Patient advocacy is a growing need. Advisors are particularly well positioned to develop guidelines, at minimum, for clients who face medical challenges.
I’m not suggesting that this type of support and advice is in fact or should be deemed legal advice—it isn’t. Rather, it’s vitally important information that we’re well-equipped to offer in light of our experience dealing with health care systems and the vagaries of aging.
The Basics
We often know whether a client has a chronic or life-threatening illness, is about to undergo surgery and/or is facing an imminent hospitalization. These experiences are in the medical realm, and we may not be involved unless a specific legal problem arises or long-term care (LTC) costs are on the horizon. However, we’re in a position to offer help. Knowing at least some of the basics about patient safety allows the opportunity to provide practical, possibly life-saving advice at a time when it can accomplish the most.
Medical error. The unintended down side of medicine is the very real risk of being harmed by errors and certain practices that may occur in medical care and the institutions that provide it.
The estimated number of deaths in the United States resulting from preventable medical error differs. But, whether we accept the Johns Hopkins patient safety experts’ number of 250,000 (or 700 deaths per day) or the Journal of Patient Safety estimate of 440,000, either number is too high.
Preventable medical error may now be the third leading cause of death in the United States—more than respiratory disease, accidents, stroke and Alzheimer’s.
Countless others suffer illness or injury as a result of medical errors.
As a practical matter, family members and friends are well positioned to serve as patient advocates. They may be named in advance directives or other documents appointing surrogates in the context of medical care decisionmaking. However, if they are, the directive can indicate the desire for help with the medical world even when capacity isn’t impaired or absent. Perhaps you can suggest a document that allows Health Insurance Portability and Accountability Act (HIPAA) authorization for those whom the client/patient trusts the most.
Prominent geriatrician Dr. Mark Lachs asserts, “As perilous as hospitalization can be … I firmly believe that there is no health-care venue where laypeople—patients, families, concerned friends and neighbors—can have a greater impact on improving outcomes of care.”
That’s because many of the dangers of hospital care aren’t a result of technical procedures and tests. Most of the time those are done well. The devil, as they say, is in the details—those that occur before, after or in between the procedures or surgeries. Errors, as noted above, aren’t the only way that harm can be done.
The effects of hospitalization itself. Patients often suffer from being kept in bed too long, from confusion, even from malnutrition—all of which impair recovery. Concerned lay people can, among many other things, help to ensure that the patient is as mobile as soon as and as often as possible; they can facilitate communication and help to coordinate multiple medical professionals. Even a reminder to a staff person or a visitor to wash hands can be lifesaving. This simple measure can prevent a virulent hospital-acquired infection.
When family members or other caring individuals take such steps, they’re acting as patient advocates.
The Advisor’s Role
The sheer number of clients we see who are facing medical issues, together with our awareness of the avoidable dangers of dealing with medical care, puts us in an opportune position to give practical tips and information that are uniquely valuable.
We can be proactive when a client or client family member faces hospitalization. We can encourage him to identify the best individual(s) who can help him survive a hospitalization and enjoy an effective rehabilitation experience. We can alert clients to their own and their family’s abilities to facilitate recovery and avoid harm.
Sometimes, it takes a village. A client may not have the perfect individual to advocate and otherwise watch out for her. Or, she may have one ideal advocate, but one individual alone can’t be there 24/7. Friends and family, as well as religious groups may be called into play to help. A professional patient advocate may even ultimately be needed if no other resources present themselves.
Advisors routinely counsel clients and family members about health insurance, Medicare, Medicaid, HIPAA, medical malpractice, asset preservation in the context of LTC and other matters. We tend to become involved in the health care setting only when problems arise. We become involved reactively.
I suggest that advisors become much more proactive, offering clients practical, fact and research-based advice and information to equip them to serve as advocates for their family members. Give this advice and information, in particular, to individuals named in advance directives. Family members who’ll be present in the hospital room or at doctor visits should be similarly educated and empowered.
In addition, you should add “patient advocacy” to your arsenal. Nothing prevents you from including it in your consultations, your correspondence or even your document preparation. It will expand your practice. It will add to the quality of health care for your client community as well.
This is an adapted version of the author’s original article in the September 2017 issue of Trusts & Estates.