Blog | Friday, March 13, 2020

Do you need a patient advocate?

I wish I could write that medical care today is an optimal, cost-effective and efficient system that consistently provides appropriate and sterling medical care. I wish I could write that pharmaceutical companies, hospitals and extended care facilities all view patient care as their primary and overriding mission. I wish I could write that physicians all share the highest ethos of patient advocacy.

It is not possible to achieve these idealistic goals as the individual professionals, corporate entities and the government that comprise the medical profession are imperfect and face numerous conflicts of interests. Indeed, this blog as devoted considerable space to highlighting these issues.

Here's a representative vignette from my world.

I was asked to see a hospitalized patient for an opinion on her low blood count, or anemia. This is a common request for gastroenterologists as internal bleeding is a frequent explanation for anemia. This is when we gastroenterologists get a truly “insider's view” of your intestine with our colonoscopes and other gadgets. Not every anemic patient, however, needs to be subjected to our probing. If we judge, for example, that the anemia is not caused by blood loss, then we will hold our fire and request that an appropriate medical consultant be recruited. Another reason we might keep our scopes securely holstered with a patient who has had true blood loss is if we have safety concerns about proceeding with procedures.

The patient I saw was ailing and elderly. She had many chronic medical conditions. There was no evidence of blood loss explaining her anemia. Therefore, I advised against proceeding with any scope intrusions. The attending physician was dissatisfied with my advice and requested that another gastroenterologist, presumably a more compliant practitioner, see the patient. The doctor reached over me instead of reaching out to me.

I am not asking readers to support my medical advice. Perhaps, I was entirely wrong and the attending physician correctly recognized that internal bleeding was the culprit. Perhaps, she was aware of certain medical facts that I did not know. Maybe I am a mediocre specialist. The point is that the next step in the process should have been for the two of us to engage in a conversation so when we could have a dialogue and arrive at a decision that we both felt served the patient's interest.

Of course, conversations between physicians are commonplace. But, patients would be surprised how seldom conversations between medical colleagues occur. For example, there are certain physicians who don't send reports to me when they see one of my patients.

For these reasons and others, there is increasing space in the medical marketplace available for an emerging medical professional, the patient advocate. These folks can be hired by patients to make sure the medical evaluation is proceeding smoothly and that everyone on the case is fully informed. Isn't this what we doctors are supposed to do?

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.