Patient Advocates and The Kindergarten Principles

You may remember Robert Fulghum’s book, published in the 1980s, All I Really Need to Know I Learned in Kindergarten… The book is a group of essays focused on the wisdom that helps us lead a good life – basic tenets including sharing, being kind to one another, cleaning up after ourselves and living a balanced life.

The book and its basics have come to mind so many times in recent months during exchanges with some of the patient advocates who have reached out to me. Their outreach, a mix of questions, complaints, reports and misinformation, leaves me scratching my head and wondering what I can do to remedy such dissension.

I raise this topic today because some of these behaviors need to be nipped in the bud. Further, if you ever experience these behaviors, you can point the perpetrator to this post without saying another word.

If I sound like I’m scolding, well, perhaps I am. But I’m not one to scold unless a behavior is having a negative influence on our profession – and you know what? These behaviors really are. And we need to stop them.

The Behaviors

The behaviors I’m talking about are those where one advocate (or wannabe, soon-to-be advocate) is disdainful of any other. Her behavior is easily identified as disdain, but in several different forms. (Yes, sadly, I say “her” because I never witnessed these behaviors from male advocates.)

Here are some of the ways I have been exposed to that disdain just in the past few months. No names, of course, but I know some of you will see yourselves and if you do – PLEASE STOP IMMEDIATELY – and begin to embrace The Advocates Kindergarten Principles (see below.)

  1. One advocate, a nurse, sends email missives to other, successful advocates who are not nurses, calling them names, and telling them to stop doing business because they can’t possibly do their jobs right or well – because they are not nurses.
  2. Many advocate wannabes report that they have tried to connect with advocates they find online, some in their own areas, some many states away, but they are turned away, sometimes rudely, when seeking advice about establishing their practices.
  3. One advocate emails me to complain about another advocate who (at first glance) is claiming to be something she is not – with a request that I be the person to go after the offending advocate to tell her to desist, because it’s “deceptive”, “deceitful”, and “a misrepresentation.” Now – I’m all for getting rid of any deception, deceit and misrepresentation – of course. But it turns out that the judgment was made incorrectly. In effect, I was asked to do accusation dirty work over something that was not as it appeared.
  4. and more…

Some Context

The armchair psychologist in me wonders what on earth would make advocates, as a general group, so defensive and territorial? Why would advocates react in these ways to make life difficult for others?

I’ve come up with a handful of possible explanations – maybe some are correct, maybe not – maybe you can come up with others. Two are topics I’ve written about before, so I’ve included links if you want to learn more about them:

