An advocate for patients might save your life in the hospital

by Dennis Grace

So, you have to go to the hospital. You’ve had an accident and the doctor wants to keep an eye on you for a few days. Maybe you need major surgery. Whatever the reason for the stay, a lot a people think you should have an advocate with you.

Why? In my life, I’ve had lots of hospital stays. Why is this suddenly a big deal? I didn’t have an advocate when I was in for observation after a concussion at age eight or when I had my tonsils out at age ten or when I had pneumonia at age twelve. Hospitals were supposed to be the safest place to be when you were hurt or sick. Of course, at ages eight through twelve, I had my parents there making sure I got the best possible care. Still, I didn’t seem to need someone there all the time.

Anyway, I’m an adult now. Why should I need a babysitter?

For one, hospitals are more complex and dangerous places today than when I was a kid. Antibiotic-resistant infections run rampant in hospitals across the globe. Doctors, nurses, orderlies, therapists, technicians are all required to wash their hands when they go from one patient to the next. Repeated surveys, though, show that many aren’t doing so well at this. Someone has to be there to be sure the hand-washing happens.

Plus, today’s hospitals are busy, hurried businesses. Every filled hospital bed is one less available for the next customer.  They want you out almost as soon as you’re in. In that kind of rush, mistakes are made. Every year, thousands are harmed and many die, simply because someone misread a prescription. Someone needs to be there for you to make sure you get what you need (and don’t get what could harm you). That someone should be an advocate who knows what drugs you’re supposed to get, someone who can ask questions for you when you’re unconscious or when you’re just not quite yourself.

(Note: When I say “advocate,” I don’t mean someone who works for the hospital. Many hospitals offer the assistance of in-house advocates. Think of them as ombudsmen. They work for the hospital to facilitate communication, but you don’t want a communicator whose first duty is to the hospital. You need someone who works for you.)

When I was in the hospital for major surgery a few years ago, Kathy, my wife, took off work and stayed by my side from the recovery room until my discharge. She left only a few times to eat and to check on our daughter. I remember thinking, “She really doesn’t need to do this” and at the same time being deeply grateful that she was there. Every time I awoke, she was there beside me in that terrible visitor’s chair: sleeping, reading, waiting.

I can’t imagine how horrible my stay would have been without her. When I first woke from the anesthesia, I fell into an ocean of nausea. Even though I hadn’t eaten a bite in the preceding twenty-four hours, I wanted more than anything to throw up. The combined painkillers were apparently more than my stomach could stand, even with a powerful anti-emetic. The post-op pain was intense, and that plus the nausea left me a lump of groggy nothingness. The only clear thoughts I had were wanting to throw up and needing to escape the pain in my back.

Kathy worked with the doctor to get me onto a painkiller regimen that worked for me. My stomach eventually settled, and I was eating again by early the second day. Freedom from the pain and nausea allowed me to begin the movement I needed for recovery. Kathy was more persuasive (and insistent) than the physical therapist at getting me on my feet and walking. First, it was just to the door and back. Then it was just outside the room. Then ten floor tiles from the door—twenty—down to the nurses’ station. Without Kathy’s presence, I doubt that my progress would have been so rapid.

Kathy got the nurse in to change my slipping IV needle. She made sure that I ate right. She checked that the doctors, nurses, and therapist used the hand-wash station just inside the door to my room. She also made sure that someone promptly answered the alarms on my pain-meds injector and checked every new drug I was given, including the IV bags.

During my second week, I was moved to an inpatient rehab center, and Kathy returned to work. I missed her, of course, but I got to see her during visiting hours, and frankly, I no longer needed an advocate by my side. On my own, I could move around without constant coaching, make sure the staff washed their hands, and get the doctor when I needed her. Plus, I no longer had tubes and wires trailing from my arms.

Having experienced one inpatient week where I needed an advocate and a second week where I didn’t, I think I understand the dividing line between the two kinds of stays. If you expect to be unconscious, disoriented, or disabled—no matter how briefly—you should have an advocate. If you are as lucky as I was, you have a loved one who can fill that role for you. If you don’t, though, you might want to consider hiring someone to do the job. Even if you do have a caring spouse with time available to advocate for you, he or she might not feel knowledgeable enough to fill that role. It is a lot of work.

Remember that medication errors and antibiotic-resistant infections kill even young and otherwise healthy patients. Don’t let your ego get in the way of your safety and health. At least until you’re sure that you’re in a stable, alert condition, have an advocate by your side to provide the diligent attention that a drugged and disabled you can’t provide.

It just might save your life.

Dennis Grace is co-founder of and blogs at The BillDog Blog.

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  • Michael F. Mirochna, MD

    I think you needed the advocate before you went to the hospital. It sounds like you had back surgery. Hopefully you were having extensive pain and neurological deficits (numbness or weakness).

    Great post, the squeaky wheel gets greased (it’s the same reason we don’t pick up on delerium all of the time because if someone is having negative symptoms, sitting their quietly, they don’t cause a problem, but the old lady yelling and screaming and talking about the great depression (like its the present) gets plenty of attention).

