Be “respectfully relentless” when advocating for yourself or another for health services | Expert Opinion
A patient taught her physician her approach to self-advocacy — doggedly persistent, while at the same time showing sincere respect for health-care professionals.
/cloudfront-us-east-1.images.arcpublishing.com/pmn/3G7AKNWIEBB7HD6J3YABNOGXXU.jpg)
Over the last year, my patient, a recently retired attorney in his 70s, has brought his wife (also in her 70s and a retired kindergarten teacher) to his primary care appointments.
Her kindness, intelligence, and supportive nature were quickly apparent, as was a certain no-nonsense sensibility. She knows what it takes to be a highly effective health-care advocate for her husband, who requires multiple doctor’s appointments per month for conditions including diabetes, heart valve disease, and balance trouble. Plus, she has to schedule his many tests for him and keep track of his multiple prescription medications.
On their last visit, she told me about placing what felt like an excruciating series of phone calls and messages recently to secure a visit with a sought-after specialist. As she described her experience, I was struck by her intensity and resolve — and lack of anger. In fact, she was grateful to eventually get the appointment scheduled.
“That’s quite a story. How did you manage to navigate this misadventure while preserving such optimism and appreciation?” I asked her.
“I’m a realist,” she said.
She is a practitioner of what she refers to as “respectful relentlessness,” meaning she is doggedly persistent, while at the same time showing sincere respect for the professional training, stressors, and barriers that health-care providers face. I was intrigued by her approach and asked if we could explore it further for this column, as perhaps it may inspire others trying to make their way through our highly competent but often dysfunctional healthcare system. She graciously agreed.
She explained that this approach has roots in her upbringing, which placed a high value and emphasis on showing respect — not only for authorities and accomplished professionals, but also for family, friends, and in all social interactions. Her many years working in early childhood education helped shape her as a problem solver. She has navigated many challenging conversations with worried parents, whose concerns are similar to worried patients.
She shared the following tips from her “respectful relentlessness” repertoire.
State your expectations directly: For example, she uses the following phrasing to advocate for a timely appointment: “It is medically important, per the advice of his care team, that my husband is seen in your office in the next few weeks.” If told that she will be put on a “waitlist,” she will frequently check on the status, even if not contacted by the medical office.
Prioritize respectful conversation over confrontation, such as through phrases like, “I know you are very busy...” Keep your focus on the ball — which is the patient. “There is no sense getting waylaid in a pit of negative energy,” she told me.
Finally, when all else fails, ask clinicians to speak directly with each other to clarify the urgency or priority of a consultation, if this is not happening through the usual channels. Clinicians are pulled in many directions, and my patient’s wife has seen persistence in encouraging clinician-to-clinician communication make a profound positive impact on her husband’s health.
My patient’s wife was truly clear with me that this approach is not a panacea, nor a complete antidote to frustration. In no way aiming to throw medicine “under the bus,” she understands that reform is greatly needed, but is a long-term work in progress. So it is better to be savvy in the current situation than to become mired in pessimism.
She also offered suggestions for medical providers and staff to defuse some stress for patients: Be honest and transparent about appointment access constraints and show empathy for patients’ often frustrating medical journeys.
The “respectfully relentless” model for civil self-advocacy in health care deserves a call-out, especially during these socially tense and polarized times. It does not take medicine off the hook — we must innovate to make receiving care less onerous, safer, and more effective. In the meanwhile, we can all benefit from the valuable wisdom of someone who has been advocating on behalf of her husband, trying her best to work with a flawed system rather than against it.
Jeffrey Millstein is an internist and regional medical director for Penn Primary Care.