What is it about the world of healthcare, where someone leaving the hospital is “a discharge” and we talk about surgeries as a Whipple Procedures or a CABG (pronounced “Cabbage”)–and we use that language with the patients and clients we work with.  How easily that language slips out!  What I am realizing is that the world of healthcare is a foreign language–just as the worlds of insurance or accounting or law are separate languages.  And people entering the universe of healthcare, under stress, without knowing the language or having an interpreter to guide them–end up under even more stress.  We end up sounding like an exclusive club–and that’s not good healthcare delivery.

So what can we do?  Drop the medical language when talking with patients and clients.  Draw pictures instead; talk about risks and benefits to whatever is being considered; don’t be rushed in explanations; involve the individual and their family in a discussion that is exactly at their level of understanding.  It’s up to healthcare professionals  to figure out and match that level.  So the focus is on us speaking our client’s/patient’s language, not the other way around.

Consumers continue to be overwhelmed by healthcare.  Decisions about treatments, choosing and understanding specialists, coordinating care, addressing billing and insurance issues–all of these areas can be overwhelming to someone in the middle of a complex medical situation.  While many people are alert to the difficulties that seniors encounter in navigating the healthcare system, people who have very ill babies and children, young adults with new diagnoses of diseases or people of all ages facing surgery or treatment decisions need people to help them navigate through.

But who is doing healthcare advocacy and what are their skills?  What are the “best practices” for the profession?  how can consumers find someone near where they live?  These are the questions a National Association can begin addressing.

Who can join?  Everyone with an interest in healthcare advocacy:  medical professionals, consumers, academicians, policy makers.  But the data base of members is open to the public, who can search without charge for an advocate in their geographic area and read about their particular qualifications to help them decide if the advocate is a good match for what they need.  There is only one credentialing program right now in the U.S, and that is run by Healthcare Liaison and is for medical professionals.  Will there be one for consumers?  What are the skills a heatlhcare advocate needs to have?  What about licensing?  Join the Association and join the dialogue!

This client was expressing a feeling often voiced by my clients: there is “no one there” to look after them, no one who is looking at the big picture. In fact, this is a common complaint of clients being treated at major medical centers:  who is in charge of all my care?  What he realized in the subsequent discussion was that Healthcare Liaison creates that system for him, and that he had found his “Medical Home”.  A good healthcare advocate does exactly that:  in a complex medical world, we create the “Medical Home”.

The concept of “Medical Home” is not a new concept.  In the era of medicine that pre-dated the rise of specialty practices, there was a medical home with the family doctor.  If someone needed to see a specialist, the family doctor referred them and was in close communication with that specialist and continued to provide the overall care. If you asked someone “who’s your doctor?”, they could easily answer that question.

With the rise in specialty practices, the picture became less clear.  You could go see a specialist for a particular problem, but maybe that specialist was outside of the regular group practice that you used.  Would the information from the specialist get back to your primary care (“regular”) doctor?

With Medical Home, we go back to the original design:  there would be a primary care physician (and office) that would effectively manage a person’s care, contacting specialists, getting updates and keeping the big picture in place.While the concept is very appealing, there are some major structural changes that would need to happen in physician’s practices to make this an effective practice:
1.  The standard primary care physician will not have the time him or herself–and it will not be cost effective–to do all of the  follow-up that needs to happen; the office will need to hire nurses or medical social workers to accomplish this–and that will be costly.
2. Finding qualified personnel to do this kind of care will be difficult:  there is currently a shortage of both nurses and medical social workers;
3. The question of whether insurance will reimburse for these services has yet to be decided;
5. The electronic medical records systems are not yet sophisticated enough for all primary care physicians and specialists to be able to communicate seamlessly with each other.

As a concept of providing care, Medical Home is exciting–and so new, it’s old!