  • dspacl

    Certainly, helping to avoid medical mistakes is a primary goal for anyone in the hospital and an advocate can be an extra pair of eyes, but perhaps more importantly, there is someone who can communicate your needs and wishes even in situations where you might otherwise be compromised, like when “The only clear thoughts I had were wanting to throw up and needing to escape the pain in my back.” If ever there are serious decisions to be made regarding ongoing treatment choices, an advocate is crucial. Don’t leave home without one!

  • Dr. Mary Johnson

    Heavy sigh. Sometimes the “patient advocate” is actually a doctor – getting pummeled for it – right under your nose.

    Going on 12 years and counting . . .

    • Molly Ciliberti, RN

      In the ICU, it most commonly your nurse who is with you every day and knows more about you and has seen more of you than even you have :-) We take being our patients advocate very seriously.

  • J.T. Wenting

    And of course most hospitals don’t want any such “busybodies” around and therefore ban everyone who’s not a patient or staff from the floors outside of visiting hours.
    Many will go as far as having security physically remove you from your family if you dare come to visit them outside approved hours.

  • Brenda

    And what do you do if you don’t have a family member or friend willing and able to take on the role? I think wives make great advocates for their husbands. Husbands for their wives? Not so much.

  • Dennis (Investigator/Negotiator) at MedicalBillDog

    Dr. Mary, I’m not sure what you’re saying.

    J.T., if the hospital says you can’t bring your advocate (especially if it’s your spouse), tell them you don’t care what they’re policy says. You’ll be surprised how flexible they can be when it means losing a hundred thousand dollars or more. If they insist, insist right back. Stand firm. If they absolutely won’t budge, tell them to get stuffed and go to another hospital.

    Brenda, if you don’t have a family member or friend who can help you, you’ll have to hire a patient advocate. You should be able to find someone (or at least get a lead) at .

    As for your other comments: once upon a time, Brenda, when men brought home the bacon and most wives were full-time homemakers, your comments would have been valid for most households. Today, with a majority of families being double-income, I think you’re mistaken. If the roles were reversed, I’d stay with my wife. I know my father would stay with my stepmother. Most of the married men I know would gladly stay in the hospital with their wives.

    • nancy

      it is not that most husbands would not stay with their wives…it is they might not be as skillful acting as an advocate for their spouse as women are :) Most wives are also mothers…and mothers spend their lives “advocating” for their children…”advocating” for their husbands comes naturally :) Most wives will know their husband’s medical history, meds, family history, Social Security number, etc, etc…how many husbands know any of that info about their wives ???

  • Dr. Mary Johnson

    Okay Dennis, I’ll explain (P.S. Perhaps you should take a gander at my blog before you ask such questions).

    Many doctors, during the course of doing their duty on any given day in any given burg, are ALREADY trying their best to be patient advocates. We consider it part of the job. Alas, we hit all kinds of roadblocks imposed by our corrupt & broken system. But those of us who’ve suffered retaliation for being advocates cannot seem to get anyone’s help. And NO ONE (especially not our frequently-vacationing leader who didn’t really reform the things that really need to be reformed) cares.

    This all brings back a lovely memory associated with the hospital that fired me for saving a baby’s life (I’m pretty sure that what I did falls under patient advocacy – again, not that it’s ever mattered to anyone): A few years back, one of my best friend’s Mothers was very sick . . . she was dying . . . in the hospital ICU (in this case, the aforementioned hosptial that fired me). My friend, who had lost her Father just months before – and had who medical power-of-attorney over her Mother’s affairs – and who felt just a little bit over-whelmed by it all – and who was concerned about a few little things (and they were little things) that she did not like – asked me to take a look at her Mother’s chart. She let the ICU nurses know that I had permission to do so. Neither one of us thought it was a very big deal – I mean, I’m a fricking doctor and a longtime family friend.

    They used to call it professional courtesy.

    But I could not just do this at my leisure, by the bedside, as in the days-of-old. No. I had to schedule a sit down in a conference room (as if I were some lawyer) with a hospital middle-management peon glaring me down/watching my every move. It was absurd.

    And my friend was made to feel horrible for the asking.

    If I was treated like this as a physician, I can only imagine what lay people-trying-to-advocate-for-their-loved-ones endure every day.

  • Linda M Raileanu, RN, MM/PA, BSN

    You said: (Note: When I say “advocate,” I don’t mean someone who works for the hospital. Many hospitals offer the assistance of in-house advocates. Think of them as ombudsmen. They work for the hospital to facilitate communication, but you don’t want a communicator whose first duty is to the hospital. You need someone who works for you.)

    As the President of a Healthcare Advocacy firm, I can attest to the fact that hospitals do not like us for just this reason. Facilities want the patient to use their ‘advocate’, this ensures the hospital maintains control of the situation and the opportunity to mitigate any issues that may compromise the hospital’s position.

    You are absolutely correct, the primary loyalty for most hospital & insurance advocates is to the company, it must be, this is who gives them their paycheck, this is who provides job security. One could probably make a case for ‘conflict of interest’. Believe me; we see it all the time.

