Day in the life of a patient advocate

  • A patient advocate will help guide a family through the medical and insurance maze that follows a health crisis.

    A patient advocate will help guide a family through the medical and insurance maze that follows a health crisis. Stock Photo

 
By Teri Dreher
Updated 12/5/2021 9:34 AM

When I'm asked what I do every day as a patient advocate, I never know how to answer because no two days are alike. What I do know is the quality of health care has suffered over recent years because of staffing shortages -- particularly in nursing -- and COVID-related challenges. As a result, advocates like me are experiencing growing demand for our services.

My job is different from that of other "patient advocates" who work for hospitals and insurance companies. It's a question of allegiance. Hospital advocates usually work in the risk management department and are focused on limiting their hospital's liability. Insurance company advocates are trying to keep their company from having to pay out claims.

 

A patient advocate's only concern is what is best for the client. And that client is the patient. That means I find myself frequently representing the patient's interests in discussions with hospitals, doctors, nursing facilities and insurance companies. So negotiation -- whether it's trying to get a patient home from the hospital or trying to get an insurance company to pay for something -- is a big part of my day.

A nurse patient advocate like me has an advantage when representing the patient because we talk the language of the health care system, have the medical background to devise care plans and know how to identify resources. Because I'm working from a position of knowledge and strength, I don't have to yell or threaten legal action. My negotiations are calm and respectful, as I point out to insurance companies and medical providers that executing a sensible care plan will not only benefit the patient but also save them time and money -- and possibly avoid a malpractice suit.

Very often, I am contacted when a patient is in a crisis situation. Family members have watched with growing alarm as their loved one experiences repeated hospitalizations, medication mix-ups, hospital-acquired infections or other mishaps.

The other day I was referred to someone whose husband had been having one medical calamity after another. This man was playing golf weekly six months ago. Yet now, he was so weak he couldn't sit or eat normally, suffered a terrible bedsore and suffered a fall at a facility that resulted in nerve pain.

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I sent a nurse to help manage his care, get him into a quality facility, talk with all of his doctors and push for better rehabilitation. The family told me their only regret was they did not call us in when things started to go wrong. "I wish I knew you when …" are the saddest words we hear.

A patient advocate will help guide a family through the medical and insurance maze that follows a health crisis.
A patient advocate will help guide a family through the medical and insurance maze that follows a health crisis. - Stock Photo

Patient advocates also accompany clients to doctors' appointments. We ask technical questions and don't give up until there's a satisfactory answer. People often tell us, "I would never have known to ask about that!"

And, of course, the doctors love it because they know we will help their patient understand the outcome, prepare for surgical procedures and remind them about scheduled tests. More education and support prior to procedures leads to fewer complications afterward.

                                                                                                                                                                                                                       
 

I also spend a part of my day reviewing clients' health records, making sure their profiles are accurate. I field phone calls from attorneys seeking advice, and I'm helping to plan educational programs so individuals can improve their health care literacy and advocate for themselves. I also help families select a nursing or assisted living facility, often when the immediate family does not live in this area but an elderly loved one does.

I never stop learning. It takes time to stay abreast of all the new rules along the health care landscape, but we have to keep ourselves informed so we can better advocate for seniors and adults with disabilities who hire us to keep them safe.

Being an advocate is the purest form of nursing there is. They say, "Do what you love and you'll never work a day in your life." And I love being an advocate!

• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). She offers a free, 30-minute phone consultation by calling (312) 788-2640 to make an appointment.

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