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    Dorothy Kamaker

    Jen Morris’ paper was wonderful. The challenge is how to translate this theory into practice when “patients” themselves are so vulnerable and powerless at the exact time when they individually need to assert and fend for themselves in the health care system.

    Morris says “patient voices can be a very effective “canary in the coalmine” to detect struggling or problematic practitioners” but this kind of data is gathered and understood at a significant remove from the acute scenario. When someone is sick, they require immediate help and what is needed in the micro situation of one persons experience is a capable advocate: family, friend or professional.

    She also asserts “healthcare will only get better when we start talking about ‘patient expectations’ as though they are right to have them.” I would add “talking and ENABLING”. Health professionals can be the means by which patients recruit a vital, timely and forceful advocate to collaborate in management. But the paranoia/aggression that I am seeing by doctors is a serious barrier to this “patient engagement”. And health care staff who either advocate themselves or recommend a professional independent patient advocate are being intimidated and disciplined.

    There is still a god complex in the medical profession that finds compliant patients, subserviant nurses and health care staff and timid family members their preferred “team”. I spent 90 minutes yesterday at a meeting with all the providers of care to an elderley lady in Sydney’s most exclusive aged care facility listening to a complete dinosaur of a GP rail against patient advocacy. He advised the facility not to permit scrutiny, he asserted advocacy would complicate management and finally, when he was told that everyone else welcomed the assistance, he complained that he was being made redundant and he no longer had a role to play in the patient’s care. Translated, he felt his power and autonomy were threatened. His illogical and menacing rant was embarrassing and marginalised him and not once did he refer to the patient’s best interests.

    6 months ago I was approached by the Clinical Service Managers of 2 of Sydney’s leading private hospitals to present my credentials to their hospital Credentialling Committes in order for hospital management to encourage their staff to make patient advocacy services available to patients who needed them. The service was described by them as a “risk and quality control” strategy for the hospitals. At both hospitals credentialling meetings the medical representitives fiercly fought making the service officially available. The comments by the doctors included “shining a torch where it should not be shone”, “if patients value this kind of service, let them find it themselves” and (to the risk manager) “if there is a need for this hospital to make this service available then maybe you shoukd ask yourself if you are doing your job properly”. Not one minute spent on patient considerations. In both hospitals the medical chairs of the committees ensured the credentialling application and discussion/decision was not tabled in the minutes. The same illogical, menacing “god complex” behaviour as yesterday. Rampant power and aggression. And yet I have had respectful, grateful and functional collaborations with each individual managing doctor so far. An advocate us not your enemy. An advocate is a collaborative member of the patient’s team and their voice.

    Jen Morris is spot on when she described the essential components of a functional health care partnership from a patient’s perspective that ” included asking questions, evaluating suggestions and identifying needs, barriers and enablers to help them achieve their goals”. She defined exactly the role of an independent patient advocate.

    Dorothy Kamaker MN RN
    Independent Patient Advocate


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