Mom & Me Three Archive

...for 11/18/05. Her hemoglobin is lower than I expected but still within her range. Although there aren't any tests for this period of time last year, her test for 9/02/04, while still in "the nines", is even lower than Friday's draw results, so I'm okay with her readings.
    I ran into a laboratory glitch this morning. It seems that they still have the old prescription from her old office and The Shiny New Doctor who dismissed us in their computer and faxed "the doctor" off that old prescription. I faxed her current (and constant) PCP this morning with the lab results, as they hadn't received a copy, and called the lab to change that information. They were swamped. "The front desk" didn't answer the phone so I was told to call back in the afternoon. Yet another medical administration disappointment. If you readers think you can get away with Medical Advocate-Lite status if you are managing the health of a loved one, think again. At this time, chaos reigns in in every corner of the medical-industrial complex.
    Which reminds me...a few days ago I ran across my posting about Steve Case's Revolution venture into medicine, including his desire to create a company of medical advocates. In that post I mentioned that I planned to comment on his commercialization of medical advocacy. I never did. This seems a good time to do it.
    Although I think commercial medical advocacy is an excellent idea, I worry that commericializing medical advocates for patients may devolve into medical advocates being curried by doctors to the point of actually advocating for the medical-industrial complex instead of patients. I have visions of a professional medical advocate for my mother, for instance, responding to me much the way MPBIL, who is a social worker as a patient liaison in the transplant field, did when I was in a quandry about whether to allow my mother to be colonoscopized: "It's standard, now. Everyone gets one just for history. Trust the doctors regarding her risk assessment." I was both surprised by and suspicious of his advice but, as you know, several months later I was finally beaten into agreeing to the colonoscopy. As it turned out, the gastro-enterologist who performed the procedure (and who I was supposed to trust regarding risk assessment) admitted that the procedure had been a bad idea and Mom should never again be scoped, she was too old and frail and the procedure had been "torture" for her.
    Obviously, medical advocates are going to need to be trained (hopefully highly trained). Commercializing medical advocacy will probably and inevitably mean that their training will be institutionalized through the medical-industrial establishment; including doctors, nurses, facilities, drug, insurance and equipment companies. I shudder to think what this could mean for their ability to advocate on behalf of their clients.
    In my ideal world medical advocates would be not only highly trained but highly aware of the constant, myriad blunders the medical-industrial complex stumbles through on behalf of patients and the reasons for such blunders. Although it would be important for some of their training to be directed by the medical-industrial establishment so they were thoroughly familiar with this section of medicine, another part would involve alternative training which would make them aware of such problems as:

• The tendency for doctors to support one another's diagnoses rather than their patients;
• The likelihood that drugs and procedures might be encouraged on the basis of the vociferous lobbying of drug and medical equipment companies rather than the needs of their patients;
• The certainty that, with the current "get 'em through and get 'em billed, as many as possible" climate infecting medicine right now, many doctors, even those of long standing patients, are not making accurate diagnostic, prognostic and prescriptive decisions based on a patient's history because they don't have the time or motivation to check those voluminous histories they collect on their patients;
• The fact that understaffing in both hospitals and clinics increases the likelihood that any particular patient will not receive top-notch treatment in any medical facility and mistakes will be made regularly in such areas (all areas of which my mother has experienced medical mistakes) as:
  • diet prescribed for a hospital stay;
  • inattention to skin tears from the attachment of IV supplements;
  • extreme bruising of diabetics' fingers when blood glucose levels are taken;
  • misreading or ignoring of prescribed treatments;
  • prescribed treatments being abandoned after a discussion with medical advocates then represcribed by an ignorant staff doctor who disdains medical advocacy;
  • lists of medications that are solicited from the patient and/or medical advocate being ignored;
• Lack of attempt at reasonable risk assessment being passed off as adequate risk assessment;
• Physicians and nurses being unprepared for visits with patients;
• Physicians taking offense at a patient's or medical advocate's questioning of and/or denial of prescribed treatment and dumping patients rather than considering and respecting the patient's/medical advocate's research and opinion.

    As you know, I do a great deal of medical advocacy on my mother's behalf. I would, however, love to be able to access the services of a professional medical advocate. If I could, this is what I would want from and ask of such a professional:

• I would use the professional to back me up with the ability to perform and produce all-inclusive, up-to-the-minute research on all my medical (including alternative medical) questions and problems. My expectation would be that the professional would have this access and know how to hone research to specifics quickly and with little fuss.
• In disputes with physicians and other medical personnel I would want my professional to support me with reasonable back-up, which includes being able to trust that professional to determine, with complete information, when I was misguided or wrong.
• I would want my professional to be up-to-the-minute on all medical facilities and personnel appropriate to my mother's care in our area and available specialists-of-interest in other areas in case I need an unbiased second physician's opinion or need to hire a medical and/or therapeutic specialist, etc.
• I would want my professional to be familiar with the eccentricities of my mother's medical profile, including my own difficulties with the medical-industrial complex, and have this information finger-tip available so that I knew I could trust their personnel refreshment from patient to patient.
• I would want my professional to be able to translate technical medical language, including test results, for me into terms I can understand and use.
• I would expect my professional to have alternate ideas on diagnosis, prognosis, treatment and the handling of my mother's medical care and be responsive to my requests for such.
• I would expect my professional to advocate on my behalf in the tug-of-war to have access to as much medical information about my mother as I deem necessary at any particular time.
• I would expect my professional to be thoroughly aware of the ins and outs of all my mother's insurance plans and be able to answer questions about coverage and availability almost as quickly as I asked them. I would also want my professional to act as a reminder when I need to perform insurance recertification procedures for my mother.
• I would want my medical advocate to be familiar with the down side of her insurance plans (i.e., when doctors give me lectures about "Medicare in rural communities") and have suggestions on how to affirm and/or counter such down sides.
• If I have legal questions or concerns about my mother's medical care I would expect my professional to pay attention, inform her/himself of the possibilities, speak to me about such contingencies from our point of view as well as medicine's point of view and, in the final analysis, be able to advise me wisely and from the patient's perspective on whether to initiate legal action.

    Hmmm, I wonder if Steve Case would be interested in my opinion. I think I'll check his site to see if there's an email address to which I can send the above posting. I'll report back...
    ...later.