When Clients Lie

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Years ago, I hosted a radio show where I had the opportunity to interview medical providers from many specialties about their work with patients. One of the recurring themes was that “Patients lie.”

Now – you might wonder why that would become a theme, but the answer is quite simple. It was important to discuss it during the show because smart patients need to know that their providers assume they are lying as a part of the diagnoses or treatment they provide.  (Good advice for smart advocates, too.)

Here are some examples:

  • An anesthesiologist told me that patients are always asked how much alcohol they drink. Whatever answer the patient gives, is then (at least) doubled when it comes time for the anesthesiologist to determine how much anesthesia to administer during surgery. (An honest patient may not receive enough anesthesia based on that “doubling.”)
  • Endocrinologists ask their diabetes patients whether they are watching their carb intake. The patient may say “yes,” but when the provider sees an A1C value that is too high, they just assume the patient has lied instead of seeking another cause for that too-high A1C. (That’s problematic if there truly is another cause.)
  • Many primary doctors and nurse practitioners told me that when they ask a patient if she smokes, and she says no, they may not believe her if she has a history of smoking. (An honest, smart patient needs to be aware that untrue judgment is being made.)

So what does all that have to do with patient advocates?

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The Binder, the Meltdown, and Some Advocacy Karma, Too

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I beg your indulgence today as I relate a personal story. I don’t usually do this – rarely do I share this much personal information! But I promise you, if you stick with it – it will make sense by the end.

As mentioned in last week’s post, my husband and I are getting ready to move. In less than three weeks, we’ll have begun settling in more than 1200 miles away.  Since we will have no basement (!) and since it’s just really about d*mn time (!) – we are cleaning out, purging really – getting rid of the excess stuff in our lives that we just don’t need or want to have to deal with (or don’t want our kids to have to deal with) in the future.

Yesterday was “clean out my office” day. It was a daunting task, a room chock full of everything from old computers to old paperwork, personal papers, workshop materials, plus books, books and more books, and more tchotchkes and little collectible things than you can imagine. Now about 2/3 of it is either set aside for yard-sale-round-2 – or is in the trash or recycling. Gone. Much of the rest is packed up and ready to move.

Today I’m actually feeling quite pious about the whole thing. I was organized, got started early, and played my favorite music – loudly –  all day. I made it as much fun as I could, considering the huge job that it was. By the time I was done, there was a certain “high” to having completed such a huge task.

Cleaning out was physically demanding. However, the real challenge was the emotional demand – something I had not anticipated. Cleaning out meant I dealt with memories all day long, some good, some not, and some alarming, as you’ll see in a moment.

I found my daughters’ birth certificates. I found the draft of my first book (one I never published). I found my divorce papers from 1988. I found all my newspaper column clippings – 6 years worth! I found my mother’s hole-in-one golf trophy from 1977. I found proposals I had written when I owned my marketing company, and thank you notes from past clients. I found the little give-aways from the radio show I hosted several years ago…. the list goes on and on.

Finding memorabilia means you revisit their history; it’s not like you can just sort those items them without processing them.

And thus – the melt-down.

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These 8 Yard Sale Lessons May Improve Your Advocacy Practice

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We’ve made the decision. My husband and I have decided to leave cold Northeastern winters behind, and in just a few weeks we’ll be moving south.  We’ve sold our home in Upstate NY. We’ve purchased a home in Florida. We’ve put together the details for the actual move itself…

The only continuing challenge is one that will sound familiar to many of you. We have too much stuff.

When we moved into our current home in 2007, we were newly married. We jammed two entire households worth of stuff into this home – most of it simply moved to the basement. Then parents passed away and we collected even more stuff. Over the years our kids have removed their stuff, we’ve sold a few things, we’ve given a lot away… From holiday decorations, tools, and hobby supplies to old tax records, books, grandkids’ toys, games, and luggage. Family, sentimental, nostalgic, even historical. It’s the stuff accumulated throughout two lifetimes and those of our loved ones and… well, overwhelming, really.

But in Florida there are no basements!  Therein lies our problem….

The solution?  A yard sale, of course. So Saturday’s sale was round one.

Throughout the day I haggled, chatted, rearranged and sold stuff. But I also spent time just observing shoppers, and by the end of the day, I had put together a list of relevant customer service lessons for private, professional patient advocates.

Granted, there are some major differences between yard sale shoppers and patients who need advocates. But I hope you’ll be able to use this list to improve how you conduct business with the general public – most of whom will need to hire a private advocate sometime in the future.

Here are the customer service lessons that may be helpful to you:

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Patient Advocates and The Kindergarten Principles

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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.

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Mixed Messages Are Just a Lawsuit Waiting to Happen

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A few weeks ago, I wrote Fool Me Once, Shame on You, But Fool Me Twice about the problems that can hurt patient-clients which also hurt our profession because they violate our ethical principles and best practices.  Those problems range from advocates working beyond their own abilities to help clients because they may not have the experience or education to do so, to selling medical products on their websites, and others.

