Can an Advocate Do More Harm Than Good?

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Yes, sadly (although rarely) a patient advocate does more harm than good.

I was reminded of this recently when I heard from one of our Alliance members who was picking up the ball from another advocate (not an APHA member) who had totally messed up the work a client-patient needed to have done – an advocate who had actually made the client’s situation worse.

The problem-creating advocate had been working with her client through a hospitalization. As far as we know, that work went well. Her core business is medical-navigational advocates. However, later, when the client’s hospital bill arrived, the client asked the advocate to help him appeal several items the insurer had denied, then to attempt to reduce the hospital bill.

I don’t know all the details. What I do know is that the advocate in question had never filed an insurance appeal before, and had never negotiated a hospital bill before, but she attempted to do both for this client, and she failed at both.

The client, frustrated and upset, reached out to the APHA member-advocate to ask for help. What the member told me was that it was too late. Only one appeal was allowed, and the hospital billing department had dug in its heals because the first advocate had become verbally abusive.

Yikes.

The salient point for this post, is that the first advocate attempted to perform services she was not equipped, educated or skilled enough to perform. In fact, this is SO wrong, that it is a violation of the Health Advocate’s Code of Conduct and Professional Standards (which, no, that first advocate has never subscribed to) – see #8:

Health advocates will, at all times, work within their professional boundaries and will reject any requests or demands that would cause them to violate those boundaries.

A professional patient advocate would never have taken on such an assignment him or herself. In fact, that’s the difference between a professional and a pretender.

Other Ways Advocates Can Harm Their Patient-Clients

The question of whether an advocate can do more harm than good has actually been raised before by an APHA member. Her question regarded those advocates who impose their own opinions, even if they don’t realize that’s what they are doing, potentially causing harm.

Specifically she was worried about advocates who might be such firm believers in integrative medicine (traditional/Western medicine combined with complementary and alternative treatments) that they suggest options to their clients that have not yet been tested or found effective through research for their clients’ diagnosis.

There are other ways, too, that an advocate can potentially do more harm than good.  Here are a few I can think of. (Maybe you could add your own ideas below.)

  • An advocate who is not totally familiar with all the harms a hospital can impose (patient safety – from drug errors and surgical mistakes, to acquisition of infections and falls) – and claims he can keep a patient safe during a hospital stay.
  • An advocate who decides to offer nursing home placement services, and is paid by the nursing home, not the patient. (A conflict-of-interest – see the code #8 again).
  • An advocate who offers Shared Decision Making, but isn’t really familiar with the process.
  • An advocate who offers medication reviews, but does not have a clinical background and has not studied bio-chemistry enough to understand how to deliver this important service.
  • An advocate who offers to mediate a family healthcare dispute, but isn’t trained as a mediator.

…and, of course, many more.

I have often made the statement that patients are better off having SOMEONE to help them, even if that person isn’t a trained and experienced advocate (like a family member.)  But in that case, the family member doesn’t claim to be skilled or knowledgeable. The family member operates on common sense. 

The important role of professional advocates goes far beyond just common sense.

Therefore – yes – it’s entirely possible that someone who claims to be skilled and knowledgeable can be detrimental to the patient-client if they make claims about their expertise that are not really true, and promises they may not be able to keep.

makingclaims

 So what’s the solution?

  • If you are a patient or caregiver reading this post, then be sure you ask about an advocate’s experience specifically with the work you need to have done. Then trust your gut. If the advocate sounds confident and believable, then move forward with the interview.  (Here are questions to ask during your interview.)
  • If you are an advocate, then don’t make claims that you can do something that you cannot. If a client or potential client asks you to do something beyond your skill set, then either refer them to the AdvoConnection Directory, or find another advocate to subcontract to (here is a step-by-step guide on how to hire and work with a subcontractor: Growing Your Business with Subcontractors – available to APHA members. Please login first.) 
     
     If you think it’s a service you would like to offer in the future, then follow along with the subcontractor’s work, and look for educational opportunities to learn. Your subcontractor might even be willing to mentor you.  
     
    And, of course, be sure at all times you are not imposing your own opinions or wishes. Never present information that isn’t tried and true (evidence of favorable benefits and outcomes.)

It goes without saying that putting a client in harm’s way, whether it is intentional or not, whether it’s a mistake or not, is bad for the client.

But it’s also bad for our entire profession. Until we have certification in place, we have to monitor these sorts of problems ourselves. We have no way to sanction offending advocates (I do keep a list of names I hear about. It is not public, I will not share it, there are only four names so far. None of these people will ever be accepted to be listed in the AdvoConnection Directory).

Further, it will be an incident such as the story told here that causes the first lawsuit for a private advocate.

Even when certification becomes the norm, there will still be advocates who violate the trust their clients put in them, harming our profession at the same time. In the future there will likely be a process developed for sanctioning an advocate who has harmed a client, resulting in suspensions or loss of certification.

Be sure YOU are not that advocate.

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