    Unfortunately most people truly believe they can navigate this very complex system between just themselves and their family. It’s not possible today; too much can go wrong and does, right down to monumental billing errors that leave the patient with large out-of-pocket expenses.

    Nothing like being overcharged for the experience.

  • J.T. Wenting

    ” the hospital says you can’t bring your advocate (especially if it’s your spouse), tell them you don’t care what they’re policy says. You’ll be surprised how flexible they can be when it means losing a hundred thousand dollars or more. If they insist, insist right back. Stand firm. If they absolutely won’t budge, tell them to get stuffed and go to another hospital.”

    Not in this country. Socialised healthcare (that’s Obamacare, or what it will inevitably evolve into) means I have no hospital choice.
    I get assigned a doctor, he assigns me a hospital (usually the one he’s stationed at of course), and that’s it.

    I’ve no decision in the matter, and apart from refusing any treatment at all, no decision even as to what they’re going to do to me.
    Requesting a second opinion is still allowed, I wonder for how much longer (it does cost money…).

  • Dennis (Investigator/Negotiator) at MedicalBillDog

    J.T. Wenting, you’ve clearly been misled. For a clear outline of the PPACA (which, sadly, is not socialized medicine) see:
    Show me which phase of the act takes away choice. Please, no slippery slope analyses. If it isn’t there, let it drop.

  • Steven Reznick MD FACP

    As a primary care physician who still follows his patients in the hospital I try to be that advocate. I spend a good deal of my time fighting for my patients to get the correct meds, fighting to get my consultants to communicate and coordinate, fighting to get nursing to call me when there is a problem before calling the covering physician for the covering physician in the specialty that has been consulted because I actually know the patient best. That doesnt mean that I dont call the consulting physician if necessary, but it does mean that errors that might occur because the doctor and nurse do not know the patient , are less likely to occur. The strong push by hospital administration, insurers and employers for separate outpatient and inpatient physicians exacerbates the problems created by caring for a patient you do not know. Dr. Mary Johnson seems to understand this . Few of you new to the profession seem to understand this.

  • Dennis (investigator/Negotiator)

    You’re a rare bird, Dr. Reznick. Keep up the good work.

    There’s just one problems with the model you suggest, but it’s a fatal flaw. You aren’t there –in the hospital–all the time. In fact, if you have more than one patient in the hospital, you’re not available to any one patient during the whole of your hospital visit. So, you can’t ensure that everyone is sanitizing their hands or doublecheck the drugs before they’re administered or do most of the things my wife–my brilliant but relatively uneducated in medicine–did during my week of recovery.

    An effective in-patient advocate needs to be present most of the day–24 hours per day, if possible.

  • Dr. Mary Johnson

    Dennis, if would be nice if we “rare birds” were not be driven to extinction in our own nests:

    Maybe if we weren’t, you would need the 24-7 advocates.

  • Kate Murphy

    Sometimes it’s not the big stuff — wrong meds, dirty hands, unmanaged pain — that the advocate needs to manage, but the small, but critical comfort things that get lost in all the technology: dinner trays left out of reach, unfilled water glasses, being left in the bathroom with no way to get back to bed, not being able to turn off a light or turn on the TV. A family member or friend can reduce stress, make recovery easier, and get you home where things are a heck of a lot easier. By the way, my husband tracked down the nurse who went to dinner with the opiate drug key in her pocket just before I arrived from the surgical recovery room. Finally, more flies are caught with honey . . .

  • Shannon

    You’re dead-on. When I had my emergency appendectomy, I was SO grateful to all of my friends for looking out for me. When I was out of it, two in particular cajoled, prodded, hinted at … well … “threats” is a strong word, but created credible hints that there could be consequences for not taking good care of me. When I regained my wits, there were SO many errors and problems, I counted my lucky stars that I had a brain, and an education, and the ability to manage my care – Lord knows the hospital wasn’t doing a bangup job of it.

    Fast forward to this spring, when my mom died and was brought rather miraculously to life. In a vegetative state for days, and minimally conscious for days after that, she had no chance of speaking up for herself. I am grateful that I was able to be there nearly 24/7 (and for some dicey days, exactly 24/7). She was in a much better facility than mine, but her case was infinitely more complicated, and the handoffs, no matter how carefully done, tended to be error-prone. Some of the reasons related to the rotating staff, and some were due to the sheer volume of her medical records after a few days of lots of procedures. I was the point of continuity, allowing me to question the doctor who was graduating her from one liquid in her feeding tube to another – he had missed that she was diabetic. Oops. Or argue that her arm was subtly swelling – the bandaging was beginning to pucker – and after I got the testing I wanted, confirmed a blood clot. Shifts of nurses subbing in and out, and hospitalist docs (NOT her personal physician) popping in for 5 mins in the morning were not going to catch that until it had gotten far far worse. Or advocate for adjustments in pain meds, or notice immediately that she had soiled, or had gotten bound up in tubing, or a thousand things that I know about my mother, or observed about her medical condition because I was very fortunate to be able to be there hour after hour.

