Last week, I received an email from a woman, I’ll call her Miranda, taking me to task for an article I had written that she found online. If Miranda had her way, I’d be walking the plank about now, or on my way to life in prison.
The article she found is about patient modesty and how it affects one’s ability to get medical care. It poses the problem, considers the roots of the situation, then offers ideas to help someone get beyond modesty hurdles in order to benefit from better medical care.
Oh, but Miranda was not happy about that article! She graced my email inbox with a missive (out of curiosity I pasted it into a word document to see how many printed pages it would be – about 5!), as if she was the prosecutor outlining all the reasons I should get life in prison, taking me to task because I had not taken into account survivors of sexual abuse. Further, the fact that I used a car as a metaphor offended her because people aren’t cars! (She’s right. They aren’t. I didn’t say they were. I used cars as a metaphor.) She expected me to rewrite and republish the article, and she wanted a “public apology” for being so callous and ignoring the plight of sexual abuse survivors.
A little back story: I wrote that article almost 8 years ago when I was writing patient empowerment articles for About.com. I stopped writing for them in early 2014, and I no longer have access to change or edit the 1,000+ articles I wrote for them. In the meantime they have changed the name of the site to VeryWell. They edit the articles themselves from time to time, and change the dates to be more current – all to keep Google happy, but confusing people who think I wrote them recently.
So – for Miranda – I replied – politely – that I was sorry she had suffered sexual abuse, and I was sorry she wasn’t satisfied with the article, but that the intent of the article was to help patients get care if they are modest, and not to attempt to cover all the reasons they might be modest. And, finally, that I had no access to edit the article, and I was not going to make a public apology – I didn’t feel as if I had anything to apologize for.
Turns out I had simply poked the Miranda-bear. She was even unhappier in her reply – another several pages worth… I once again replied that I was sorry that wasn’t good enough and that I would not be replying to her again. She sent her venom one more time, and I simply deleted the email.
So what does that have to do with patient advocacy and care management? Plenty.
Like Miranda, many patients, when they feel wronged by the system, are loaded for bear. Sadly, and truthfully, that frustration and anger is often understandable.
However, and unfortunately, they choose to handle any interface they have with the system by being confrontational, angry, impossible, even abusive, and that means the system will do what it can to avoid engaging with them. There are many reasons doctors refuse to work with patients, many wrong and shameful, some of them fair and understandable.
Sometimes those patients contact an advocate to help them. If an angry patient contacts you, remember: you are an independent practitioner and you have choices:
1. You can attempt to help. This requires a few things:
- making an assessment of what help they really need (which may mean physical health help, or mental/emotional health help, or financial billing help, or all of the above)
- making an assessment of whether they really want advocacy help, or they just need someone to be angry and confrontational alongside them
- making an assessment of whether they are willing to pay for that help
- making an assessment of whether you can help them keep their anger separated from their real health care or cost needs
2. You can decide against providing help. If you make those assessments in #1 above, and you realize you’ll be spinning your wheels, then this is the smarter choice.
The point to this post is this: Patients are wronged by the system every day. That is horrible and tragic, and the system should be ashamed of itself.
However! (A Big However!)
…. it is NOT up to us as patient advocates to fix those situations. It is NOT our responsibility to overcome their anger or be confrontational alongside them.
As such, if you are contacted by a patient who has been hurt by the system, do not feel an obligation to take him or her on as a client. It will be extremely difficult to focus on what is really needed medically or financially, vs the expectation that you will fix the wrongs of the system.
Would it be “nice” for you to help? Maybe. But don’t forget: no good deed goes unpunished!
Spend your time with those who aren’t angry, and those who will respect your ability to help them get the real care they deserve.