YOMs – and That Sense of Entitlement

It arrived in my email a few days ago – a demand for a reply.

It came from a person who reads my articles at About.com. She had sent me a question the day before regarding trouble she was having getting copies of her records from her doctor. I had not yet responded to that email.

The second one arrived, shouting in capital letters: WHY DIDN’T YOU ANSWER MY QUESTION? I SENT IT YESTERDAY AND YOU HAVEN’T ANSWERED IT YET!

There it is. A simple example of that sense of entitlement we all seem to be dealing with. I get it in email. You, as a patient advocate, probably get it more from phone calls from potential clients. They phone you with questions – and think you should just give them the answers they need, as if you have time to just sit by the phone and answer questions for people, for free, day in and day out.

Like you owe them something.

Some even get mad if you don’t give them what they want! One advocate told me about a phone caller who “ripped her a new one” because the advocate wouldn’t go to the caller’s home to try to convince her husband that he needed medical care.

Another advocate shared an experience with a potential client who was upset that he would be charged for her advocate services. “That’s what I pay my taxes for!” he exclaimed.

Let’s call them YOMs, as in, You Owe Me!

There are a few reasons I can think of for the existence of YOMs:

First – many people who aren’t paying directly for their healthcare, meaning they are covered by many types of programs from private insurance (paid by employers) to Medicare or another program, believe that entitles them to all the healthcare services they want. They feel entitled to unlimited resources to get what they need – whether or not that perception is correct.

For many aspects of healthcare, many people ARE entitled – meaning their care is paid for 100%. We have entitlement programs for many populations – the poor (Medicaid), and many Native Americans who belong to certain tribes. These YOMs may be entitled – but not to unlimited care, even though many think they are.

Some people think they are entitled because they earned current and future care. Those who paid into Medicare for an entire working career get their healthcare covered. Veterans and members of the military, and their families, have earned healthcare because they served their country. Those are not entitlement programs – they are programs those people earned. But many do not understand that they did not earn all the care they want, when they want it. They feel entitled beyond their earnings.

Some will tell you they are entitled to healthcare when they aren’t, and may even know they aren’t. “It’s my right!” they state emphatically … to which the only correct response is, “No, it’s not. We have no right to healthcare in the United States.”

The problem is, those who try to impose their indignant senses of entitlement are assuming that we, as advocates, are part of “the system.” And that’s where we, as private advocates, need to make some clear distinctions to help YOMs better understand. We need to provide some education.

Here are some ways you can diffuse a YOM:

First – accept that no one except a client is ever entitled to your time or efforts. You are NOT part of “the system” – and that’s exactly why your work is so valuable! Being separate from the existing healthcare system means you aren’t beholden to anyone else but your clients.

Second – be sure to provide parameters for any conversation you have with a potential new client who contacts you. Try not to ask open-ended questions to which their responses can go on for hours. Instead, try to ask more limited questions and try to force them to limit their answers. “What type of service do you think you need?” or “What do you hope to accomplish?” or “Do you think you were misdiagnosed?”

Once those first few, short-answer questions are answered, then explain that you are a “in the business of providing privately-paid advocacy services”, explain your fee structure, describe your contract – whatever your start-with-a-new-client parameters are. Focus on the benefits of working with you. Tell them what to expect when you begin working together, as in “We’ll begin with a health assessment, I’ll get copies of your records, etc.” They need to know they will get their money’s worth, of course.

If they begin to object by citing the cost of your services, then you know you may have a YOM on the phone with you. That’s when you need to kick into anti-YOM mode. “M’am, I provide private services. I’m not part of the (Medicare, Medicaid, insurance) system. If you decide to be my client (or if you’re bold enough, “If I decide to accept you as a client”), then you’ll find that there are distinct advantages to having someone help you who is not a part of the system. But since I’m not part of it, I have to be paid separately.”

Do NOT apologize! I know, it’s tempting to add “I’m sorry, but…” in there somewhere. But you should not be sorry! You don’t see private schools apologizing, right? You don’t see real estate brokers apologizing, or CPAs who do taxes for their clients apologizing! No – you are providing a service, you have a right to be paid for your time, knowledge and effort – and you have no need to apologize to anyone.

We’ve all run into these (practically abusive) YOMs. Further, I suspect we’ll be seeing them more frequently as word gets out about the existence of private advocates, and as people mix us up with cancer navigators or hospital advocates, people who may have provided advocacy services at no cost to them before.

But now you have some tools and background for dealing with YOMs. You owe them nothing, even if you wish you could help them. But you can provide a bit of education – some antidote to their YOM-ism.

Have you had a YOM experience? Did you successfully diffuse it? Or was it particularly troublesome? Why not share it with the rest of us?