    I am not there now, but she has my siblings taking care of her rehab needs, and subsequent hospitalizations, once for a hospital-acquired infection (C-diff), and once for the broken leg she suffered in a fall at rehab during one of the times they were not able to be there (of course).

    Sorry – I see this has turned into a total wall-o-text – but I am passionate about this. Patients don’t get to be cared for, and medical people don’t get to care for them properly, and are discouraged from caring ABOUT them at all. Patients are not cared for – their cases are managed. It is a critically broken system.

    Please, if a loved one has to go to the hospital, be there for them as much as possible, whether they know you’re there or not. Especially if they don’t know you’re there. It is not hyperbole to suggest that you might save their life.

  • Dr. Bruce Douglas

    I couldn’t agree more with Dennis Grace. I’m a surgeon and, wherever and whenever possible, in-patient or out, my office advises my patients to bring someone with them who cares for them– in other words to be their advocate. I can site three incidents where it was important to me. First, I was a patient in my own hospital recently, for two days. The admission officer, showing partiality, made sure that I had a private room, even though my insurance only covered two-bed rooms. My wife was with me the first day of admission. The nurses came by every hour or so to be sure I was OK. I later learned that it was only because my wife “advocated’ in my behalf. The second day, the only one who came by, without encouragement, was a nurse’s aide, when it was time to check my vital signs, and I didn’t see my doctor until late in the day, even though I expected him early in the morning. I was sensitive to his other obligations, but my wife, if she had been present, I am sure, would have called his office to find out when he was coming by. I know that I was ready to be discharged in the morning, but I had to wait until his arrival at 6 p.m.
    Just yesterday, I had two patients for surgery, one an in-and the other an out-patient. The out-patient, a teen-ager, was a resident of a half-way house for problem teens. She had a social worker who, following the rules of the half-way house. followed her everywhere she went or was taken in the hospital, except into the operating room. That patient got the best care imaginable. The social worker, by the way, hardly spoke up. She was just there, which made a big difference.
    The second patient, who had been badly injured in a motor vehicle accident, had his mother with him 24 hours a day..
    She was delightfullly pleasant; therefore, I gave her my cell phone number and told her that she could call me at any time. Sometimes, she got a voice mail response, but I returned every call she made. She was a wonderful AND NECESSARY advocate for her son. She helped me out, as well as her son, because she was not only his advocate, but she served as a liaison between the hospital nurses and me. None of us objected!
    I am reprinting Dennis Grace’s article, with his permission, and handing it to every patient who leaveas my office for a hospital stay, to remind them of what is in their best inter-ests. I simply don’t have the time to go into that important subject with every patient, but it is my hope that they will, on my office staff’s advice, read that article carefully and follow its advice.
    As for Dr. Mary Johnson, I respect your “twelve years and counting.” I have sixty and am still practicing and no longer bothering to count. Your curt reference to “Obamacare” was snide and irrelevant. Our so-called broken system is not broken because of government. The government, for both Medicaid and Medicare, has the strictest rules for patient care that exist. The problem is that no one reads them. Doctors (and nurses) are overwhelmed because of a non-system that is completely out of control. I, AND MOST OTHER DOCTORS, Republicans and Democrats alike, would prefer a single-payer (Medicare-for-all) system, as exists in Canada, where doctors and hospitals are relieved of the burden-some paper work that takes up hours each day.

    Dr. Bruce Douglas

    • Dennis (Investigator/Negotiator) at MedicalBillDog

      Wow. Thank you, Dr. Douglas. I’ll be framing a copy of this, highlighting your first sentence, and pointing it out to my kids for years to come.

      Seriously, though, I am thrilled to see that you found my comments so share-worthy. I’d love to make this article available to you and your patients as a PDF for an easy-to-use handout. (And, of course, may I quote you on my blog?) Please go to and click our email address at the bottom of any page to contact me, so I can get you a nicely formatted PDF.

      I look forward to hearing from you and, again, many thanks.

  • Dr. Bruce Douglas

    Dennis: I would hope other doctors would also ask for permission to hand out copies of your article to each and every patient who, at some point, is on the way to the hospital. Now that I have your permission, I am having the article translated into Spanish, since I have many Spanish-speaking patients. They, especially, need the kind of help that an English-Spanish speaking advocate can give them.

    Thank you.

    Bruce Douglas

  • Trisha Torrey


    Great topic – one I am intimately involved in, as you know.

    To the doctors who have posted about being advocates – yes – we absolutely understand that IF YOU COULD you would be there to help. But we know the system is not set up to let you do that as much as you would like.

    To the nurses and other hospital personnel who have their hands tied behind their backs – your ranks are too thin and your responsibilities too vast to be able to advocate for patients as much as you would like.

    Smart patients and loved ones realize all this – and realize that, as a result, it’s the patients who are suffering. The answer is to have someone sit by your hospital bedside 24/7. It’s the only way to get the attention you deserve!

