Sleep Deprivation Spells Opportunity – and Responsibility

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Saturday night (well, OK, in the wee hours of Sunday morning) across most of the US and Canada, we “sprung forward” our clocks, resulting in lost sleep, and at least a day of being totally thrown off because the day seemed… well…. just weird. Since most of us don’t work on a Sunday, the day of adjustment helped us acclimate, and then – life goes on with a longer day of sunshine through next Fall.

But what if you had to lose that sleep every few days, then re-acclimate every few days?  What if you spent your life in a constant battle with the time of day, and the loss of sleep? What if you had to put in 28 hour days of work and then, somehow, try to catch up on your sleep, returning just 8 hours later to do it all again?

And then what if your job was brand new and involved saving lives, because you were a first-year resident doctor (no, they don’t call them interns anymore)… and your patients, who were hospitalized so YOU could take care of THEM, were constantly at the mercy of your lack of sleep?

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Carly Simon, Ketchup and an Advocate’s Secret Sauce

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Many readers of this blog (members of The Alliance of Professional Health Advocates) know we’ve been burning the candle at both ends trying to complete the build of the new APHA membership website.  Short of raising my two daughters, I think it’s the biggest project I’ve ever undertaken – just enormous – hundreds of resources and thousands of pages – and I’m happy that it is now complete! (Or at least as close as it will ever be – these things are never truly complete.)

Along the way, I’ve learned a few lessons about how to approach the work that can help you, too. And here is the bottom line to those lessons:

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Revisiting the Case of Farid Fata – Why Patient Advocates Must Take Notice

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In July 2015, we took a look at the case of Farid Fata, the Michigan oncologist who is now in prison on fraud charges because he diagnosed and treated more than 500 people for cancer they didn’t have, many of whom died.

Yes – you read that right.  You read the part about treating more than 500 people for cancer they didn’t have.  And, I hope you caught the part that he is in prison on FRAUD charges – not murder, not manslaughter – nothing that recognizes the horrible physical condition he left those patients in after aggressive chemo and radiation. Whatever he could make money from, that’s what he did, and that’s why he is in prison.

See:  A Second Opinion Isn’t Good Enough

Shortly after publishing the post about second opinions, I wrote about how, if any of Fata’s patients had hired a patient advocate, they would not have become victims. There are tasks we do to help our clients that would have prevented harm once we were hired. 

See:  How Professional Patient Advocates Would Have Stopped Farid Fata

Then, last night, NBC’s Dateline took a more in-depth look at the case of Farid Fata, featuring interviews with a number of the patients he had treated, plus an interview with a nurse, Angela Swantek, who figured out what he was doing during a job interview three years before Farid was arrested. No, she didn’t take the job. Instead she blew him in – and the State of Michigan did nothing about it then. (I say KUDOs to her and a pox on the house of those people who decided not to investigate.)

What I learned during the Dateline interviews was that Continue Reading →

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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.

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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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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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What’s a Bad Outcome? And Where Does the Fault Lie?

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Scenario:

Joan, age 75, living in Ft. Lauderdale, was diagnosed with Stage IV Ovarian Cancer.  Joan’s daughter, Beth, who lives in Kansas, contacts Maxine, a private patient advocate and RN who works in Ft. Lauderdale, to help her mother.  Joan, Beth and Maxine have extensive conversations about the care Joan will need. The decision is made that Joan will need surgery and chemo.  Maxine is hired to oversee the care since Beth lives so far away.

The surgery goes well.  The hospital stay is typical. Joan is discharged from the hospital, but three days later begins to show signs of an infection at her incision location.  Sure enough, it’s a staph infection which is already running rampant through her body.  Joan dies less than a week later.

A bad outcome – no question about it.

And now Beth is furious, an emotion only heightened by her grief.  Further, Beth blames Maxine for the loss of her mother because, after all, Maxine is an RN, a private advocate, who was expected to make sure her mother came through her diagnosis, surgery and chemo so she could go on to lead a quality life for many years to come.

………………

This scenario is an extreme, I grant you.  But bear with me while you see how it influences every step you take, every conversation you have, as a private health advocate.

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Watching the Headlines for Opportunities

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A link on Twitter precipitated today’s post and idea for you.  It contains a challenge, too!  See below.

The tweet linked to a news article: A second set of eyes cuts errors at HCMC.  It tells about an initiative at Hennepin County Medical Center (Minneapolis) that cut the medication errors found in patients’ discharge paperwork from 92 percent – to zero. 0.  Nada. No medication errors.  Impressive.

Now, if you or your patient-client happens to be discharged from Hennepin County Medical Center, that’s great news.

But the article got me wondering – what about the other 99.999 percent of discharged hospital patients in the world?  How many other hospitals have such horrendously dangerous medication error rates in the discharge paperwork given to their departing patients?

And then an a-ha moment…  Continue Reading →

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