Patient Advocacy and Medical Historian

Professional Patient Advocacy

A Patient Advocate is a professional who knows the values, wishes and medical requirements of the patient and acts as coordinator and assistant to assure that all pertinent information is communicated to health care providers so the patient may access any and all appropriate treatments, services and benefits.

Patients and families often assume that employees of hospitals, health care facilities and doctor offices understand all aspects of Elder Care and will address a patient’s needs with a comprehensive approach. The reality is, these professionals all have a very limited job description and they do not have the latitude, knowledge or time to help a patient understand the full scope of what they need and what is available.

The reality is, our health care system has become very segmented and most professionals limit their involvement to their specialty. For example, if a patient’s leg hurts below the knee, they will see a podiatrist. If their leg hurts above the knee, they will be treated by an orthopedist. If a patient goes to a hospital, their own doctor does not usually meet them at the hospital to provide the treatment. Instead, the patient is treated by a doctor called a “hospitalist” who tells the patient to “follow-up” with their primary care physician after discharge. The hospital does not automatically send the medical records to the primary care physician so there is no communication and no continuity of care.

When it comes to the health care system, the hip bone IS NOT connected to the leg bone.  Medical professionals rarely do a good job of communicating with other physicians about a shared patient. Case managers working in a Skilled nursing and Rehabilitation setting will send patients home with a home care company, but they have no time to figure out how the patient will afford the home care services or whether the home is a safe environment for the individual to return to. A home care company may care for a patient very well, but when the money runs out, they terminate services and often they do not get involved in helping the patient figure out what to do next.

A Geriatric Care Manager in the Patient Advocate role will know the patient’s background, medical needs, core beliefs, values and fears as well as their financial capabilities. They see the big picture, address current needs and plan for any future issues they can anticipate.

Most importantly, the Geriatric Care Manager in the Patient Advocate role has NO AGENDA other than obtaining the best care for the patient. Hospitals look out for hospitals; rehabilitation centers are there to rehabilitate and then discharge. The orthopedist only wants to hear about the orthopedic problems and does not address any other medical issues.  The Care Manager in the Patient Advocate role addresses the entire person, considers all medical diagnosis and facilitates interdisciplinary collaboration and communication for the greater good of the patient. In this way the Care manager is the most essential piece of the puzzle in a patient’s successful transitional care.

Medical Historian/ Medical Appointment Attendance

When a health care provider asks questions about an elderly patient’s medical treatment history, medications, allergic reactions, operations, etc.. two things often happen: The patient may forget to mention important facts or they begin to tell the doctor the long version of their life story and the doctor cuts them short, leaving important details left out. Both situations can lead to serious medical treatment mishaps.

When a Care Manager assumes the role of Medical Historian, they collect medical records, interview the patient and family to document the full history and research the current medications. This attention to detail takes time, but it can save a life. Recently a client was prescribed a pain medication which contained opioids. Neither the Client nor the physician realized that there was a history of low tolerance for medications containing opioids however, the Care Manager in charge of filling the prescriptions caught the error and called the doctor for an alternative. Had the patient taken the Medication containing an opioid she may have had a medical emergency.

When a Care Manager attends a medical appointment with a patient, they bring the medication list and medical history to the appointment. The Care Manager will complete the physician’s paperwork and give the doctor the pertinent information needed to treat the patient. The Care Manager acts as a historian to report to the doctor past treatment reactions and side effects and any other factors.

If an elder comes to the emergency room exhibiting signs of confusion, delirium or psychosis, the emergency room staff may assume that because the patient is elderly, that behavior is typical for this patient and may be caused by dementia. A Care Manager can help the medical staff know what new and unusual behavior and describe the patient’s typical behavior and level of functioning to the medical team.

The Care Manager at the medical appointment will take detailed notes and make sure that changes in medication and treatment orders are relayed to the family, elder care facility staff or home care professionals. The Care Manager will check the medical charge during scheduled visits to make sure that the physician orders have been followed.

All elders can benefit from a professional Geriatric Care Manager serving as their Medical Advocate and Historian.