The first time I met an official patient advocate, it was the spring of 1991. I was a first-year fellow, learning by treating patients with blood disorders and all kinds of cancers.
A young gay man with low platelets came to see me in consultation. It was his first visit to the clinic. As I walked by the desk on the way to greet him, the receptionist mentioned that the patient was accompanied by an advocate. "He's from an organization," she whispered. "Just thought you'd want to know."
"OK," I agreed, not sure what to expect.
My patient was a frail, tired-appearing and polite young man in his 20s. He lived in the West Village and was no longer employed, suffering from AIDS. The man who accompanied him was also thin, perhaps 30 years old--like me, then--and what you might call assertive. The advocate explained that he'd stay with the patient during the evaluation and discussion of recommendations. He added that he'd seen a file on me at ACT UP, and that I was "all right."
We walked into one of the small consultation rooms. I took detailed notes on the patient's medical history--too long for his age, approximately 23 years. His body was frail and bruised. A bouquet of tiny red spots lined his palate. Similar marks, a bit darker, coated his legs over and above both ankles. We called those, a manifestation of low platelets, petechiae. I reviewed the patient's prior blood tests, and drew a sample that I might examine his cells under the microscope. Later on, the patient, advocate and I spoke about his likely diagnosis and treatment options.
This encounter, my first with an advocate, happened approximately 22 years ago. I don't know the long-term outcome of the patient's story, but it's likely he died of AIDS within a year or two of that encounter. He'd already had several serious infections, and his T cells were quite low as I recall. The advocate may have died, too, but I was not privy to his medical history. All I learned about the advocate over the course of a few visits, and never by my asking him questions, was that he was involved with ACT-UP, that he was extremely familiar with AIDS manifestations, and that he cared that my patient have access to treatment by a considerate doctor.
So who's a patient advocate, today?
I've been wondering about this, in part because I'd like to serve as a patient advocate on a committee and help decide on priorities, meeting agendas and funding for, say, breast cancer research. Some agencies consider that someone like me, a physician who's had significant illness, can't serve as a patient advocate at a table with limited chairs, because I have a medical degree. The problem is I'm on "the other side," or something along those lines.
It happens that some physicians, including your author at Medical Lessons, are among the fiercest proponents of patients' rights I know. I support patients' unrestricted access to information about medicine and new research, to reasonable treatments matching their preferences and values, and to respect from health care providers. At the same time, I've seen doctors who, it seems, promote or outright advertise themselves as "patient advocates" on blogs, websites, in books and elsewhere. Suspicious, yes, but not necessarily untrue.
So here's the question for the crowd: Can a good doctor, or a nurse, or a physical therapist, or any other person employed by the health care system, serve as a patient advocate?
I'm sure I served an advocate for my patients, years ago, while I was practicing, just as I might now, for people with various illnesses. Tell me I'm wrong.
Comments please! How, exactly, might we define a patient advocate? And, while we're at it, who's a patient navigator, and what's the difference?
This post originally appeared at Medical Lessons, written by Elaine Schattner, MD, FACP, a nonpracticing hematologist and oncologist who teaches at Weill Cornell Medical College, where she is a Clinical Associate Professor of Medicine. She shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology and as a patient who's had breast cancer.