As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to. At those times, in particular, we evaluate their health in the context of relationship, family, and workplace. Having practiced family medicine for so many years, and now in counseling medicine, I have had the responsibility of advocating for my patients with their health insurance companies, within their families, and with their employers. I take this responsibility very seriously.
Occasionally I see a patient who has been previously seen by another health care provider who does not want to advocate for the patient. These providers feel uneasy about “taking sides,” and do not want to find themselves in the morass of letters and forms that inevitably come as the price of advocacy. Perhaps they are not sure if the patient is really sick enough, depressed enough, injured enough. They may think that if the patient pushed harder, that she could go to work, that the pain isn’t that bad, that there must have been some good reason he was fired.
Healing takes place through the relationship between doctor and patient. The foundation of that relationship is trust. The patient trusts us with the most intimate details of his life. She trusts that I am competent and caring, that I’m giving her the best care I can, that I will respect his privacy, that I will listen with full attention and an open mind. He trusts that I will tell the truth, ask for help when needed, and that I will never abandon him. I, in turn, trust my patient to tell me as full and accurate a story as possible, to be clear about what she needs, to cooperate with the treatment plan and follow-up.
It is part of my job to believe in my patient. (Yes, we all have occasional patients who are seeking drugs or inappropriate treatment, or who are challenging or abusive, but even those patients deserve our belief in their ability to change and heal, while we set appropriate limits or regretfully decline to continue to see them.) Sometimes the patient is unable to believe in herself and her ability to heal (this includes situations where cure is not expected, and refers to recovering wholeness), and it is my responsibility to hold that possibility for her when she cannot.
Thus I feel strongly that we have a natural role as advocates. If a patient could benefit from a treatment not covered by his health insurance, we must go as far as we can to get him that treatment. I remember a case from my family practice days in which a patient had a potentially life-saving treatment in another state denied by health insurance, and the doctor spent hours and days calling and arguing with the insurance company. Eventually the patient received the treatment and did very well. If a patient needs us to continue to write letters and complete forms in order to qualify for disability benefits, it is another opportunity to use our “MD” degree in service of our patients.
To benefit our patients, we willingly put in long hours of work, we regularly pursue continuing education; we spend time consulting other doctors and health professionals. We hold family meetings, visit our patients in the hospital even when we are not directly treating them, and some of us still do the occasional home visit. When we freely advocate for our patients, our trust and belief in them becomes manifest, and our therapeutic relationships become strengthened. This benefits both sides of the doctor-patient relationship.
Danielle Rosenman is a former family physician and founder of medical counseling practice. She blogs at 5 Cents: The Doctor is In.
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