Emerging Knowledge Work: Patient Advocacy

Most baby boomers, especially those with surviving parents, were nodding solemnly if they read the NYT story, "After a Diagnosis, Someone to Help Point the Way." The story offered several anecdotes describing the assistance offered by patient advocates. The story's author, Lesley Alderman, like most other journalists, depicts the role played by patient advocates as an extension of the U.S. health care system, perhaps in the same league as home health paraprofessionals.

This characterization is not necessarily incorrect, though patient advocates are unofficial extensions of health networks. Presumably they're generally not referred directly by providers, and have an uncertain and ill-defined status in the health services sector. Further, there's an assumption, borne out by ad copy on some health advocacy websites, that a primary purpose for patient advocacy is to ensure expeditious and fair treatment of insurance claims. This function is valuable, but represents a business rather than a health care source of support.

A broader interpretation, one favored by knowledge engineers, sees the patient advocate at least in part as a knowledge worker. The patient advocate's knowledge of the health care system is the role's key asset. That body of knowledge is a moving target, steadily increasing in depth and challenges.

Consider just a few of the issues touched upon by a patient advocate:

• Risk management
  
• Cost-benefit analysis
  
• Federal Government workflow (e.g., Medicare)
• State Government workflow (e.g., Medicaid)
  
• Multiple providers with possibly unshared medical records
  
• Lack of access to automated processes
• Potential lack of consensus on recommended treatment plans
• Potential lack of consensus between family members
  
• Lack of direct access to drug interaction detection software
  
• Privacy considerations
• Need to rely upon
  
• Expertise in specific disease treatment plans (e.g., diabetes, hypertension)
• Differences between provider facilities -- e.g., inpatient vs. outpatient
• Advocate may be introduced late into the mix after many issues and decisions are already in play
• Knowledgeable use of web-based forums, information sites
• Ability to train patients and family members in the proper use of web-based information assets, even when some information provided there may be unreliable or confusing
• Risk disturbing patient-provider-payor relationships while acting as expeditor-facilitator
  

And that's just a start.

The challenges are numerous, but the demand for quality patient advocacy may one day be keen among those who both recognize the value of the service and can afford it.

Photo Credit: Markus Hanser

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Emerging Knowledge Work: Patient Advocacy