Patient advocacy.

  Yesterday, while looking  for a book in Indigo, I ran into a lady I  know and learned that she had recently lost her husband, who was a diabetic and not very old.  After expressing my condolences, I listened with horror to the story of her husband's management.  Not his medical management as such, he was going to die in a short time whatever the treatment, but the total lack of compassion with which he was treated, the tardiness of access when he needed it, the inability to contact the family doctor and the inadequacy of the response when by all accounts an urgent response was called for.   (She had to call 911 when a return telephone call would probably have avoided a trip to the hospital and an overnight stay.)  She stayed with him around the clock because she was fearful of what might happen to  him if he didn't have an advocate when he was no longer capable of looking out for himself.  Having practiced medicine for more than half a century, I hear stories of this sort with alarming frequency.  The technical service that patients receive is usually of a high standard, but the level  of indifference to the discomfort and sometimes distress of the patient is such that I would recommend that no one with more than minor illness should be without an advocate such as a family member or close friend.

   Nowadays, one reads increasingly  of groups that label themselves advocacy groups, often suggesting that what we need is the establishment of further government funded groups allegedly looking out for the patients welfare.  In an era when there are more highly paid, highly pensioned people, without any health care training, employed in the health care field, consuming an increasing portion of the health care budget, I am often surprised to hear of the huge gap in health  care advocacy,  particularly in relation to the elderly.  I can only write it off as indifference.  This should be a major part of the training of every health care administrator and for many years I laboured under the misapprehension that it was.  There are already many advocacy groups supported by various pharmacy and medical appliance interests.  There are also privately paid patient advocates . But the  sort of advocate that every patient needs most of all, is  a loving family member or friend who is going  to accompany them whenever serious situations arise or are anticipated.  No stranger provides that sort of input.

     As layer upon layer of health care administrator evolve, holding endless meeting at which the ultimate objective often seems to be the hearing of one's own voice and an attempt to assert a degree of authority unmatched by talent, I recall with horror the amount of time I was forced to waste as a department chair at such meetings.  I knew, of course I was only there to give an aura of legitimacy to the proceedings ("of course we had medical input!"), nevertheless, I was sometimes afraid to go to the washroom for fear of the decision that might be made in my absence.    I frequently noticed at these meetings that the emphasis was almost entirely on the non clinical aspects of medical care.  This was because the committee as a whole, understood little of the clinical attitudes, knowledge and skills necessary for a first class medical system.  There are issues important in health care management  that physicians and nurses need to be aware of and point them in the the appropriate direction to be resolved.   These are responsibilities for administrators and social workers to deal with so that physicians and nurses can spend their time doing what they are trained to do instead of wrestling with administration.  I am referring to attempting to resolve issues such as social determinants of health, poverty, ignorance, cognitive impairment, financial management and the business of administering hospitals and other physical plants..  I am also talking about dealing with obscene waiting lists for which there is no excuse.  Absurd Medico- legal situations that have earned themselves the title of 'health care lotteries' should be dealt with in a very different way, instead of resulting in huge expenses in performing investigations that are necessary only because physicians have to protect themselves.  Keeping up to date in medical skills is a full time job and maintaining physician patient relationships that benefits both the patient and the physician takes time, eye contact and meaningful communication.  Unfortunately, the computerized medical record seems to have taken the wrong track and become more a tool for administration and administrative control than a tool for patient care.  It is time our Colleges got back on track and instead of mindlessly adopting the 'politically correct', start looking out for patients and physicians.    
  And it is time for the armies of healthcare administrators to roll up their sleeves and start dealing directly and efficiently with the non clinical problems of patients, instead of trying to turn physicians into medical technicians whom they can manipulate as they please.