Chutzpah! Know When It Crosses the Line

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One of my favorite words:  Chutzpah!  Pronounced “hoots-pah.” A Yiddish word translated as “shameless audacity” or “supreme self-confidence,” as in (according to Merriam-Webster) “personal confidence or courage that allows someone to do or say things that may seem shocking to others.”

….  and sometimes a trait required by the most effective of health and patient advocates.

  • Do you have chutzpah?
  • And more importantly, do you know how and when to use it?

I ask this because I think there are appropriate times, and inappropriate times, when an advocate needs to showcase his or her chutzpah.  Lately I have experienced both, and I wonder how that translates to its use for clients.  I know some of you experience it, too.

Having chutzpah, and being able to use it, means you have enough confidence in what you are asking for that you believe you are entitled to, or possibly deserving of the outcome you request.

An example: your elderly client is in the hospital, sharing a room, and a single room comes open across the hall. You know your client would be much happier in that single room, so you ask to have him moved. Of course, they have already determined that someone else who is private pay is going to get that room, but you make the case (just enough of a stink) and ultimately your client finds himself alone in that single room.  Yes, you demonstrated your chutzpah. Now your client is happier.

Another client-related example might be when that same client gets the bill for that single hospital room, which wasn’t approved by Medicare, and for which you now argue with the billing department to have the extra charges removed from his bill.  After all, you believe it was crucial to his ability to heal.  And, oh, by the way, you’ll do your best to be sure he doesn’t need to return to the hospital within that 30 day window, meaning they won’t lose money on his readmission. <<wink wink>>

That’s chutzpah!  But – does it cross a line? Is it more like bribery? or blackmail?  or….  ?

That’s the big question.  Where is the line? And is it appropriate to cross it?

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Don’t Let the YesButs Stand in Your Way

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Man showing tongue upside down .This post is dedicated to all our APHA members and non-members who have been infested with YesButs.

What’s a YesBut?  A YesBut is the answer to all those questions and suggestions intended to help them build their practices that they prefer to not think about. Further, it’s the answer that, until these same advocates find a solution, they will not succeed.

I wish I had a dollar for every YesBut someone fires back at me!

  • YesBut they need the help so badly and they don’t have any money!”
  • YesBut I’m afraid to quit my fulltime job until I’m making enough money to support myself!”
  • YesBut if the doctor doesn’t want me in the room, I don’t want to upset him.”
  • YesBut they get so unset in the hospital billing office when I ask questions!”
  • YesBut my client just calls out of the blue and an hour later we get off the phone. She’s so sweet, and I can’t just hang up on her!”

You get the picture.

Now – to be clear – there are some circumstances under which a YesBut is a perfectly appropriate answer.

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The VITAL Piece of Information the Press – and Many Patients AND Advocates – Are Missing

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Soldiers march in formationIt happened one more time this week, frustrating me one more time this week, making me feel like a broken record again this week and then realizing…. hey!  Why not make this point louder and clearer enough so that YOU can all be a part of my “point well spoken” army!

What am I talking about?  The press – which has produced one more article this week about this “new career” of patient advocacy or navigation, making it sound like a grand dream come true for anyone who cares about helping patients.  None of these articles have been realistic about the realities of employment, or the lack of employment, and the conflicts of interest that arise through advocacy employment.

What happens next is the many dozens of email inquiries I begin to receive about GETTING A JOB as a patient advocate.

But I digress…

So before I begin – please understand that the point of this post is to enlist you in the army of advocates who are going to make this VERY IMPORTANT POINT (VIP!)   Please raise your right hand and swear that YOU will share this point with at least 10 other people this week …..

That is:

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Hospital Providers Come to Patient Advocates’ Defense

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chicksLast week I had the opportunity to speak to two groups of hospital quality personnel; those folks who work in hospitals who are charged with overseeing the safety of their patients. They are QIOS, that is, Quality Improvement Officers – and their jobs depend on making sure that their body of patients this year are safer than their body of patients were last year, that next year’s patients are safer than this year’s, and so forth.

My overall message was “let patient’s help”- the idea that no one cares as much about a patient’s good outcomes than the patient and the patient’s families and loved ones. Therefore, by intentionally including them in care tasks and decisions while they are hospitalized, their outcomes may be better:  fewer falls, fewer pressure ulcers, fewer central line infections, etc.

We looked at why this could be important, and how to embrace this kind of help from patients and caregivers… plus I included several slides that suggested that they embrace the presence of private patient advocates. That such advocates are another professional set of eyes and ears that can be devoted to the patient. That devotion means the patient will have less chance of suffering “sentinel events” or “serious reportable events” (also called “never events” – meaning, hospital errors) – which in turn makes the hospital look good.  It’s win win – so why could any hospital object?

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An Advocate’s Allegiance Makes All the Difference

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allegianceJust in the past week alone, I’ve been asked three times why someone would hire a private patient advocate when there are so many other forms of help available.

What other forms would those be?  A variety:

  • hospital patients can call on the hospital’s patient advocate for help
  • cancer patients find navigators to help them through treatment
  • insurance customers can call their customer service rep, or even an insurance company patient advocate
  • a newly diagnosed patient can often find that large disease advocacy organizations, like the Leukemia and Lymphoma Society or the American Diabetes Association, will provide an advocate to help them sort out questions they may have

Yes – those are all resources patients have when they need assistance.  And to some extent, patients may find the answers they seek with any of them.

But there is something each one is lacking, and that one thing can mean the difference between life and death, the difference between quality of life or lack thereof, or the difference between solvency and bankruptcy.

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