On Sunday, September 29, 2019, the Cleveland Plain Dealer published a newspaper article about Patient Advocates and Hospital Ombudspersons.

I was pleased to see such a thorough article addressing our industry, especially the clear distinction between the work of private advocates versus those who work for hospital systems, the focus and scope of their work / services and possible conflicts of interest for hospital-employed advocates. I began by writing a letter to the editor to share some concerns about the way in which the article portrayed one of the advocates in the piece. The following is from the original letter to the editor, which was too long for publication in full:

There was one aspect of this article, however, that I found problematic.  In relaying information about advocate Wenzinger’s work with her patient Gesci, Washington notes that Wenzinger was his advocate and since she is also licensed as a nurse, she was able to provide his home infusions for him, as well. The code of conduct for patient advocates clearly states that advocates do not provide clinical care, even if they are licensed as clinical providers.

If Ms. Wenzinger was contracted as both advocate and home health care, then she could be providing both services.  If she was only contracted as an advocate (as this article implicitly implies), then per the Patient Advocate Certification Board she was practicing outside of the scope of practice of a Board Certified Patient Advocate.

The Patient Advocate Certification Board is not the only organization that holds their members to this ethical standard.  APHA (Alliance for Professional Health Advocates), NAHAC (National Association of Health Care Advocacy), and the Beryl Institute, an educational program offering a certificate in Patient Advocacy also have ethics statements that indicate the same.

The Patient Advocate Certification Board Code of Ethics Statement reads: 

Ethical Standard B. 1: The Role of an 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. Advocates shall not recommend specific treatment choices, provide clinical opinions, or perform medical care of any type, even if they possess clinical credentials.

This role shall be regarded as such at all times while using the title Board Certified Patient Advocate whether the advocate is under contract with the patient-client, working (and being paid) by another individual or entity, or providing pro bono or reduced fee services.

The Beryl Institute’s Code of Ethics Statement reads:

Health advocates’ primary commitments are to promote the health, safety, and rights of their patients and clients.

Health advocates will guide and assist their clients-patients in medical decision making but at no time will make decisions about health or medical care or payment for medical services on their behalf.

National Association of Healthcare Advocacy’s statement reads:

Healthcare Advocacy shall not include directly imposing specific treatment choices, providing clinical second opinions; or direct, hands-on medical care of any type. The role of the advocate is to enable clients and client communities to actualize choices and access resources.

And the Alliance for Patient and Health Advocacy states:

Health advocates will guide and assist their clients-patients in medical decision-making but at no time will make decisions about health or medical care or payment for medical services on their behalf.

While many patient advocates may indeed be licensed as other health care professionals, such as nurses, social workers, physicians, or others, the role of the advocate is a supportive role to assist patients as they navigate the health care system and make decisions related to their health-related situations.  Providing clinical services is the domain of clinicians.  IF patient advocates are working in dual-roles with patients, the contracts and insurance for those advocate-clinicians must be clearly defined and both patient and advocate must clearly understand the distinctive roles of the advocate-clinician.

There is a fine ethical line that advocates must not cross when working as advocates, regardless of whether they have clinical skills and licensure or not, unless they have been contracted and hired to work in their specific clinical capacity. The professional standard is that for a person to act in a dual capacity beyond just serving as an advocate, there must be a clear contractual agreement between the provider and the client definitively articulating the services to be offered.

Because this article implies that Ms. Wenzinger is potentially crossing that line in her role as a Patient Advocate by using her clinical license to provide Mr. Gesci care, I reached out and spoke with her to better understand the nature of her role with the patient.  Ms. Wenzinger shared that when she began working with her client, she was not yet a Board Certified Patient advocate.  Indeed, she had not even begun to study for the exam.  More importantly, by the time she became a BCPA, she was no longer engaged by the client for professional advocacy services; hence, no ethical violation took place.

While the article brings needed awareness to professional patient advocacy, it also demonstrates how easy it is to misrepresent the role of the patient advocate. On the other hand, some relevant and accurate information about our discipline and place in the health care industry is presented in this article. As a growing and rapidly emerging profession, these are the kinds of discussions that will continue to surface for patient advocates as we carve out our place as professionals. Let’s remain vigilant in our efforts to educate others in the health care industry and those who will seek our services to understand the skills that we have to offer.

Christine L. North, PhD, MPH, BCPA
President, Patient Advocate Certification Board
Professor of Public Health and Health Communication, Ohio Northern University

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