The Birdcage: How to Ruin a First Impression

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Many readers know that my husband and I moved last year to Florida from Upstate NY, where – yes, thank you! – we have truly enjoyed this winter. No shoveling, mostly mild temperatures, lots of sun, and golf! – a big change from the past many winters.

So here in our new home in Florida we’ve decided to bring some of the outdoors in. Or maybe we’re going to take some of our indoors out. Whichever way you look at it, we’re getting ready to build a “birdcage,” a screened room which will be attached to the back of our house.

We began by soliciting estimates from four different birdcage builders, inviting them over to discuss our project.

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Can’t Decide?

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Today’s post will be short and sweet (for a change.)

It’s about making a decision. It applies to ALL decision-making processes.  It popped up in the past week several times, in these scenarios:

  • Conversation with an APHA PACE member. She could not decide whether to quit her job to start her practice.
  • Conversation with an APHA Premium +ADL member. His potential new client could not decide whether to sign a contract with him.
  • Conversation with a potential APHA member: She could not decide whether to join APHA or buy The Health Advocate’s Start and Grow Your Own Practice Handbook.
  • Visiting friends’ conversation: Should we go out to dinner or eat in tonight?

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The 2017 Advocates’ Challenges

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Since I started this blog, and as each new year begins, I try to think of ways to challenge advocate-readers (and advocate-wannabe-readers) with ways they can improve their work, their results for clients, and their businesses, too.

This year, that task is so very simple.  Unfortunately, that’s not the good news. Sadly, it’s more like the bad news.

Bad news – because this year’s challenges all come from complaints and problems I’ve been asked to respond to – or even fix – in just the past few months. Oh how I dislike this part of my work!  I hate dealing with complaints – hearing them from people who feel they have been wronged, attempting to be reassuring, defending some of the actions they think were wrong….  And I hate fixing problems, no matter whether I caused them myself, or they have to be fixed for someone else. I suspect you feel exactly the same way.

My biggest concern, which you’ll understand as you read this post, is that not attending to these problems may invite even bigger ones.

So today I’m going to address three of them, all of which YOU can pay attention to, and make sure you’re doing them right yourself. They set the stage for this year’s challenges, turning negatives into positives. There are lessons – and challenges – here for us all. Continue Reading →

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Shooting Your Advocacy Practice in the Foot

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Readers of this blog may remember that my husband and I have been in the process of moving – from Upstate NY (where they had 40 inches of snow last week!) to Central Florida. (No, no snow here so far 🙂 )

Moving is a bear – there are no two ways about that. Ours took place in two stages: first to a rental house, putting 75% of our household goods into storage. Then Stage Two, this past week, moving into our newly built home, bringing our goods out of storage. Now, of course, we’re trying to make our way through all those boxes, put everything away into its new place, learn to live in a new space, dig through the chaos that any move entails, all the while wailing “This is the last move! No more! Too much!” 

Many of you have been there, and done that.

As I did during the early part of the move last spring, I’m going to share with you a couple of lessons gleaned along the way of the move because they are about working with people – the bread and butter of any advocacy business. They are so important, they can make or break your business.

The moving business is a service business, just as advocacy is a service business. Moving is extremely stressful just as any healthcare challenge is stressful. That makes it incumbent upon any service provider who supports clients going through stressful events (from advocates and medical providers to movers) to make stress relief part of their jobs.

The basics of stress relief are communications and consistency. You have to do the work, and you have to do it well and correctly, of course. But if you can’t communicate effectively, manage expectations, or be consistent, well – you are shooting yourself in the foot. Lack of those basics will undermine your success.

I would never again hire The Mover who moved us from New York to Florida. The reasons provide some excellent lessons for today’s post.

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Preventing Our Own Brexit, Saving Our Clients and Advocacy Practices

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The whole world was fascinated last month by Brexit: the vote in Britain to leave the European Union. Would they leave? Wouldn’t they?

But to me, the most fascinating part was what happened the next day. Once the vote had taken place and the (bare) majority had voted to leave the EU, those who had voted to leave began to learn the real truth of what they had chosen, and realized they had been duped.

Yes, duped. Because the leaders on the “leave” side immediately disclaimed the promises they made. Ooops! they said!  No, we can’t really apply the billions of dollars we send each year to the EU to healthcare. We didn’t really mean that!  We lied to you because we wanted you to vote our way!

How could those politicians make all those promises they never intended to keep?  How did the majority of a citizenry fall for it? Why, now, do many of those citizens who voted to leave the EU wish they could take back their votes, because they have changed their minds?

Brits can blame themselves – period – for not being smarter about reality. They voted for something that wasn’t true or possible because they believed and shared what they heard and read, never vetting possibilities or veracity.  They Facebook-liked, and shared, and re-tweeted, and Instagramed, and discussed in pubs, all that misinformation, disinformation, political venom, disdain and hostility – never fact-checking, never discerning the truth.

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They simply passed on messages that supported their own wishes or philosophies – even when they were lies.

… Exactly like we Americans are doing today with our presidential election and its issues.

It had quite the ripple effect. Because they shared all those lies and vitriol, the world became a more dangerous and unstable place. (Just what happened to your 401K the week after Brexit?  My point is made.)

So what does this have to do with health and patient advocates?

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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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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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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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