Forum Fireworks Tackle the Question: Who Is Qualified to Be a Patient Advocate?

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Fireworks erupted in the  APHA Forum recently.  I call them fireworks because those involved are so passionate about their work – no matter what their points of view. Fireworks are awe-inspiring and truly beautiful, even if they don’t accomplish much, which is exactly what transpired.

The questions and statements that caused that passion are worth sharing here, because they can help all of us clarify our roles in this growing profession of patient advocacy and navigation.

The initial question was ” I’d love to hear from advocates –like me– who do not have medical credentials –about how you position yourself in the market. Why should someone choose us when they can get an RN advocate?”

What the discussion evolved to was: Who is qualified to offer patient advocacy services?  Who is “good enough” or experienced enough or worthy of the title?  What roles do patient advocates and navigators play in their work with their clients?

And, like in any argume… I mean… fireworks display, there were some bright shining stars, some explosions, some oooo’s and aaahhh’s – and some duds.

I won’t recreate the discussion because, frankly, it stands by itself in points, counterpoints and personalities. But I will provide some commentary to share with everyone, whether or not you are a part of APHA’s Forum, because these are the truths I hold for this marvelous profession which exists to serve the patients and caregivers who desperately need us: 1.  Despite what some would claim, or would want you to believe, you do not need medical / clinical credentials to be an excellent patient advocate. I have addressed this question previously and won’t go into all the same reasons again.  Honestly, at this point, anyone who continues to make that claim has just not been paying attention.  There are so many services that patient advocates provide, that to believe one has to have a clinical background to be an effective and successful patient advocate is like suggesting that you need to know how to rebuild an engine in order to drive a car.  Or that you need to know how to build a house to be a real estate agent.  Or that you need to know how to run a printing press to publish a book. In fact,

I would go so far as to suggest that for some tasks, medical training can get in the way. (I’m not the only one to suggest this, by the way.) Training brings with it certain processes and attitudes that may not be helpful to a patient who isn’t getting what he or she needs from the medical profession.  An example: One Forum poster emphasized working with patients who have been diagnosed. No where did I see anyone suggesting that one of the very necessary tasks at the outset might be questioning whether the diagnosis was correct to begin with.  That’s not clinical – it’s practical.

2. CredentialingThere is no nationally or internationally recognized credential or license that recognizes patient advocates, the services they provide, or their ability to perform those services.  As a result, there is no one saying “yes, you are good enough” or “no, you aren’t good enough” to hang out a shingle that says you are a patient advocate.  We are at least a decade away from such a credential that is universally recognized as something that says anyone at all has the chops required.

Even when that credential does exist, it will very likely have differing levels to it.  Someone with no medical/clinical background will receive a different designation from someone who does have nursing or physician training – similar to physician specialties, perhaps. That doesn’t mean one level will be higher or lower, better or worse.  It just means they will be different.  To think one is better than another is like suggesting that the guy who fixes the body of your car after a crash is more or less important than the guy who fixes the axle or the steering column.  Or that the hairdresser who cuts hair is more or less important than the one who knows how to color it well.  They are different – but neither is more or less important than the other.

3.  All patients and their needs are not the same, and that is the very reason why patient advocates with a variety of skill sets and backgrounds are needed in this profession to serve the needs of patients.  To assume all patients have clinical needs not only limits the scope of your work as an advocate, but does not serve your clients well either.  Patient safety in a hospital (preventing infection, falls or drug errors) is not clinical. Billing reviews are not clinical. Fighting claims denials, or organizing bill paying have nothing to do with clinical.  Finding a second opinion doctor, or even questioning a diagnosis through research – neither requires someone with clinical knowledge. Finding better pricing for drugs, or obtaining medical records, or figuring out whether to file a malpractice suit, or researching rehab facilities – none of these requires clinical training, yet these aspects of care are just as important to some patients as someone who can help them with the clinical aspects of their needs.

4.  Finally – the most important point of all is:  The marketplace and your marketing outreach, not your background and training, will determine your success.  You might be the very best nurse advocate who ever existed – but if the people who know about your services need someone to help them with their bills, then you probably won’t be the one they hire.  You might be the very best medical billing advocate that ever tickled the keys of a calculator – but if the people who know about your services need someone to help them better understand their treatment options, then you won’t be the one they hire.

Even more true – if the people who WOULD hire you don’t know who you are, what it is you do, and how they can benefit from your services, then they won’t hire you either.