Today we’re looking at the promised Example #2 of this problem in hopes of a hard stop. That problem: the danger of mixed messages.

As stated in the Fool Me Once post,

I fully expect that some of you will be appalled, possibly upset with me, because you’ve not thought of these as violations or misrepresentations. Some of you innocently don’t realize these transgressions; but now, as of reading this post, you are on notice…. please look at this not as judgment, but as a time for correction.

Mixed Messages

Sometimes our words and behavior – vs – what we as private patient advocates can do ethically, even legally, are in conflict. Sometimes subtle, sometimes more blatant, it’s those mixed messages that will cause an advocate to be sued one day and, frankly, it will be his or her own fault because it is easily preventable. Further, when that advocate is sued, his or her liability insurance, which is purchased specifically to pay for legal assistance, will look at these mixed messages and refuse to provide that cost support for legal needs.

What’s that lawsuit-provoking mixed message? 

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Celebrating our 6th Annual Private Professional Patient Advocates Week

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This week, March 20 to 26, 2016 marks our 6th Annual Private Professional Patient Advocates Week, and as predicted last year, yes – our profession is growing marvelously!

Last year we did a recap of the history of the profession.  This year we’re going to provide some updates and some food for thought.

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Announcing – the Winner of the Schueler Patient Advocacy Compass Award for 2016

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The most prestigious award in the profession of patient advocacy, and in particular, independent, private patient advocacy is awarded this time each year to the person who best exemplifies the tenets of the award.

Drum roll please!

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Fool Me Once, Shame on You, But Fool Me Twice….

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From bold-faced lies to misrepresentation – facts that aren’t facts, withholding information, skirting the code of ethics, and shades of truth – honesty and the advocacy business have been on my mind. I’m eager to hear your opinion on the subject, too.

My thought process was actually triggered by something that has nothing to do with advocacy at all, something that seems relatively innocuous, but then, maybe not-so-innocuous at all: the purchase of a 5-lb bag of sugar to bake holiday cookies last December.  Now a 5-lb bag of sugar has always been a 5-lb bag of sugar and has yielded a certain number of batches of cookies. I’ve been buying 5-lb bags of sugar all my baking life, so I grabbed the bag off the shelf at the store as I do every December, knowing that cookie baking was in my near future.

Except that this time, that 5-lb bag of sugar was (you guessed it) only 4 lbs!  It didn’t cost any less, but it had 20% less sugar in the bag. Yes, it was labeled correctly, and no, I had not read it carefully enough. But that is SO FAR beside the point. Old habits die hard.

So now?  I will never trust that store again when it comes to purchasing sugar – or anything else that I have trusted to be of a certain size. Sugar isn’t the only problem. Many other kinds of foods, including cereal, frozen vegetables, orange juice, pre-packaged produce and meats. A pound is still a pound, but a package that has always been a certain size is rarely that size anymore. Fool us all! That cummupence got me to thinking about other places in life where things are not what they seem to be. For example – the healthcare system. For people of a certain age or older, the healthcare system was always accessible and available, provided what we needed when we needed it, through kindly and knowledgeable providers, and at an affordable price (or no cost at all.)

But now, in 2016, that healthcare system no longer exists – not in the US anyway. Period. No patient accessing the American healthcare system can trust any portion of it anymore. We expect 5 lbs of sweet care, and we’re not getting it…

We’ve been fooled once, twice – and now it seems – will continue to be fooled forever…

… which is why people need patient advocates. So, in a way, that “Fool Me Once” led to a new profession in which we are all keenly interested. While we love the work we do, it is sad, in a way, to think about why we are called upon to do it.  People can’t trust the system, so they hire us to reclaim the honesty.

My thought process then turned to patient advocates ourselves, and the foundation upon which we are building our profession. Recently I have had conversations with advocates that suggest to me that our foundation is being chipped away at by some practicing advocates. Among us are people who are, sometimes innocently (sometimes not-so-innocently) violating the honesty, ethical standards, and expectations our profession demands, even if we have no formal way to demand them yet.

And that’s a problem. We’re very new, and we have only one chance to make that positive, ethical, above-reproach first impression. When some advocates aren’t on board with that approach, it becomes a problem for the entire group of us – those of us who are trying to right the healthcare system wrongs described above.

I’m going to provide two examples – one this week, and one soon – and some of you will see yourselves. I fully expect that some of you will be appalled, possibly upset with me, because you’ve not thought of these as violations or misrepresentations. Some of you innocently don’t realize these transgressions; but now, as of reading this post, you are on notice – now you will. 

Whether or not you’ve violated your ethics intentionally or innocently, please look at this not as judgment, but as a time for correction. Continue Reading →

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