More on patient advocate services…

Dr Mark Bahnisch writes:

The health care year has begun with a dollop of controversy over the introduction to Australia of ‘patient advocate’ services, defended against AMA criticisms by Claire Crocker of Patient Advocate in Croakey on Wednesday.

Patient advocacy, already established in the United Kingdom and United States, seeks to guide patients through what can be perceived as a health care maze, and act on their behalf to maximize the quality and suitability of care received.

Crocker noted that social workers and liaison officers who perform a similar function also have obligations to health services as their employers.

Dr Steve Hambleton of the AMA has said that “quality communication” and the presence of a relative or friend, particularly at appointments where confronting diagnoses are discussed, should suffice.

Crocker rightly points out that a range of other issues going to pathways of care are often not necessarily handled well or expeditiously.

Whether or not one takes Crocker or Hambleton’s side of the debate, there are at least two key issues that neither really canvass. Both go to some of the central concerns in Australian health policy.

It would be hard to deny that pathways for patients are often complex and opaque. Posting a link to and some commentary on one of the news stories to my Facebook page quickly produced a range of narratives of confusion and misdirection from health workers when patients were seeking to access ostensibly quite simple procedures. Lest this be thought anecdotal, I would suggest that readers consult their own friends and relatives, and reflect on their own interactions with the healthcare system and see whether or not a pattern does not emerge.

Consider also that highly educated professionals often find it difficult to be advocates for themselves when ill, and the real disparities of power that are revealed even when patients have strong negotiating and decision making capabilities must be even stronger for those less able to advocate.

There’s a classic sociological dictum that private problems are often really public issues.

The need for patient advocacy actually reveals a host of systemic dysfunctions in co-ordination of care and in the practical application of principles of patient-centred care. Some of these are due to funding models which reinforce barriers between health professions, and others are due to poor interfaces between primary and secondary care.

If it is the case that a failure in co-ordination of and access to care is evident from the need for patient advocacy (and I have no doubt that there is a real need), then we also need to confront the fact that the need is being met by a market solution which is by definition one that can only be accessed by those with financial resources.

We need to reflect also on whether teaching and learning in “quality communication” in health professional education really gets to grips with the full gamut of patient needs. It undoubtedly goes beyond empathic communication of diagnoses to the ability to help patients navigate a complex system.

Rather, then, than taking sides as between Crocker and the AMA, I think this story should be an urgent wake up call for recognition of our collective failures to ensure that patient-centred care is delivered equitably, empathically and systemically. That is the real import of this controversy.

Dr Mark Bahnisch is a Fellow of the Centre for Policy Development and a Postdoctoral Research Fellow in the Centre Medical Education Research and Scholarship, School of Medicine at The University of Queensland. A sociologist, he has been active in public policy and in consultancy around deliberative participation.