’re not talking about two buddies having a conversation about a doctor here. You are a professional, and telling someone NOT to see a doctor is a professional recommendation – which could result in a lawsuit (libel, slander – I always forget which is which.) It makes no difference if the lawsuit isn’t warranted. It will cost you time, money, and reputation regardless of the fairness of it.
What to do instead…
The best way to serve your clients is to develop lists of 2 or more doctors in each specialty area they will need. When you know your patient needs to find a new doctor, you can recommend those on your list who meet the criteria (always more than one – 4 or 5 is best). Then have the patient or the caregiver choose which of the doctors they think is best for them. You can help them verbally with pros and cons, but you may even want to develop an official-looking statement that says they are choosing THAT doctor, and you have not coerced them into choosing any particular doctor.
How do you find the right doctors for your list? You talk to others about their experiences. And you always ALWAYS do a background check. Any doctor you recommend must have impeccable credentials. Further, you keep in mind that nice does not equal competent.
Providing a list to your client, then asking them to make the choice, does two things. First, it puts the power in the hands of the patient or caregiver – definitely a confidence builder and a better feeling on their part that they are (at least partially) controlling their care choices. Second, it keeps you from putting your advocacy work and reputation in jeopardy.
Agree? Disagree? Please share your opinion!
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Good advice here, Trisha.
I, too, have a large network of fine physicians. As an advocate and a medical writer, I attend medical conferences frequently and meet thought leaders throughout the world. I sometimes speak with physicians to see if a particular treatment or medication might be useful for my patients. When and if I do find something that might be useful, I sometimes bring it to the attention of my patients’ physicians–often in the form of a question: Might drug X or procedure Y work in this case?
I wrote recently about one patient whom I took to the ER. He had a painful carbuncle on his groin. I had discussed his condition with several physicians who strongly suggested a trip to the ER. All feared methicillin-resistant Staphylococcus aureus (MRSA). Good to rule this out. The ER physician, however, dismissed MRSA and prescribed amoxicillin. I was strongly convinced the diagnosis was wrong. When the amoxicillin failed, as I feared it would, I urged my patient to visit an infectious disease specialist. I had recommended several hospital-based specialists in the nearest metropolitan area. The patient finally took my advice, but only after the carbuncles had spread to his limbs. He saw a local physician of his own choosing who diagnosed MRSA. Fortunately, the patient received the medication he needed and now wears an ID bracelet identifying him as a MRSA carrier. Had the infection been more virulent, I would have trucked him back to the ER and demanded that the doctor (or another) rethink the diagnosis. In this case, it was clear that further treatment was necessary.
In this patient’s case, I had spoken with 3 physicians who urged immediate action. And although the patient agreed to going to the ER, he did not follow my advice to see an infectious disease specialist immediately. He gave in only when the carbuncles had spread and caused him increased pain.
Another patient was raising twin granddaughters born to her drug-addicted daughter. I was concerned that the girls might be Fetal Alcohol Syndrome (FAS) babies (based on their history and facial features), and recommended three physicians in our state who specialize in diagnosing FAS and who would provide treatment or guidance. I thought it might be useful to explore the possibility or to rule it out. The grandparents rejected this entirely and waited several years (5 to be exact) before seeking help. A local physician of their choice found the twins normal, despite their having some learning and behavioral difficulties. Unfortunately, diagnosing FAS is not straightforward. But the decision to use a local physician was the grandparent’s choice. Fortunately, the girls are well cared for and loved.
Each man walks his own path.
Absolutely agree! I anticipate patients asking us questions like,
“I need to go into a residential/nursing home. Could you recommend one?” or
“I need to see a specialist and am afraid of seeing someone incompetent. This is so important–I can’t take a chance. I don’t want to end up permanently crippled or in pain. Could you recommend one?”
Of course, we could give a noncommital “lawsuit-proof” answer such as: “Here’s an official published list. Go and choose.”
No! We are advocates and it is our duty to protect our clients. With an official published list, the client might be given poor treatment–because we failed to do our duty to advise constructively. In fact, such bland advice could lead us to a lawsuit after all.
The list of 3 or 4 (or more) makes perfect sense. “Here is a list of …. Although I cannot make guarantees, of course, I know them personally. I have investigated them throroughly and heard only good things about them from patients. I’m sure there are other good providers if you choose to explore further. But you may go to these [on the list] with confidence.”
Best, David Wiesenberg
Good advice but I think the advocate would still be liable for making the recommendation if anything goes wrong. As you know, we live in a very litigious society and when something goes wrong and someone feels they were wronged, is injured and makes the decision to sue, everyone gets pulled in…so in addition to providing options and having the patient make the final decision, make sure that you carry malpractice insurance.
Anne