    Sometimes I explain this to others like this — why do you hire a real estate broker to help you buy or sell a home? Because you know there are pitfalls and problems, most you aren’t even aware of, that you can’t handle yourself. Those brokers are people who are watching out for you, making sure the transaction goes smoothly, making sure you don’t get ripped off, or lose out, because you didn’t know the important questions to ask or potential problems.

    And so goes a patient advocate. A patient advocate is who knows the system and its potential problems, a facilitator who can make sure the medical details get handled in the right way at the right time, an apomediary who will help you stay safe and get the care you need (and as Kate mentioned above – take care of some of those comfort details that otherwise go by the wayside.) A protector and caregiver devoted only to one patient.

    Realistically, those tasks just cannot be replaced by someone who is paid by the hospital and has 100s of patients to attend to.

    Brenda asked what someone who has no family or spouse should do. There are hundreds of professional, private patient advocates across the country working for patients now. You can find them at:

    Trisha Torrey
    Every Patient’s Advocate

  • Dennis (Investigator/Negotiator) at MedicalBillDog

    Dr. Douglas, again, wow. If you’re going to print this article, please include the following:

    Copyright © Dennis Grace, 2010

  • Dennis (Investigator/Negotiator) at MedicalBillDog

    Dr. Douglas, again, wow.

    If you’re going to format this article for print, please include the following:

    Copyright © 2010, Dennis Grace, all rights reserved.
    This article originally appeared on MedPage Today’s

    Also, I’m in Texas, and I’d love a chance to run a decent Spanish translation of the article on my blog. Could you please forward me a copy of the translated version?

    Many thanks.

  • Linda M Raileanu, RN, MM/PA, BSN

    As one who has been advocating for patients for over 23 years, this is a topic I am truly passionate about.
    I have been privy to the suffering of so many individuals at the hands of the health care bureaucrats, whether they are private insurers, the government, or hospital administrators, each puts the cost far above access, quality, and many times the dignity of the patient, which is why I believe that it is in the best interest of the patient and their caregivers to bring on-board an outside advocate.

    Using an in-house advocate, whether they are from the hospital, the insurer, or the government, will bring about a “conflict of interest”. Furthermore, one doesn’t know what they don’t know; therefore the advocate must be medically as well as administratively savvy.

    I’ve had to correct / fix many cases where the person was lacking in the necessary knowledge and only made matters worse, and sometimes there is not a lot of time or chances to get it right. For this reason, we tend to get the most complicated and last resort cases. Did not ask for this, but once others began to explain how they “were helped”, I couldn’t just let it go, I had to fix the issues. Far too many individuals are compromising where they do not need to… but… if you don’t understand the details (and the devil is in the details), then one settles for mediocre versus maximizing the best for the patient.

    Finally, Dr Douglas stated, “I, AND MOST OTHER DOCTORS, Republicans and Democrats alike, would prefer a single-payer (Medicare-for-all) system, as exists in Canada…”

    I Must Beg To Differ. I work with and know many physicians in the Philadelphia area, primary care and specialists and they do not like Obamacare one bit… they absolutely hate it. One must remember, the AMA is not a representation of the medical community … they only have about 17 – 20% of that medical community as members.

    All the physicians & nurses I have spoken with would like simplified unified processes so they are not wasting time on paperwork, however, they do not want the Canadian or European style of medicine, a public option or anything that the government has their hands in… they’ve told me outright… they see it as socialized medicine. Every physician & RN I’ve spoken to hates Medicare… I am an RN with her Master’s in Management/Public Administration, Healthcare Policy… therefore I do speak with a large number of practitioners, I speak on Health Care Reform, and I am not hearing, what Dr. Douglas is purporting.

    My point… a public option or Canadian style of medicine is very controversial and just as there are health care providers who purport they love it, there are just as many intelligent, well versed, highly experienced health care providers who hate it.

    Linda M. Raileanu RN, MM/PA, BSN
    Genuine Healthcare Resources, LLC

  • Sheryl Kurland

    Thank you for such an informative article on patient advocacy. There’s a motto we routinely share with audiences at our presentations to various organizations, associations, seniors groups, community groups, etc.: “Never go alone.” Whether the person is a trusted family member, friend or professional Patient Advocate, it is always beneficial to have the “extra voice, and eyes and ears” on your (the patient’s) side, and supply him/her with 2 things: 1) a pen or pencil; and 2) paper. Take notes!
    Sheryl Kurland
    Orlando Patient Advocates

  • Dr. Bruce Douglas

    I’m a little uncomfortable with the introduction into this discussion of “professional patient advocates”. Correct me if I’m wrong, but they cost money, and I would not recom-
    mend to my patients that they hire someone to do the job. The kind of patient advocate to which I’m referring doesn’t have to understand hospital protocol or how to read a hospital bill. They just have to care for the person who is hospitalized, know how to speak English, AND BE THERE

    I can’t overlook Ms. Raileanu jumping from my reference to “single payer” to “Obamacare” and “government”, demonstrating to me that she probably adheres to the doctrines of the Tea Party. It’s not my personal observation that most doctors would prefer “single payer”. That was the conclusion of survey after survey conducted during the health-care-reform debate. And surveys also revealed that 3/4 of all physicians like Medicare, and, guess what, Medicare is a “single-payer” system.

