Alone, But Not by Yourself

“But she is so upset with me now!”

That was the response from an advocate who wrote to me after an unpleasant encounter with a former client. Even though they had not worked together for more than a year, the client had contacted the advocate to ask for copies of her medical records. The client knew the advocate had acquired them when they worked together, she needed them, and she didn’t want to pay for them again.

Fair request, certainly. The advocate should have been able to turn them over to the client quite easily, either electronically or on paper….

Except that once their work was finished and several months had passed by, the advocate had deleted them from her computer. As she explained to me, she didn’t want someone hacking her computer and getting records they should not have, so once she deleted them, they would not be able to do that.

I asked the advocate, “Didn’t you back them up somewhere first? In the cloud? or on an external hard drive not connected to your computer?”

No – she hadn’t thought about doing that. She didn’t think she needed to keep them, and she didn’t have anyone to ask. So now she wanted me to tell her how to placate the client – because, well – the client was upset.

I was dumbfounded.

First, I was dismayed that the advocate wouldn’t think to keep those records backed up somewhere. There are some great options for doing so, secure and inexpensive. To me that is only common sense. We’ve even had that discussion right here on the blog before, asking what a best practice would be for keeping client records.

Second, I could hardly believe the advocate had not turned over copies of the medical records to the client when their contract was complete and the invoice had been paid. Both the backing up of files, and the end-of-contract records exchange are good private advocacy practices, if not simply common sense.

But even more so, I was upset that the advocate went ahead and did something so drastic as to delete the files because she “didn’t have anyone to ask.” Why? Because through APHA, we have a marvelous Discussion Forum with hundreds of advocate participants who would love to be asked!

It got me thinking about the fact that many private advocates do work alone. Many work from home, in one-person practices. A few have a second or third person to work with, but those folks aren’t advocates; they are support personnel. Yes, some do work with independent advocacy contractors with whom they can discuss good practices, but if I had to guesstimate, I would say that fully 80% of APHA members have one-advocate practices.

The important point here is that even for those who are the sole advocate in their practice, there is no need to be “alone.”? Networking is important, and it’s easy to do, even on a daily basis.

Here is a sampler of topics discussed just within the past few weeks on the APHA Discussion Forum:

  • Has anyone succeeded in getting Kaiser Permanente to authorize out-of-network services?
  • Where can I find reasonable costs for clinical laboratory tests?
  • Referral for Patient Advocate
  • Needed – Hospital diagnosis code
  • Disability and Long Term Care Insurance Claims
  • Home office or retail location?
  • Quick Consumer’s Guide to Popular Medical Scams
  • Medicare Appeals Process
  • Surgeon Scorecard
  • Balanced Billing from Kaiser Health-new NY Law
  • Is An Executed HIPAA Release Still Valid After the Signer Dies?

Of course, by our Code of Conduct, advocates do not make decisions for their clients. But we make business decisions every day, and if we just aren’t sure of the right choice, then it makes no sense to make them alone without asking others for input, especially knowing there are hundreds of other advocates to network with, who are just waiting to help. There is peace of mind in knowing they are out there, and that we don’t have to go it alone.


So what did the advocate do? What was my advice? Digging a little deeper I learned that not only had she acquired all the records when they worked together, but she had charged the client for the time it took (several hours), and the cost of the records (about $80.) My advice was that she offer to pay for a new set of records to turn over to the client because, after all, the client had already paid for them, and should not have to pay for them again. (The advocate was not happy with my advice! I’m not sure what she expected.)

For less than what those records cost, and in far less time than obtaining those records all over again, that advocate could have joined the Alliance, and asked such a question in the Discussion Forum: “Should I be keeping a former client’s records? And if so, in what format, and for how long?”

Look at the money and grief that would have saved her! She doesn’t really have to work alone even when she’s by herself.

(By the way – when was the last time you backed up your computer? What if it crashes later today? On the APHA site we have listed a number of good, inexpensive backup services. Discuss them in the APHA Forum, too!)


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