Chutzpah! Know When It Crosses the Line

One 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?

I think it boils down to that word bolded below: entitled.

There is such a thing as true entitlement, and then there is the other side of that coin – non-entitled. But yes – there is also a gray area – where someone is possibly deserving, too.


As an advocate, working on behalf of your client, you need to be aware of which area a request or a need falls under, and approach it appropriately. If your client is truly entitled, then of course, go for it. If your client is possibly deserving, then go for it too!

But if your client is clearly not entitled, then you run the risk of creating bigger problems for yourself and your client down the road. Because making the decision-maker, the person who holds the winning cards, mad enough that they dig in their heals, may make it impossible for you to successfully get your way in the future.

I’ll give you a non-advocacy example – the request that precipitated this post:

Recently one of our APHA PACE members (who paid $49 for her membership) asked me if she could have access to the client contract we offer Premium members (who pay as much as $289 for membership.)? I politely declined her request, but invited her instead to upgrade her membership so she could have the access she needed.

I gave her some credit! I didn’t blame her for asking. The worst thing I could say was no, and that would leave her exactly where she was. She felt she was possibly deserving based on another situation that had transpired during her membership. It required some chutzpah on her part to ask – and I actually admire that. Why not ask?

She was upset that I said no. (Fair enough.) But then stated that if I made her pay for it, she would then share it with anyone else who asked her for it, no matter whether they were members or not. Therefore I should just allow her access so she wouldn’t “have to take that step.”

A threat! THAT crossed the line!

She was never entitled, and now, in my opinion, she was no longer possibly deserving. My response to her was to watch for her refund on the balance of her membership dues, and good luck to her in the future.

She’s miffed – very upset with me. I’m beyond miffed. She has also stymied her own chances to benefit from membership in the Alliance. She will not be invited to return.

Yes, crossing the line isn’t just about pushing too far, it’s about the penalties that may result.

As you work with your clients and identify their needs, I strongly encourage you to demonstrate your chutzpah when its required, or even just when it will improve the situation for your client. That’s part of what your client pays you for and will appreciate.

But know where the line is, and be sure that you (and your client) are at least possibly deserving of the outcome you’ve requested. To step over that line puts your client, and your ability to do your job in jeopardy.

Long live chutzpah! …. to a point.

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Share your experience or join the conversation!


3 thoughts on “Chutzpah! Know When It Crosses the Line”

  1. That woman is simply horri as my daughter would say, and I would add, unethical, after you said no, that should have been it.

    Besides that, the example above of the private room, would have been a very grey area for me, I do not believe I would have fought for that, except if the patient wanted me to, and after explaining the cost (you never know if they are going to waive the costs, do you?)

    Here, in europe’s “socialized medicine”, people do not feel a lot of entitlement, so my battle is the other way round. I have to fight for them to understand that they have far more rights than they believe!

    having said that, I would not change the universal healthcare system for any other, it feels wrong that if you have more money you can get better treatment…sure, we do have private medicine here, but that gives you exactly that, private rooms, nicer looking nurses, and a bit less waiting time for surgeries.

    But the outstanding doctors are in public medicine, where you have the challenging cases and the workload.

    I really believe every human being is entitled to good medicine, without taking into account something that I only heard in the USA , a “person’s net worth”, what is that? people have net worth>

    sorry if I have opened a can of worms……….

  2. Hi Trisha,
    Well said!! I believe that one essential trait for a patient advocate must be assertiveness (which can often be analogous to chutzpah). But, as with chutzpah, you need to know how and when to use it. Assertiveness is important, but when it approaches aggressiveness or confrontative-ness, it is no longer effective and does not benefit the client .

  3. Good post, Trisha.

    The big thing for me here is credibility. If you make a stink over everything, people will just start pinching their noses and moving away. To be taken seriously as an advocate, decisions makers need to believe in you so that if you fight for something, they respect you enough to step back and examine the situation. Don’t fight because you don’t like the system or the rules, fight to give your client the best healthcare at a fair cost.

    It also moves beyond the individual client. It only takes a couple of experiences of advocate/navigators as “complainers” to turn a provider off to the idea of working with them. If instead they are seen as people who improve outcomes and patient satisfaction, then they will be granted greater access and respect.

    Kent De Spain
    Antioch University Midwest

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