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 all 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.
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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