The Challenge of Assessing the Merit of a Client

This post was contributed by
Lisa Berry Blackstock, Soul Sherpa®


Most patient advocates are hungry for business, and for good reason. More customers mean better business revenues. It’s one of the major reasons people enter into business, regardless of the profession.

Patient advocacy isn’t any different. What is different about our profession, though, is a knee-jerk tendency to assume every potential client is a client worth taking. What patient advocate doesn’t want to help a person in need? We most definitely want to help people, especially those who find themselves vulnerable in the midst of a healthcare system where navigation can become overwhelming.

When I began my patient advocacy practice, I assumed every tale of woe I heard from a potential client was accurate and worthy of my advocacy services. Over time, however, I began to identify a pattern that has become part of my screening process for new clients. It turns out that every situation is not as it appears and sometimes very different than how it is described.

Every patient advocate’s goal is to perform a good and valuable service, and be compensated accordingly. However, deciding which clients are worth taking and those where taking a pass is by far the better call, requires a skill that can be described more as an art and not a science.

Many years ago I was approached by a senior man, desperate for assistance with the hospital discharge of his elderly mother. He was well-spoken and convincing. The hospital, he told me, was treating his mother unfairly and he needed the services of an advocate to protect her.

Yes, the perfect pitch I needed to spring into action. An elderly person, already vulnerable, in need of help. Of course I’d assist. This is one of the main reasons I went into business. I committed to accept this elderly woman on as a client, convinced her son’s portrayal was just as described.

When I did meet my client, a 98 year-old tiny, trembling body – deaf, dumb, blind, breathing with the assistance of a ventilator, and receiving nutrition through a feeding tube – I was struck by her helplessness as a person – not only as a patient in a hospital, but also as a person existing in this world.

I learned she had been in her current medical condition for over a decade. A urinary tract infection led to her present hospitalization. Her son, determined to keep her alive at all costs, insisted the hospital wean her off her ventilator and remove her tracheostomy tube, before he would agree to discharge. My help was needed, he told me, to make sure the hospital abided by his wishes.

What mattered most to me: the compromised, feeble, limited human I was hired to assist. Her physicians told me it was not realistic to wean a 98 year-old off a ventilator. The woman was too old, too weak, too spent. I wondered what her preference would be if she could speak on behalf of herself. Would she want to be weaned off of a ventilator? Would she want her feeding tube removed? There was no way for me to know. Not knowing these answers disturbed me.

My gut would not allow me to move forward. Even though payment had been rendered prior to my hospital appearance and paid as non-refundable, I felt I had no choice but to cancel the contract and issue a full refund.

This experience still bothers me. I learned it is my responsibility to thoroughly screen a potential new client before accepting him or her. In the case of elderly clients who are hospitalized, I ask more questions as part of my vetting process so I better understand the physical and emotional circumstances surrounding that patient.

Yes, I want to help people in a meaningful way as a patient advocate. Yes, I want to continue to build upon my income. But, no, that can’t be done in a situation that sits uncomfortable on so levels. If my work doesn’t contribute to a client’s quality of life – – including one who is dying, where pain control and emotional and spiritual comfort are always welcomed – that isn’t a client I should be assisting.


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