Author: zwb12

Daily Advocacy, A practical guide to advocating for our patients on the wards.

When I think of advocacy, I usually think of a specific cause or interest group working towards a common goal. Usually this type of work occurs outside of the wards. Yet, as a resident, a majority of my life is spent in the hospital. For me, this sparked an important question; what can I be doing on a daily basis to advocate for my patients?

In researching the topic of daily in-hospital advocacy, there was an abundance of articles highlighting what we are doing wrong. Few provided concrete advice on how to change the problems they had discovered. Oddly enough, it wasn’t a peer reviewed article that provided pearls on daily advocacy, but a job search forum, (see citation below).

While I had hoped to use a few academic articles to write this post, the sage wisdom’s list provided was far too good. Thus for the remainder of this post, I will highlight 3 of the 10 ways to advocate for your patients on a daily basis highlighted in the article.

Communication (specifically language)

It may seem obvious that good communication is the foundation of any relationship. The biblical city of Babel simply crumbled when each member was cursed to speak a different language from the next. So how do we ensure we are effective communicators? Well, I think language is a great starting point.

Its early, you have 12 patients to see, 30 orders, labs to be drawn, and all this must be done before rounds. Your last patient is Spanish-speaking, but the uncle who has been staying there speaks conversational English. You now have a decision to make: you can  discuss the plan with the uncle and hope he relays the message correctly, or you can call an interpreter  which would add 15 minutes to your morning. In a rush you opt for the former. Little did you know that the uncle did not hear you correctly and told your patient that they are being discharged today. When you return for rounds to discuss the plan of keeping him till the end of the week, the patient becomes visible confused and upset. He was told this morning he would be going home, but now he is going to have to stay the whole week. Like that, the trust the patient had for you and the team is ruined.

This is a small example of a very common and potentially dangerous issue. The best practice is to speak in the patient’s native language.  If that isn’t possible for you, don’t allow a family member to translate for you. You can be a great advocate for your patients by communicating in their own language with a certified interpreter.  It may take extra time, this helps ensure that your patients understand their care, diagnosis, and prognosis well enough to be an active participant in their own health.

Providing the highest quality of care

This one will be short, but it was a nice reminder. The fact that we take the time to look up what we don’t know, keep up- to- date on practice changes, re-assess patient daily or hourly,  are great examples of advocacy. These shouldn’t be  taken lightly. For some patients, we are their first interaction with the healthcare system. For others, we could be the first doctor who worked hard to gain their trust. Either way, we are advocates when we give it our A-game, and we should remember that on the tough days.

Communicate the plan

Listen, family centered rounds are not my jam, but what I do enjoy are the moments where I can sit down with a family and discuss medical management. I mean human interaction is the driving force behind why many of us choose medicine. But how does communicating the medical management equate to patient advocacy?

When you inform them about the treatment, they are empowered. You may be the first person to explain asthma or a genetic mutation to them. When they are empowered, they are more likely to speak up for what they need.

For example, I recently learned that getting a nail in the tread of your tire is very different from the outside of the tire. If it is in the tread, the tire can be patched, but if it is on the outer aspect of the tire, then it must be replaced. Prior to this, I assumed that any nail would mean a new tire. I was a sitting duck, and any repair shop could have taken advantage of me and charged me for a new tire. As an informed consumer I am able to go to the  shop knowing the tire only needs a patch.

Now think about an asthmatic. If all they had ever been told was that wheezing=albuterol then that’s all they will would do. But if you decided to advocate for them and explain the new asthma guidelines, along with a continued need for their rescue inhaler at the current rate, they will need a daily controller. Fast forward three months, and that same patient is now in their PCP’s office getting set up for a controller medication to be initiated. This was an appointment that would never have been made if you had not taking the time to educate that patient on their disease process.  Without that patient education, they could have  continued to use albuterol not knowing about another option to create better control with a daily medication.

To me, these interactions that define in-patient advocacy.  And I hope they show you that you can be an advocate every day for your patients.

Zachary W. Blair, M.D.