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Physician and professional certified coach Chrissie Ott discusses her article “How an insider advocate can save a loved one.” Chrissie shares a terrifying recent story of a friend’s elderly, Spanish-speaking mother who was admitted to the hospital and declined rapidly due to medication and dehydration, highlighting how the patient’s daughter suspected abuse while the real, urgent medical issues were being missed. She explains how she acted as an “insider advocate,” providing her friend with the exact script (including terms like “agitated delirium” and “acute kidney injury”) and the escalation path needed to get her mother life-saving fluids. This episode is a critical look at how overworked hospital systems fail patients, why it’s so hard for families to navigate a medical crisis, and the rising need for physician advocates to bridge the gap. Learn the language and the steps you need to take to effectively fight for your loved one and ensure they get the right care at the right time.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Chrissie Ott, internal medicine pediatric physician and certified coach. Today’s KevinMD article is “How an insider advocate can save a loved one.” Chrissie, welcome back to the show.

Chrissie Ott: Thanks for having me, Kevin. Happy to be here.

Kevin Pho: All right, so in this article, you start off with a story. For those who didn’t get a chance to read that article, lead off with that story and tell us why you shared it with us.

Chrissie Ott: I have a friend whose Spanish-speaking mom was hospitalized and had a fall, as many elderly parents have. She was in a rehab center and developed agitated delirium. Because she did not have the vocabulary, context, or understanding of agitated delirium in an elderly patient, this person was very distressed. She felt like her parent was not getting adequate or timely care in the hospital. She noticed new bruises and felt there were many things going on that she just needed help with.

She wasn’t getting the help she needed, and she reached out to me with a high level of stress and panic. It reminded me of all the times that we as clinicians get reached out to by our circle of friends and family asking, “What do I do? How do I help myself or my loved one in this situation?”

Kevin Pho: Now, when your friend reached out to you with this story and asked for help, tell us how you responded to her. What kind of tips did you share with her, and what was going through your mind as she was sharing this story with you?

Chrissie Ott: The first thing that goes through my mind when someone asks is this repeat message: How do people navigate this health care system without an insider to help them? If you do not have a family member in medicine with relationships and familiarity with the system, it is such a difficulty. It is such a handicap. I am always happy to step in and be that person, and it turns out that I’m happy to do that for more people because I just want to help counterbalance the thing.

My first reaction is compassion and empathy for what is going on. But then, as an internist, I ask: “What is the data? Does she have labs? What is her past medical history? Do you know what her hydration status is?”

We FaceTimed, and I could clearly see this woman had altered sensorium. She clearly had very dry mucous membranes, and there were no fluids hanging. So there were some things that I realized we needed to get moving. I told her, “If you can’t get ahold of your nurse, you go to the nurse’s station and ask for the charge nurse. If you can’t get ahold of your physician, here are some steps.” I named these in the essay.

I also spoke a little bit about the need to encourage the people we are helping to regulate their nervous systems. When you fly at your attending or your nurse, your message gets lost in the nervous system back and forth. This happens unless you happen to have an extremely skillful and regulated professional who is not going to be impacted by the fact that you are exaggerating, impatient, raising your voice, or being disrespectful.

Regulating your nervous system allows you to maintain an appropriate amount of both confidence in your request and need, and an appropriate amount of humility and curiosity about what you probably don’t know in the context of this particular health care situation. I tried to help co-regulate my friend’s nervous system first. Let’s calm down. If something bad has been done to your mom, we will deal with that in the future. But regarding today’s issue, right this moment, we need you to be very present, to be very focused, and to be very specific about what is needed next. It might be information that is needed next. I think that she really needed some time, some hydration, and the recognition that we don’t give benzodiazepines to elderly people.

Kevin Pho: But you would know that if you weren’t a physician, right? So what happened next in the story? Understand you gave your friend some vocabulary and some communication tips to talk with the medical team. What happened next?

Chrissie Ott: She got connected with the nursing unit director who actually came and had a small FaceTime call with me so that I could ask and urge in the right direction. There was a very concerted professional response to meet this elderly woman’s needs, and things got better.

She was being put in a position where she was asked about code status. That is very normal for you and me; we know that we ask people code status in the hospital. But because her mom was so out of baseline, she thought people were basically pushing comfort care on her. I had to unravel that a little bit and say, “No, that is probably not what your team is doing.” Then she began to calm down. She went from “My mom was fine two days ago” to “Are they telling me she’s about to die?” Of course, that can happen, but that’s not what was happening.

So she got better. Her Spanish-speaking caregiver also arrived, and that calmed her, and she was able to eat a little bit. Things worked out. However, if there hadn’t been somebody to translate, to interpret, and to help regulate that nervous system, this could have been one of the ways that people experience medical trauma. That leads to unintended consequences of avoiding health care or having a really fixed negative mindset about health care. Sometimes we have things to have a negative mindset about that are warranted, but some of that is unnecessary suffering. If we can get in the way and prevent that unnecessary suffering, I am here for that.

