A recent article in the Washington Post has triggered vigorous debate about the proper scope of practice of the professionals who are patient advocates.  

Initially, it is apparent that almost anyone can “advocate” for someone who is a patient.  Physicians, nurses, social workers, attorneys, and even friends and relatives of the patient may feel a need to help a patient obtain the care they deserve.  But service as a professional patient advocate is a separate calling that has its own boundaries and parameters.  So let’s take a look at what a patient advocate is and is not.

The Patient Advocate Certification Board (PACB) is the national body that is developing a credential for the profession of patient advocacy.  PACB defines a patient advocate as a “professional who provides services to patients and those supporting them who are navigating the complex healthcare continuum.  Advocates work directly with clients (or with their legal representatives) to ensure they have a voice in their care and information to promote informed decision making.  Advocates may work independently or in medical or other organizational settings.  They serve individuals, communities, disease‐specific populations, and family caregivers.”  

The very first Ethical Standard adopted by PACB clearly talks about the proper role of a patient advocate:  “The role of an advocate is informational, not medical.  Advocates are committed to helping clients and client communities make informed choices and access resources.”  The role of a patient advocate is further detailed in PACB’s Competencies and Best Practices.    

Taken together, all of this information tells us what a patient advocate does:

• Provides services to patients as they navigate the healthcare system,
• Works directly with patients to ensure that they have a voice in their care,
• Works to make sure that patients have sufficient information to promote informed decision making, 
• Plays an informational role,
• Is committed to helping patients make informed choices and access resources,
• Ensures that a patient’s wishes are the guiding force behind decisions affecting medical care and the withholding of care, and
• Collaborates effectively with other members of the healthcare team.

We can also look at this from another angle and clearly see what a patient advocate does not do.  

The first Ethical Standard of PACB is very clear that a patient advocate “shall not recommend specific treatment choices, provide clinical opinions, or perform medical care of any type, even if they possess clinical credentials.”  Further, PACB’s Competencies and Best Practices clearly state that a patient advocate must “avoid diagnosing or prescribing any medical/mental health treatment for clients, even if the advocate has additional licensure or training.”  

Thus, even if clinical capacity is present, a patient advocate must not provide a diagnosis, provide clinical opinions, recommend or prescribe any specific tests or treatment, or perform hands-on care.  Basically, if the service is clinical in whole or in part, the patient advocate must not provide it.  If such a clinical service does occur, the person providing it is no longer acting as a patient advocate.  Some would refer to this as being a “medical advocate.”  

While there is no need for this body to chisel out a precise definition of “medical advocacy,” it is important to recognize three important issues. 

• First, “medical advocacy” includes clinical components, which means that it is definitely not patient advocacy. 
• Second, the clinical aspects of “medical advocacy” can have very serious legal and insurance ramifications. 
• And third, there is a significant conflict of interest when one person tries to wear both clinical and advocate hats.  Unbiased advocacy may diverge from the clinical care and advice that is provided to a patient.  To be truly patient-centered, a patient advocate must be vigilant to identify, disclose and avoid conflicts of interest, not create them.

Those professionals who aspire to practice as a Board Certified Patient Advocate under a credential earned from PACB will certainly be cautious about straying away from true patient advocacy and crossing the clinical line.

As the profession of patient advocacy grows and matures, we are confident that the strong distinctions between patient advocacy and other fields will become more commonly understood.