The Starfish Story Curmudgeon

Several weeks ago, a couple we know were married. It was a wonderfully happy event, celebrated by many. The wedding itself was elegant, and beautiful, and everyone had a delightful time at the reception. You know – the stuff fairy tales are made from.

The bride chose a starfish theme for the celebration, telling the starfish story alongside it. She has worked hard for decades as a nurse and the starfish story speaks to her – a perfect choice for her, really. Starfish were part of both her wedding shower and the reception decor. Just lovely.

What? You don’t know the starfish story?¬†Well, neither did I. So, in a nutshell:

A young boy is walking along the beach when he sees hundreds of starfish washed up on the shore. In dismay, and realizing that many of them are still alive, he begins chucking them back out to sea so they won’t die on the beach. A man comes along and asks him, “Why are you throwing those starfish back out into the sea? You can’t possibly save all these starfish! What difference can you make when there are so many to be saved?” After thinking about it for a moment, and throwing one more starfish back out into the water, the boy replies, “I just made a difference for that one!”

Of course, the starfish story got me thinking about advocates. Isn’t the “one person can make a difference” a huge theme in our work? We can’t fix the entire healthcare system, but we can most certainly help one person at a time!

It would seem like the parable of the starfish fits us like a glove; as if we should embrace it, appreciate it, and even share it with others to help them understand why we do the work we do…

Until we realize that maybe – just maybe – it’s way too simplistic. Maybe we really need to take a closer look. In fact, maybe the starfish story represents how we should NOT be doing our work.

Say what?

To understand why the story should not represent the work advocates do, we need to divide the story into two different concepts:

  1. The concept of helping one starfish, or one person, at a time to improve their journey.
  2. The concept of how we actually provide that help. What it takes to improve their journey – figuring out the direction that journey needs to go.

Concept #1 – I have no argument with this one. In fact, it’s very much how I have approached all of my work both as Every Patient’s Advocate and as the founder of The Alliance of Professional Health Advocates. While there are many advocates who do wonderful work for large groups, and others who work successfully on healthcare policy, that has never been my approach.

Yup – I’m definitely into the “improve the journey one person at a time” camp. So are most of you who are reading this post.

Concept #2 – this is the one I think, for independent advocates, is misrepresented by the starfish story. Here’s why:

The little boy made the assumption that throwing the starfish back into the sea was going to improve and extend the life of the starfish. What he didn’t think about were the possible negative outcomes or unintended consequences of his choice to throw them back. For example, what if there had been sharks or other predators just off shore and the starfish had sought safety on the beach, and were just waiting for them to leave? What if the starfish needed the warmth of the beach to keep them alive because the sea water had gotten too cold? We all know that disturbing Mother Nature can upset the balance of things… and sea gulls eat starfish from the beach… so did the little boy actually interfere with Mother Nature? Did any sea gulls die from starvation?


As advocates, we should never just assume we know best. As advocates, we should never act on our own assumptions.

Instead we need to work closely with our clients, gather all the information we can from them, be sure they understand all their options, then help them execute their OWN choice of journey – not the one we think is best – even when those two approaches might be different. To do otherwise invites unintended consequences for our clients or ourselves, and violates our Code of Ethics.

I do love the starfish story, and honestly, I hate to ruin it for anyone.

But from now on, I’ll always think of it with a large asterisk (which, ironically, looks a bit like a starfish!). I hope you will, too.


1 thought on “The Starfish Story Curmudgeon”

  1. Trisha,
    I too had never heard the starfish story. Even as I was reading it, I was wondering about the asterisk issues you pointed out and playing out what you described as possible implications of the throwing back the boy was doing. The correlation and parallel to the work of an advocate is spot on. I see far too often, many people working in the health care system that don’t take the time to think about the implications of the “throwing back” they are doing. Then the patient is left with a situation to deal with on top of their original issue. Thank you for sharing.

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