Ramona – whose real name was Rosemary – has died. She did it (mostly) her way.
I first shared Ramona/Rosemary’s story with you a few months ago. She had contacted me through my About.com work asking me to help her die. After a heinous surgical medical error many years ago, she could no longer be treated to provide (by her own definition) any quality to her life, so she wanted to put an end to her misery. Her primary care doctor, fearful he would be arrested, refused to help her.
After thinking about it long and hard, I decided that determining our own time and place to die can might be considered the ultimate in patient empowerment. So I helped Rosemary learn more about options, legalities, how to make decisions, support (especially in the form of a private advocate) and more.
Included in my efforts were posting Rosemary’s request to two of the listserves I am part of, including the APHA discussion forum. I hoped members might come forward to provide additional resources. There were many great ideas posted – all of which were forwarded to Rosemary. And, immediately, one of our members wrote to me describing a woman she was working with who turned out (you guessed it) to be Rosemary. I was so very relieved to know that Rosemary had an advocate helping her!
Over the next few months, I touched base with Rosemary about once a week. She never committed to what her plans were, but she stopped replying in mid-March. So I wrote to the advocate* I knew had contact with her, and sure enough, Rosemary was in hospice, days away from death, with her advocate by her side. Her advocate then notified me just a few days later that Rosemary had passed – intentionally, yes – and peacefully.
Later I learned a few things from her advocate:
(updated January 2017)
We’ve seen fireworks in the APHA Forum before. And we’ve dealt with them. The beautiful thing about the Forum is that allows free conversations on every topic imaginable. But of course, as with any group of highly intelligent, motivated and capable people, we’re not always going to agree. We experienced that again this week.
One of our very active and valued members had visited her attorney to work on her contracts. She raised the idea of working with independent contractors, and her attorney immediately advised her against it. As she reported in the Forum, “He advised me to steer clear due to federal anti-kickback statutes. This is in part because I’m a licensed clinician (NP). But it seems anyone else who is contemplating the use of subcontractors should probably vet it with her or his attorney, especially if you plan on taking a cut.”
Here’s the GOOD and USEFUL part of her report – that she suggests others should discuss and vet the use of subcontractors with their attorneys. Amen. So right. Great advice.
The problem with her post, however, is that it does not apply to 99.9% of APHA’s members who are working with subcontractors. There are two reasons for that, on which I elaborated in my reply in the Forum. The problem, of course, is that information that doesn’t apply might keep someone from trying a successful approach to business. Others chimed in with their thoughts on the subject. It became somewhat contentious. And it most definitely required clarification.
Here’s what we can learn from this sort of exchange:
Having just returned from the APHA Business and Marketing workshops in Tampa, and in reviewing my notes and questions from attendees, I’ve come to a new conclusion about why many people have so much trouble pulling the trigger to actually SAY they are in practice – the formal hanging of their shingle, as it were….
Regular readers know I call this the “paralysis of analysis” – that inability to take the last steps. I’ve written about it here, and I’ve made recommendations here, and in both those cases, I’ve made a pretty thorough case for why advocates should not be so afraid to take those last steps.
My new thinking actually shifts the direction a bit… whittles it down to a singular fear that I think represents the great majority of paralysis of analysis…. that is, that….
Last week I shared with you the problems I had with my coffee pot which burned and melted its insides – and then, while shopping for a new one, it reminded me of a lesson in making sure we advocates take care of the little things.
My point was that we get hired for the big, important things that our clients need, but that our relationship with them, and our further ability to market our practices, is often dependent on the little things we take care of during the relationship. If we drop the ball on the little things, then they can have a huge negative impact for us going forward. Mismanaging our clients’ expectations can spell the end for a practice.
This week I was going to tell you about a way you can get the feedback you need from your clients to be sure you’re meeting / exceeding their expectations…. (and don’t worry – I won’t forget – we’ll catch up to that soon)….
And then, an email exchange this week with a woman who I’ll call Lena, who hired a private, independent patient advocate with whom she is very upset. Even if the story she describes in her email is only half-true, I can see why she would be upset. And – holy cow! – how it proves the point from the “little things” post!
Lena’s first email was one simple question:
Would you know if there is anyone I could contact about a private advocate who mishandled my case?
It was the SMELL – you know, that noxious, horrifying smell of burning rubber… That’s what alerted me to my smoldering coffee pot which was no longer just heating my coffee… No flames (OK – so that photo is a bit of exaggeration), no residual damage to my kitchen, but it did take two days to get the smell out of my house.
Once the emergency was averted (I admit – the only real emergency was that I really wanted more coffee!) – it was time to get down to the business of purchasing a new coffee pot. So I did as all good consumers do – I went online.
Truth is, that coffee pot was the best one I had ever had – with only one big drawback. So I thought… well…maybe I would just get a new one just like it. It wasn’t very expensive. It had lasted as long as any other (before it caught fire). It made good coffee. My favorite feature was the fact that my coffee was kept warm for 4 hours before it shut off automatically – meaning – hot coffee all morning long! My least favorite feature was that when I set the timer to brew the coffee before I got up every morning, it would emit 5 high-pitched beeps when the coffee was ready. Frustratingly, as often as not, I could hear those beeps from the bedroom, which (of course) would wake me up. No, that can’t be adjusted or turned off. And yes, that small annoyance was enough to make me look elsewhere.
That’s when I realized there’s a lesson for all of us in my new coffee maker pursuit. Think, for a moment about the relationships between advocates and their clients. While they are far more personal than my relationship with my coffee maker, there are some parallels from which we can learn a lesson…