Kevin Pho: So in that particular story, there was a good outcome, of course, because you intervened. How about advice for families who may not know a physician or an insider, or maybe doesn’t speak English as their native language? What kind of tips do you have for them?

Chrissie Ott: If you are in the hospital, for example, you may ask for a patient advocate. Most hospitals have somebody in a role of patient advocate, and that is a good attempt at helping to traverse this bridge when we have a communication breakdown or a difficult circumstance arising.

I, along with others, have started to frame up how I can offer these services also to the public. You could Google “physician advocate” or “advocate physician” and actually just rent a brain for 30 or 45 minutes. You can ask your questions to somebody who doesn’t have a clinical role in the situation but could help you understand the context from a neutral third-party perspective. I think even as physicians, sometimes we benefit from that. We could rent a specialist friend’s brain to understand what is going on with our parent.

Some other examples come to mind. I had an acquaintance whose child was diagnosed with PANS/PANDAS, and they were very close to being shipped off to a pediatric psychiatric facility. I gave them the right words to use. This got diagnosed, and the child is now over a year later being treated monthly with IVIG appropriately.

My own dad was not going to accept hemodialysis, but nobody offered peritoneal dialysis. I was there, so I was able to say, “How about PD?” He got another two years of his life as a result of that.

Just having somebody in the room with additional information can be priceless. As I shared in that essay, we are all going to be at the mercy of the health care system at some point. Our friends and loved ones are at the mercy of the health care system all the time. There are places where it’s incredibly wonderful and functional, and we’re so grateful for that. There are also places where it needs a supplement, not for any person’s fault or shortcoming, but from the confluence of variables that lead us to have less time and discretionary effort available.

Kevin Pho: Do you think there’s a role for AI if a patient or patient’s family doesn’t have access to a physician or a third-party physician advocate? I’ve heard stories about family putting a clinical situation into ChatGPT or Google Gemini and having it interpret that information for them to make it more understandable. Is there a role for AI to serve that purpose?

Chrissie Ott: I think there is. I think absolutely. I have both excitement and trepidation about leaning into ChatGPT because there are hallucinations. I don’t mean to single that out; other AI tools do it too. I absolutely think there’s a role. It won’t be a perfect substitute for having a human who brings their nervous system. But we also know that AI tools can express a great deal of empathy. You could ask the right prompt, such as: “With an empathic clinician’s voice, please interpret the following clinical scenario. I am most concerned about [blank]. Then fill in the data that you need to share.” I think that there is definitely a role.

Kevin Pho: In the story that you shared with us, you mentioned that your friend’s mother was Spanish-speaking. How often do you see language barriers compounding these medical errors, and what can hospitals and medical institutions do to alleviate that obstacle?

Chrissie Ott: I think that a language barrier, culture barrier, or implicit bias is always a factor anytime there is a difference or a historically marginalized group being cared for. It’s incumbent upon us to be vigilant about that implicit bias. There is an entire field of professionals looking at how to mitigate some of that difficulty.

Of course, having native speakers around and having a diverse workforce will serve. I’m thinking right now about a complex pediatric case that’s being transferred to our unit, and the family speaks Chuukese. It is a common language in some of the Pacific Islands. Thank goodness we have tools like our tele-interpretation that we can use an iPad on a stand to help do that, or that we have some AirPods that can translate supposedly in real time from a lot of different languages. So I think that technology is part of it, and also having a very diverse workforce and being vigilant about our own implicit bias where it comes out.

Kevin Pho: So in terms of the potential root causes that would lead to the situation that your friend contacted you for, is this simply because of staffing, that the nursing staff is short-staffed, or perhaps a hospitalist census is too big? What are some of the root causes why your friend’s mother was in that situation in the first place?

Chrissie Ott: She was in another state, so I can fill in what I suspect were the reasons. I do think probably nursing staff shortage is one. A hospitalist census is one. She may not have been the first five people on that person’s list that day, or they seemed like this is not the most complex case of my list, and I’m mentally triaging right now to take care of what is the hottest potato on my patient list right now. If you’ve ever been a hospitalist, you know exactly what I’m talking about. Sometimes it’s really hard to decide what is the most urgent thing because they all feel really urgent.

I don’t have any specifics to say that this person received implicit bias, but I think even age evokes implicit bias. People say, “Well, we don’t know what this person’s baseline is.” We know that they look old and frail, and so we might confabulate that old and frail and low functioning is their baseline, even when she was standing up vertically and doing exercises in an inpatient rehab facility two days before.

Kevin Pho: We’re talking to Chrissie Ott. She’s an internal medicine and pediatrics physician as well as a certified coach. Today’s KevinMD article is “How an insider advocate can save a loved one.” Chrissie, let’s end with some take-home messages you want to leave with the KevinMD audience.

Chrissie Ott: Yes. My take-home messages are that it’s understandable that we get into these circumstances and that it’s figure-out-able that there are resources, whether they are technology-based or humanoid. Resources can make all the difference. Do not give up without searching for them and identify when they are needed.

Kevin Pho: Chrissie, as always, thank you so much for sharing your story, time, and insight. Thanks again for coming back on the show.

Chrissie Ott: Thank you, Kevin.