A complicated health system, an elegant solution

Fear of Asking Questions.

As a patient, the consequences can be serious.

In today’s health care climate, the demands of self-advocacy and involvement in your own health care planning are only on the increase. It’s a daunting challenge, even for those who have self-advocacy skills and the willingness to shoulder the coordination of appointments, specialists, and learning the language of medical communication and assuming responsibility for your own body and health.

Physician and patient communications are strained on many levels. Physicians are tasked to see more and more patients and earn more and more money for the health care machine. Most people don’t have the years of education to understand how one part of the body that is not functioning correctly can understand how everything else is affected, too. So right away, we have lack of time, language and context mismatch, and understanding a very complex interplay of physiology and anatomy.

Then, there is an eternal truth that endears yet: What the physician says is often not what the patient understands. Without a basic knowledge and willingness to realize that one’s body is indeed one’s business, and a more common language and context – what is said is often different than what is heard and understood.

The catastrophic level of misunderstanding leads to an agreement but one at cross purposes.

Patients often say “My doctor doesn’t listen to me. All she wants to do is give me a prescription for something.” And yet, in focus groups, it’s often heard from physicians that “Patients don’t seem to listen to me. I think all they want is a prescription for something, and often they don’t need it.”

Is there any wonder that the mismatch exists?

And today, more and more patients are having to navigate a very complex system of insurances that pay for this but not that; or maybe they’ll pay for that once this set of tests is run; and language like co-pays, deductibles, benefit level exceptions, in and out of networks, plan exclusions and maximums, and why the latest and most effective medications or procedures are deemed “experimental,” or are “plan exclusions.”

Not many years ago, it was normal to have Registered Nurses on doctor’s staff in offices to coordinate care, make appointments, and educate patients in a language that’s understandable on what their next moves are, and why other appointments might be needed. This was called “medical case management,” or “care coordination.” Enter the profession of Medical Assistants, who often call themselves nurses (illegally I add), who have a ten-month certificate and are less expensive by far than professional registered nurses. Most states have practice acts that restrict case management and coordination to independently licensed nurses, who seem to be distinctly absent on the scene these days.

Communication, being a two-way process, has been hampered, and we act with the best intentions but with the worst understanding and lack of complete information.

As an RN, I advocate for patients to ask questions, get answers, and have this conversation in a language that is understood by the patient. Yes. The patient is the most important part of the team here, but often the one that feels the least able to ask for answers to be restated in simpler language, and often feel disempowered and leave because they don’t understand and are embarrassed to ask yet again what is meant.

It’s time for a new environment where both medical professionals and patients can commit to better patterns of communication with assertiveness skills and also with the help of intermediaries.

One such intermediary I advocate is a Registered Nurse Health Advocate (RNHA™) who is skilled in the medical model and has taken the extraordinary effort to develop the skills associated with health coaching. This combination can help in many ways.

An RN health coach is an independently licensed person who can take complex instructions and a plan from a physician and have conversations to help the patient or client:

Devise a workable plan to make progress toward health goals established with the physician.

  • Work with a client to improve medication compliance.
  • Identify health behavior changes that the patient can include goals to improve health and decrease the progress of chronic diseases.
  • Write a summary that the patient can take to their doctor
  • Advocate for the patient (that’s the chief role of every RN)
  • Listen to a patient’s story and notice trends and patterns that might disempower a patient’s living patterns (often the triad of helpless, hapless, and hopeless is present)

There may be a need for someone to mediate between the language, intention and timing barriers, and perhaps retaining the services of an RNHA™ would make sense.  I can think of a couple of opportunities such as retaining the service of an RNHA™ to (with permission, of course) attend doctor visits with elderly parents when adult offspring do not live nearby, or to do wellness check ups, or set up medication stations (medisets).

For people not in the need of medical coordination, perhaps having an RNHA™ as a health coach to obtain excellent health or living skills would be beneficial.

It’s time to open the conversation about retaining private Registered Nurse Health Advocates with coaching skills and therapeutic conversation skills to serve as patient advocates in the physician offices, coach to specific health needs, and be the ally of the disempowered patient population trying to navigate a complex system with complex health requirements.

Lizzie Bennett, MSN, RHC, CCM, RN

Master of Sciences, Nursing – Integrative Health

Registered Health Coach

Certified Case Manager

Registered Nurse

Owner, Three Moons Medicine™

RNHA™ and Registered Nurse Health Advocate™ are trademarks owned by Three Moons Medicine™ which is a licensed Washington State Business.

Lizzie Bthree_moons_medicine-1ennett is a Registered Nurse and Ordained Minister of some years. She is a thought and cognitive therapist and owns Three Moons Medicine™ as her private counselling and coaching practice, a blog, educational forum, Facebook page, and outreach to support others on their journey.



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