    Bruce Douglas

  • Linda Raileanu RN, MM/PA

    I am a little dismayed at Dr. Douglas’s comment. As one who has been in the healthcare system for over 23 years, I have seen my share of mistakes and errors that have not only cost patients and their families thousands upon thousands of dollars, but I have also seen more than my share of poor, negative, and fatal outcomes of patients in both hospitals where I worked… and the case studies of such events continue today.

    As an RN in two center city hospitals in Philadelphia, I was very straight forward with my patients and their families due to the high acuity of the patients on the floor and the almost grossly negligent lack of resources for the RN, who at times had over 14 medical/surgical patients and no help. My mantra those days were, “I would rather be a little messy and alive then clean and dead.” With 14 patients, prioritization was key… and I NEVER lost a patient on my shift. Patient safety and stability always came first.

    Therefore, I would much rather have a person with my family member who could identify a potential medical error or question the possibility of an unnecessary invasive procedure, or pick-up on the fact that the morphine drip is too high, a medication is wrong, or that their condition requires immediate attention, then only to have an advocate hold their hand.

    Patients have thrown strokes, lost limbs, had cardiac arrests, gone into kidney failure, respiratory failure, and died due to medical errors that could have been prevented, that a lay person would not be able to identify… and I am sure that Dr. Douglas, like myself, can actually attach patient names to the scenarios I just noted.

    Furthermore, my comments on Obamacare, unlike many others, are made from first-hand experience and extensive knowledge in the health care system. I am an RN who has worked in the hospital setting, health insurance setting, in the pharmaceutical industry, is a practicing holistic nurse (CAM), a DON for Home Health, and I have a Masters in Public Administration, Health Care Policy. I do not just regurgitate an ideology or believe surveys with a questionable agenda or source… I do my own homework.

    I just had another meeting with a physician’s office today at 3 PM, in West Chester and they are at complete odds with Dr. Douglas’s statement. As I stated previously, some will gravitate to it and some will hate it. By the way, I actually implemented Medicare Advantage plans in multiple states when working in the insurance industry.

    Linda M Raileanu RN, MM/PA, BSN

  • Trisha Torrey

    Dr. Douglas,

    You don’t like the idea of paying a professional to keep you safe? There are dozens of scenarios in which this model is important, both for health and medical purposes and outside healthcare, too.

    What about the elderly adult who has a stroke and is hospitalized – it can take a day or two for the adult child who lives in another state to get there to be by the parent’s bedside. What about the patient who has diabetes but needs heart surgery – you KNOW that patient is not getting the care he needs in the hospital because in the midst of the cardiac care, the diabetes is often forgotten. What about the patient who goes from doctor to doctor for comorbidities (silo to silo) and is prescribed drugs from each, but no one is looking at the entirety of meds and how they affect each other?

    When you purchased your home, did you use a real estate broker? When you wrote your will, did you ask an attorney to help? Do you have an alarm system on your house? (We do have the police, after all.) You hire all those people because they have inside knowledge you don’t have. They know the potential pitfalls and dangers. You trust them to protect your body or your money.

    If doctors weren’t constrained by insurers and reimbursements, then perhaps we wouldn’t need a protector in the middle – but insurance and reimbursements are reality. You might be surprised to know that many of your colleagues all over North America have not only embraced the concept of private patient advocates, but some even have them on their own staffs.

    Professional advocates are invaluable and life-saving in any number of cases. Their job is to facilitate the relationship between you, the doctor, and the patient to be sure the patient is making his/her best decisions, and then adhering to them. You just can’t argue with that.

    Trisha Torrey

  • Shannon


    I have no medical training at all, and I have to take issue with the notion that all a loving family member advocate can do is hold someone’s hand. While holding that hand, you can pay attention to everything, and ask about everything.

    “What’s that for?”
    “What’s the usual dose on that? Will Mom’s current kidney issue interfere with the dosage assumptions?”
    “This formula isn’t noted for diabetics like the last bag was, and Mom’s a diabetic.”
    “What’s the number we’re looking for?”
    “That’s a different dose/amount/approach than the last person gave/did – what’s up with the change?”
    “Mom’s urine is flowing a lot faster/slower than it was before.”
    “Mom’s breath smells odd”
    “It’s an hour past the usual time for a dose of (whatever). Has there been a change, or are they running behind?”
    –Basically any change is to be noted, and asked about–

    I caught the first symptoms of her blood clot because I noticed that something changed. I learned about O2 sats because I asked. I used that knowledge to question a nurse wanting to administer Atavan because my mom was being “combative.” Mom was not really conscious, her O2 had just plummeted, and someone had shoved something on her face. Yes, it was the mask she needed, but Mom wasn’t able to reason that out at the time. All she perceived was that she was suffocating, and something was being shoved on her face. Of COURSE she was combative! That nurse was unhappy with me, but within 5 mins Mom was all done being agitated, and much closer to regaining her faculties.

