Although you may not realize it, there is a debate raging about titles in advocacy.
I chose this topic today not because I have an opinion on THE right title; rather because I think the debate is a waste of time, and is a distraction from the more important work of helping people understand how advocates and care managers can help them.
The debate is this: Should we be called Health Advocates? Or should we be called Patient Advocates?
It might surprise you to know that some people not only have very definite opinions on the answer to that question, but that they argue the point for hours at a time. In my (not so) humble opinion, for every hour they argue, they could instead have promoted advocacy and the many benefits to working with an advocate – no matter what he or she is called.
Here are the reasons I think this argument is a waste of time:
- Waste of Time Reason #1:
What we call ourselves is far less important than what those who need our services call us. It’s the marketplace that determines what we are called. We are known by a variety of titles, depending on how they are introduced to the concept. Advocate, navigator, case or care manager, facilitator, negotiator, representative, ombudsman and others. These titles are no reflection on the quality of services we provide.
- Waste of Time Reason #2:
What you want to be called – vs – what you are called may always be two different things. Example: Years ago I was a newspaper columnist, writing on patient empowerment topics. My editor insisted that for consistency sake, we always use the word “doctor” and never the word “physician.” I’m sure there were some MDs who disliked that choice, but the newspaper’s editorial choice was to ignore them. The editors chose one word, and used only that word, with no regard to what doctors/physicians preferred. Again, that was no reflection on the quality of their medical care. It was simply an editorial choice.
- Waste of Time Reason #3:
Health Advocates and Patient Advocates might be the same person, doing the same thing, or there might be a shade of difference.
I see two sides of a coin in which we all work. One is medical-related, where our work focuses specifically on facilitating some aspect of medical care. I call that “patient advocacy” because we are helping patients get what they need from the medical system.
The other side of the coin is the health-focus, where the advocate is helping a client maintain his current state of health, or helping him improve upon his health AFTER a medical problem has been taken care of. That, to me, is the health side of advocacy.
Health Advocates might be patient advocates one day, helping Mr. Jones navigate his heart bypass surgery, but then the next day helping Mr. Jones join a gym or get a massage, or meet with a nutritionist, or other health maintenance-focused activities that were required post-surgery.
A patient advocate might navigate Mr. Jones through his bypass surgery, then hand him off to a health coach who would handle the other referrals he needed post-surgery.
Regardless, the people who hired them got what they needed without regard to the title they gave themselves. In all cases, the care was managed, and the patients got what they needed.
The nexus of all these forms of advocacy is so huge, and the distinctions so gray, that I see little or no need to take sides as to what title you choose. As long as you are working only within your areas of competency, it shouldn’t matter.
- Waste of Time Reason #4:
The IRS might, in the future, determine the preferred answer. To date (March 2017) there has been no ruling from the IRS on the deductibility of an advocate’s work as a medical expense. However…
A tax accountant friend shared his opinion with me, that service costs paid to a “health” advocate might not be deductible because the rules specifically eliminate health maintenance-related deductions like health club memberships, nutritional supplements, even non-prescribed drugs. The deductions that are allowed all relate to the need for medical care – a “patient” advocate’s domain – at least the word “patient” suggests that.
Not that health advocates don’t also provide medically-related, patient advocacy services – most do. But the distinction is muddied, perhaps enough, according to my tax accountant friend, to eliminate the deduction because of the use of the word “health” in their chosen title. (Disclaimer – I am not a tax accountant! Read more about deducting patient advocacy expenses.)
- Waste of Time Reason #5:
Someday someone might just co-opt your choice anyway. Early advocates, recognizing that their work was about navigating patients through the healthcare system, called themselves “navigators”. Then along came hospital (cancer) navigators, who are paid by hospitals to – yes – navigate a patient through a prescribed treatment (with no independence whatsoever in terms of second opinions, shared decision making, or other basics to an independent advocate’s work). Then, to add insult to injury, the ACA called its insurance advisors navigators, too.
Now those with “Navigator” in their company names or titles, find themselves at a disadvantage for branding an other communications purposes.
- Waste of Time Reason #6:
A rose by any other name… Shakespeare’s words tell us that what matters is what something IS, and not what it is called.
You could call yourself “Stanley” – and as long as you are providing clients with what they need, and they are willing to pay for that, then it matters not whether you use “health” or “patient” in your title.
- Waste of Time Reason #7:
We have far better things to do with our time than debate titles. We need to be growing our profession, not debating what we call it. Our time is far better spent focusing on attracting clients, and helping them out – not trying to determine a right and wrong in an area that really has no right or wrong answer, nor a need for one.
Conclusion
Our organization’s name, The Alliance of Professional Health Advocates calls our members “Health Advocates” because that term is more inclusive, both sides of that coin described in #3 above. We include all care management in our description of our members, along with many other titles.
The Patient Advocate Certification Board chose “Patient Advocate” because its work addresses certification specifically for the medical guidance and facilitation a patient needs, and not the additional services a health advocate might provide (which is more in the line of health coaching or counseling). It’s definition cites “the continuum of care” – as in medical care – as its focus is on the patients its (future) certified members will work with.
Your choice of what you want to call your advocacy is just that – YOUR choice. No one else should impose on you what call your work any more than someone has the right to impose some other name on your child. Whatever you feel is right in your heart and mind – THAT is what you should call yourself.
Or, as Gramma used to say, “I don’t care what you call me, just don’t forget to call me for dinner.”
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Thank you, Trisha. I enjoyed your blog! Just finishing up my website and trying to decide particular wording in different sections. But decided after reading this, it truly doesn’t matter all that much but rather I just need to go live and do what I love doing, helping people with their health care needs!
The field as a whole needs to unify if it expects to be recognized, and fees paid. I get lots of calls from individuals who want free service, and it doesn’t matter to the caller if it is Patient or Health, they want help. I am not a registered nurse or a clinical social worker, I have an MBA and many years in financial services before I started my Advocacy firm in 2009. I saw the need for better communication, patient knowledge and insight into their illness, and the blatant disregard for a persons rights and the gross lack of respect towards another human by one. It was not focused on health, but getting the healthcare the person deserved to get. It focused on a service industry understanding that the person (patient) was their boss. The person paying the bill (whether insurance or person who paid the insurance premium) was the employer and deserved more than lip service. We held medical teams and facilities accountable for the healthcare of the patient in order for the patient to get well. I do not know many nurses or social workers who have gone up against the likes of CIGNA or Health Care Partners or Aurora Behavioral Sciences on behalf of a client, who was held without consent, abuse of the statutes, denial of service or coverage, breach of contract, breach of fiduciary obligation, or mismanagement that put the patient/policyholder/persons life at risk. I advocate on behalf of the Patient, in the end it boils down to the healthcare they are getting or not, but I do not argue on a patients behalf that ABC treatment or medication is to be used, there lays the difference.
Health advocate implies a broader role than patient advocate. A health advocate might assist someone who does not have any treatable medical problems but is overweight and wants guidance how which method of weight loss would go well with their lifestyle. A patient advocate might help an overweight person find the best resources of medical practitioners who might offer a surgical option, suggest a list of dietitians, or help the person understand the drugs available to help lose weight. These people are closer to having consequences of their weight affect their health.
BTW, doctors don’t mind being called doctors vs physicians. Just don’t call them health practitioners, or you will be lectured.
If you look through the ads for patient advocates, you find a broad definition and salary offered depending on the place. That is unfortunate because the role should be better controlled.
There is a tremendous difference between an advocate that works inside a facility and directs patients down the funnel of that organization vs. an advocate who is truly unbiased and may suggest that patients seek out other medical resources before making a decision.