  1. The nurse in example #a – A woman of strong personality in general, this nurse-turned-advocate was an early professional, independent advocate, and she doesn’t understand that having many more advocates in the marketplace, advocates with a variety of skills, actually HELPS her build her practice. Further, I think perhaps she was kicked around by doctors for so many years, doctors who she observed to be professional and successful, that she has patterned herself after them. Human nature has a ripple effect – people who are bullied and kicked around in life tend to lean toward the same behavior. She needs to be shown the light – that she’s actually hurting herself by this behavior.
    8x20Even still – such behavior cannot be excused no matter what its genesis.
    8x20Advocacy, by its nature, requires many different skills, many different points of view, and certainly points of view that are not always medical. By embracing our differences our professional will grow stronger.
  2. The very nature of advocates, the core of our work, is to DEFEND our clients against a bad system that creates too many hurdles for them. Is it possible that we become so defensive in our work that defensiveness becomes the go-to reaction when discussing our work? Or, is it possible that so many advocates come from horrible bureaucratic experiences where every decision was questioned, and where they may have been bullied (like the nurse described above), that defensiveness and territorialism are their knee-jerk reactions to someone seeking advice?
    8x20Ironically that instinctive reaction to defend and protect our clients may be at the heart of what makes us successful advocates. But that same ability creates trouble when it comes to sharing our sandbox with other advocates. In fact, it‘s the very opposite reaction to what will help us build our practices and create a successful profession – the OPPOSITE – and that cannot be stressed enough.
    8x20Too many advocates become defensive, unwilling to share their business models, or their pricing, or their suggestions for building a good practice. In some ways it’s a natural reaction to protect our hard work. And, fairly, for those advocates who work in the same geography, there should be a certain amount of withholding of information for competitive purposes – no one is asking you to give away your trade secrets. 8x20 In fact, the best reaction for all parties is to pitch in and help each other as much as possible. The more support you provide to others, the better the reinforcement for yours, the stronger the foundation for their practices, and the more business (in the form of new patients who want to work with you) everyone has.
    8x20But even in the same geography, some sharing is not only a fair request, but it’s a practice building idea, too. The rising tide floats all boats. Don’t you want it to float yours too?
  3. From example #c – in this case, the complaining advocate was jumping to a conclusion that just was not true. Granted, I could see what she was complaining about and I understand why she didn’t like it. The problem was that she assumed she was right, and she was not. What she had read most definitely required clarity.
    8x20I have to wonder – why would any advocate be so quick to judge without considering instead that she might not have all the facts? Why did she instantly side on the negative instead of asking questions first?
    8x20 When we find something that is offensive, or we believe is disingenuous, or even just plain wrong – then the approach should be to ask questions, not to make what can become a painful leap to a conclusion. If, after asking the questions, the problem remains and resolution can’t be found, then the next steps will be to complain – but even then, the complaint should be made to the offender, not in tattletale style to someone like me. We are all adults. We are all professionals. At the very least, we need to treat each other with that sort of respect.

The Advocate’s Kindergarten Principles

So let’s return to Robert Fulghum’s thoughts; several of his principles apply to these scenarios.

  1. Share everything.
  2. Play fair.
  3. Say you’re sorry when you hurt somebody.
  4. When you go out into the world, watch out for traffic, hold hands, and stick together.

And I’m going to take the liberty of adding a fifth one:

5. Ask questions before you leap to conclusions.

None of these principles requires further explanation. Just know that when you follow them, you will find that your work will improve, your demeanor will improve, and your practice will grow as a result.


With one final piece of wisdom from Mr. Fulghum. That is,

It doesn’t matter what you say you believe – it only matters what you do.


2 thoughts on “Patient Advocates and The Kindergarten Principles”

  1. Such a great article, Trisha-

    I am reminded that oppressed group behavior in nursing causes some of us to attack each other instead of addressing the real source of the problem – the oppressive system with its powermongers.
    Nurses are exposed to it every day.

    Good news! We can stop it, and it starts with each one of us.

    Hooray for the Kindergarten principles!

  2. I could not agree more, Trish. It’s unfortunate that the nurse you cited in example is setting a poor example for nurse advocates in general, because most of us operate on a much higher plane. I myself have received many unkind accusations from non nurse advocates as well. One even publicly condemned a physician advocate who had saved a little boys life because he had a former alcohol problem. One accused me of looking down on non medical advocates because I am vocal about being an excellent nurse advocate. Advocacy begins with us…we have to believe in our goodness and competence and skills before we can go out and help others. Confidence and respect within my community sometimes makes others feel insecure and their response is to try to malign me, sometimes viciously. You have to know who you are and what you are to stand tall and not let the “mean girls” discourage you too much. It is sad to see so much unprofessional behavior in the field. When we hold our Chicago Patient Advocacy Symposium this June at Northwestern, one of our speakers will speak on this topic itself: Advocacy Begins with Us by Dr Melanie Dreher, former CNO at Rush. Mean people should not be in this field…there is plenty of work to go around and we should be all working together to build the profession rather than to tear each other down. We are all unique and have wonderfully different specialties. I am proud to say that almost all of us in the Chicago area work and play well together and I would never hesitate to refer a client to a colleague who could help them better than I could…it is ALL about the patient for me and it always will be. Thanks for the message.

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