    I could give so many examples… so many…

    I do not discount the value of a medical education, and there were many times I wished I’d had one. But I needed to not dwell on what I didn’t know, and focus on what I did know, and focus on learning more, and REALLY focus on being eyes and ears.

    A layperson with the Sesame Street song playing through their head, “One of these things… is not like the other… one of these things just isn’t the same…” can be more valuable than they’d think.

  • Linda M Raileanu, RN, MM/PA, BSN


    I do apologize if my post caused any confusion; accountability always rests with the communicator. I was not speaking about family members when addressing Dr Douglas… I understood his statement to mean that he sees no value in a professional patient advocate, which should be someone with the necessary credentials and training if they are to purport themselves as Professional Healthcare Advocates.

    As a Holistic Nurse I am more than well aware of the fact that no one can replace family and I many times am the one trying to help the adult child understand why it is so important to make time to be at the bedside, even if one’s parent is nonverbal and in a coma… they can still hear you and they feel your presence.

    Healing Touch is taught in many nursing university programs and as a Reiki Master I recommend healing touch be incorporated into the Reiki treatment… human touch is vital to the healing process.

    No one should ever discount the value of family members reading to the patient, singing songs, showing family videos, looking at pictures, playing games, doing a puzzle, and yes, asking questions… always asking questions. However, even with all the family at one’s side, I can review countless numbers of patients, in my 23 years, who had a negative or fatal outcome because the reality is, Medicine is a complicated specialty; it is an Art as well as a Science.

    The point of my post was to make Dr. Douglas aware of the value of a Professional Healthcare Advocate, for Registered Nurses are taught in their BSN programs to be that person; in addition, it is formally part of our Nursing Code of Ethics (2001). “Nursing promotes, ADVOCATES FOR, and strives to protect the health, safety, and rights of the patient”. Therefore, Professionally trained Healthcare Advocates, Registered Nurses, do bring value to the situation and can help relieve the stress and hopefully make the situation less overwhelming for both the patient and their families… but nothing… no one can replace the family!

    Linda M Raileanu RN, MM/PA, BSN

    • Dennis (Investigator/Negotiator) at MedicalBillDog

      Linda, I realize that your comment was directed at Dr. Douglas, but I also found the comment about a non-professional being nothing more than a hand-holder to be extremely insensitive.

      As for your comments about “Obamacare,” you are as out of line here as Dr. Douglas. More so. The PPACA (Obamacare is a non-existent concept) is a far cry from a single-payer system and represents some real (if smaller than I would have liked) advances in patients’ rights. Even if the public option had been approved (and a few years from now we’ll all be wishing it had been), the system would not be socialized medicince. Finally, if an actual single-payer system had been approved like the largely successful systems in France, Canada, or England, that would have been socialized medicine, and we’d all be better off. What, precisely, is your complaint about socialized medicine? I have friends in France, England, and Canada–I’ve lived in England and Canada–and they do not envy us this hyper-priced mess we so ludicrously call a “medical system.” So, again, I ask, what’s wrong with socialized medicine? You and the tea-party fruitcakes all seem to think “socialized medicine” is an end-all argument in itself. Is it simply that we would lose our selected doctors? Most Americans don’t get to select doctors now, so how is that different? See if you can come up with an answer on your own without quoting Glen Beck or P. J. O’Rourke.

  • Dr. Mary Johnson

    I have been watching this thread with some dismay. So I’m gonna try this comment again:

    Bruce, as the blog I author attests (click the name), my “twelve years and counting” bear no resemblance whatsoever to your 60. I work on the road and do not get to sleep in my own bed more than 9 days a month because the Federal government could not manage/oversee its way out of a wet paper bag with the bottom blown out . . . hardly “irrelevant” to the bloated/expensive bureaucracy that Obamacare embodies and wants to expand. If I’m “snide” or “curt” I’ve more-than-earned the right to be.

    I’ve gotten the same amount of help from the “reformers” currently running DHHS and the US Justice Department that I got out of the Clinton administration (well, not counting the too-little-too-late crumbs they threw nine months after the fact). Doctors need advocates too.

    The IRS is going to be Obamacare’s primary enforcing arm in his new grand plan for healthcare. It might interest you to know that the IRS told me that while a “non-profit” could not lie to the IRS, but it could lie to ordinary citizens all day long and the US Justice Department would not lift a finger. So much for those strict rules. And ordinary citizens.

    So tell me again, Dr. Bruce Douglas, that the story I have to tell (indeed that many other doctors in similar circumstances can tell) is “irrelevant”.

    Moreover, if no one reads the rules we had before the healthcare reform bill-that-few-legislators-completely-read-much-less-understood was passed, do you SERIOUSLY think anyone but the lawyers are going to spend time on the 2000 more pages of rules Congress just laid-like-a-rotten-egg-on-our-heads?

