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What does it mean to be a patient advocate?

I first learned this term from my original EMT textbook, and since then, it seems like it’s been the favorite buzzword of the medical profession. It’s a little bit like “leveraging synergies”; it sounds surely good while having no clear meaning at all.

I think this is a shame, because to me, patient advocacy is actually a very meaningful concept, and in EMS, a very important one. Perhaps this isn’t true for doctors and nurses, radiologists and cath technicians — although I’d like to think it is — but on the ambulance, it’s more than just a pretty ideal.

This was what the textbook had to say:

As an EMT-B, you are there for your patient. You are an advocate, the person who speaks up for your patient and pleads his cause. It is your responsibility to address the patient’s needs and to bring any of his concerns to the attention of the hospital staff. You will have developed a rapport with the patient during your brief but very important time together, a rapport that gives you an understanding of his condition and needs. As an advocate, you will do your best to transmit this knowledge in order to help the patient continue through the EMS and hospital system. In your role as an advocate you may perform a task as important as reporting information that will enable the hospital staff to save the patient’s life — or as simple as making sure a relative of the patient is notified. Acts that may seem minor to you may often provide major comfort to your patient. (Limmer 11)

Not half bad, really. But raise your hand if your eyes glossed over that paragraph.

You see, as a prehospital provider, you occupy a unique role in a patient’s course of care. Your time with this patient, from initial contact until transfer of care, is one of the only periods when they’ll have the one-on-one, undivided attention of a healthcare provider. Think about that for a moment. Ms. Smith may previously be, or soon will be, under the auspices of a veritable pantheon of specialists — cardiologists, endocrinologists, orthopedists, neurologists, and more. On this occasion alone, she might pass through the hands of an ED physician who stabilizes her, an internist who admits her, a surgeon who operates on her — never mind a supporting battalion of nurses, techs, CNAs, therapists, and witch doctors. It takes an army to treat a patient.

But that army has other responsibilities, too. That ED doc has two dozen other patients screaming for his attention, most of whom have already been waiting for hours. The internist is running a code in the next bed. Those nurses are overworked, underpaid, and really want to get home.

As a rule, they all have the best intentions, and they all want to look out for the patient. True bad apples or apathetic mercenaries are a rarity in this business. But everyone’s simply spread thin. Even when they have the resources to give their undivided attention to an individual patient, it’s rarely their responsibility to do so. The cardiologist is here to provide a consultation on Ms. Smith’s heart — not to champion her care like the Hospitalist Prince of North 6 and butt into everyone’s else’s work. It’s just not his job.

But what about you, the humble stretcher monkey who brings her in? For that brief period of time, you really have no business except Ms. Smith’s well being. That’s why you’re here; that’s what you were dispatched to look after; and it’s your legal, medical, and moral responsibility to do everything you can for her, until such time as you transfer that responsibility into the aforementioned healthcare cloud (or she refuses further care). Assuredly, you have a defined scope of practice, and company policies to follow, but we’re not talking about cutting out her gallbladder or taking her to a dive bar. We’re talking about — say it with me — patient advocacy. And everyone upstairs agrees that’s part of your job.

Your job is to be her champion. Not because you’re Superman. But because she’s so vulnerable right now, she doesn’t need Superman; she just needs anyone who will step up. Anybody who’ll stand there and say, you are not alone. We all need that, and we all deserve it — but many of these patients, after countless years and battles, have no one else to turn to.

Let’s steal a quote — this is from Danielle E. Sucher at Legal Agility, responding to the question of why she practices criminal defense.

I don’t like hurting people. Is that so hard to understand? When I go to bed at night, I can sleep easily, knowing that I fought for freedom, and for less suffering rather than more. That I stood by someone accused so that he would not have to stand alone. I can’t know whether anyone is truly guilty or innocent, or what they deserve, and frankly, I don’t care. We all deserve at least one person on the damn planet willing to stand there next to us and fight on our behalf. [Source]

Patients have problems. You can’t help with all of them. You can’t cure their cancer, or pay their bills, or make the world fair and right. But you can do an awful damned lot, because it’s astonishing how large the gap is between what the patient would do and what they can do in their current, largely powerless position.

You have resources. One’s this big ambulance, and everything in it. But you also have the resource of knowledge: you know how the system works. You know where to go for certain things, you know who to contact to get what you need, and you know what’s available for the asking. These would serve you very well if you should need to visit the emergency room or become hospitalized, or if your mother should, or your child. If Ms. Smith were your mother, you wouldn’t just shuffle through the process of putting Person A into Slot B, ignoring her needs and looking for ways to avoid going the extra mile; you’d fight like hell to keep her as happy, as comfortable, and as looked-after as possible. Because patients can’t fight for themselves, any better than defendants can argue their own cases. And because although other professionals will be involved in this process, they won’t be fighting for the patient either. I have immense respect for the docs and the nurses, but sometimes, you’re standing in a place to do things they can’t. A few of them may go above and beyond, but they all have their jobs to do, and this isn’t it.

But it is yours.