And if people don’t hire you to help them, then you won’t be successful.  Period.  End of your dream, no matter what your background or what you hope to build.  This isn’t about credentials or training.  This is about making sure the people who might hire you know you are available and have the skills to help them accomplish whatever THEIR needs dictate.

Those are the real truisms behind the original question of how to position oneself in the marketplace.  They aren’t the answers – they only set the stage.  Next week I’ll provide an approach you can use to answer that question about marketplace positioning based on these truisms, no matter whether you are clinical or not.  Stay tuned….

•  Part II of this series:  Your Success as a Patient Advocate Isn’t About You

•  Part III of this series:  Tooting Your Own Horn, and Playing a Tune People Want (and Need) to Hear

•  More about the non-need of medical credentials to be a patient advocate:  Remembering the Mean Girls

• • • • • • LEARN MORE • • • • • •
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Comments

  1. Julie Heath  September 19, 2011

    Bravo! Very well stated! This needn’t be a turf war. The needs of our patients are as diverse as the expertise we each hold and bring to the table. Lets respect each other, recognize our own strengths and limitations. Hand off the ball when it’s in the patients best interest and we all will win. There is no “I” in “TEAM”.

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  2. Michelle Lewis  September 19, 2011

    Well said Trisha! We can all fulfill a role for the patient. The patient’s needs should be our primary concern.

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  3. Steve Luptak  September 19, 2011

    As always, your is the very articulate voice of reason. Thank you for this and all of your ongoing work!

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  4. lisa martinovic  September 19, 2011

    Thank you so much for this incisive overview, Trisha. You have me breathing sighs of relief–and happily emboldened!

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  5. Dalia Al-Othman  September 19, 2011

    I have not been reading the responses on this issue in the Forum, but I will go back and do so now that I realize that the topic created “fireworks” 🙂 Nevertheless, Trisha, I LOVE what you wrote here, you are exactly right. I am a lawyer, and started my patient advocacy business to help ohers because of my OWN medical mishaps and horrors over the past 4 years. My legal background will come in handy, yes, but what will be even more useful is the knowledge I have gained about what it really takes to be one’s own best advocate and receive the best medical care possible–hands-on experience and know-how that nobody could have taught me in any school or while working in any profession. Siimlarly, a medical professional (nurse, doctor, etc.) is NOT providing the same services to a patient/client as a patient advocate, and while such a background MAY be helpful (or in some cases may be UNhelpful as you pointed out Trisha) it is not important or required by any means. That fact should be obvious in my opinion. Also, in my opinion, what is MUCH MORE important than one’s professional credentials is one’s PERSONALITY: are you intelligent and motivated? are you ASSERTIVE and resourceful? are you compassionate and insightful? are you a good multi-tasker? These are the traits I plan to look for when I start hiring advocates for my own business, and these are the traits that I will be bringing to the table for my clients. I agree with the statements that we should all do what is in the best interest of the patients, whether we have a medical background or not. Thanks again Trisha, and I look forward to “Part 2”!

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  6. Dr. Pat Arthur  September 20, 2011

    Trisha:

    It goes back to the simplicity of the old adage: Do no more than what you were trained, but do no less.

    In other words, don’t go over your head on things you might not understand, but never use less than your training. It is not necessarily what “school” has taught you, but what Life has given you in the form of Common Sense.

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  7. Angela Connolly  September 22, 2011

    Fantastic article Trisha and a brilliant overview of emotions about a topic that is always controversial. There are many opinions as to who has the “right” to be a patient advocate, and unfortunately there, at times, can be professional snobbery about this role. Speaking for myself I find it of great benefit not having a clinical background when I am representing a client who is seeking clarification about a medical condition. Clients are laypeople who are worried, confused by systems and in need of clarification. When I, as a layperson, understand the information that is being communicated to my client then and only then am I happy as I am confident that the information provided has been clear and “jargon” free. I am not there to judge clinical decisions but I am there to ensure that the patient has been enable to make an informed decision based on clear information received.

    Well done again! Another passionate and thought provoking article.

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  8. Loving Heart Patient Advocacy, LLC  October 3, 2011

    Great article. Very informative for a beginner like me. I am not a physician or a nurse but I have a medical humanities/ethics background and can understand how the patient needs to be the center of what is going on. The thing I bring to the table is that I am very organized and can help patients with paperwork , i.e. insurance follow-up, appointments, monitoring prescriptions, etc. This services can also be value to patients and their families.

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