    As for being a patient, I was one twice – at the same non-profit that fired me . . . whose VP deemed Board-certified Pediatricians “a dime a dozen”. Surgery botched BOTH TIMES:

    I didn’t need an advocate on their under-staffed floor so much as I needed one in the OR (OBTW, I didn’t sue).

    I had to have two MORE surgeries to fix what those surgeons botched – at my own expense. Of course, that was in conjunction with the insurance I now pay nearly $900/month for – insurance that I’m told is going to go WAY up. Wanna tell me my thoughts are “irrelevant” again?

    Here’s the thing Bruce: If I found no aide and assistance from the Federal government I served honorably and well after BEING FIRED BY A NON-PROFIT FOR SAVING A NEWBORN BABY’S LIFE, I sincerely doubt that you/the other MD’s who support government-run single-payor will get help with your paperwork.

    Instead of trying to marginalize and drown out/delete inconvenient voices like mine – a concerned government would be listening and working to plug the holes – rather than cover them up.

    And if you support converting to single-payer without fixing what’s wrong, I guess I’ll get to welcome you to my world.

  • Linda M Raileanu, RN, MM/PA, BSN


    You obviously did not read my post above, and if you did, you made the choice to completely ignore it. I am fully aware of the fact that when one communicates via email or blog there is always a chance of communicating in a way that Does Not reflect what one is truly thinking. I assumed that someone like you would know that over 65% of human communication is via body language, then verbal and written. Therefore, if this were a face-to-face verbal conversation, the Misunderstanding would not have taken place; so much for my assumption that most individuals who blog professionally understand that it is important to seek clarification first… prior to accusation.

    As far as your assessment of Obamacare, BTW: it has become a nationally accepted term, just Google it… enough of that.

    I am fully aware that Obamacare / PPACA did not Formally incorporate a single-payer system into the final bill… as studying health care legislation is what I do. As far as addressing advances in patient’s rights… I again must beg to differ. I would suggest you go back and study HIPAA (The Health Insurance Portability and Accountability Act… and yes, the “P” actually stands for Portability of Insurance – NOT Privacy).

    This has nothing to do with Tea Parties, but everything to do with studying and understanding the various health care bills since the days of LBJ. If the public option had been approved it is Your opinion (and many democrats) that it would not be socialized medicine… there are many learned individuals who believe it would have been and can substantiate their concerns… however, that didn’t formally happen yet, so let’s move on.

    As far as France, Canada, and England having successful health care systems, there again I must completely disagree. Having many family members who emigrated from Romania to live in England & Canada and having studied England’s atrocious healthcare system, I cannot, as an educated health care professional ever at this time purport their system to be successful… it is barely adequate. I suggest the readers study England’s NICE agency as well as how they incorporate QALY (Quality Adjusted Life Years) into their decision making process… it is all about the cost & money… nothing to do with quality or the person. I have spoken with physicians, nurses, and patients who at one time lived or practiced in England, one of the physician’s lives here in PA and practiced at CHOP for quite a few years. There are individuals who live in Canada and come to the US for their care specifically because their system is inadequate and the wait times for care far too long… we are talking months to years. There is an entire industry which helps individuals come to the US to have access to better health care. Furthermore, nothing is ever free… most Americans do not want the exorbitant tax structure one finds in Canada, Europe or Greece… they still pay, however they pay in high taxes while having limited empowerment or control over their health care treatment decisions, because a government bureaucracy (NICE) sets very strict protocols…

    Many American’s ARE still able to select their doctors today and for those who have plans that limit selection… two wrongs don’t make a right. No one should curtail any patient’s ability to see the physician they connect with and who can heal their medical condition the best.

    Our system is not perfect and neither are the socialized systems around the world. The health care system was to be “fixed” by HIPAA, which was signed by Pres. Clinton in 1996; however, the legislation fell short and was allowed to move forward with its deficiencies. BTW, it was a Ted Kennedy Bill. I have written an article which specifically speaks to the fact that all Washington had to do was fix HIPAA, fill the gaps… not create some monstrous massive take over that most cannot understand, no one read, nor can figure out how to implement. A heath care bill did not need to revise the Tax Code, create an agency to mirror Britain’s NICE, or to have College Loan provisions in it (which was removed and later passed under a different legislation).

    Finally, resorting to the childish manner of calling names does not help or bring any positive solutions to the table. However, here’s one:
    Repeal Obamacare, re-open HIPAA, identify the gaps (which I have already documented most given my master’s thesis was on HIPAA), and
    Revise the HIPAA legislation so that it works and does what it was suppose to do – address health insurance portability, accountability, pre-existing conditions, costs, access, and quality… Sound Familiar!!

    In other words, follow the 80/20 rule… address 20% of the gaps and you’ll fix 80% of the problems (500 page bill max)… this would make for a very happy America.

    Linda M. Raileanu RN, MM/PA, BSN

  • Dr. Bruce Douglas

    I’ve had zero success arguing with other members of the Tea Party, so I won’t try with you. Sorry! I guess we just have to agree to disagree.

    Bruce Douglas

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