An Advocate’s Guide to CYA

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An Advocate’s Guide to CYA

One of the simplest best practices for patient advocates is also the one with the fuzziest line. Sometimes it can be difficult to know at what point that fuzzy line will be crossed, and since crossing it can lead to problems for a client, put a private advocate out of business, or even result in a lawsuit against the advocate, we need clearer definition to be sure we C our own As (that is, CYA = Cover Your A**.) Let me explain. Recently I heard from an advocate member of APHA with a question about billing her client. She had accompanied him to a second opinion appointment, and he had balked at her charges for that service. The client, a man of 70+ years, had depended on his advocate to help him resolve some strange symptoms he was having. So I asked the advocate to walk me through the work. She told me, “Finally I made an appointment for him with a friend of mine who is a dermatologist” …which made me raise my eyebrows… I asked her what sort of discussion she had with her client before she made the appointment. “We didn’t need a discussion. He was having trouble with this, this, and this, and that just made the most sense,” she told me. “He needed another opinion and I thought my friend could provide that.” Except – that’s what the client was disputing. He believed the visit to the dermatologist was a waste of time because no opinion was rendered except a suggestion the client see an endocrinologist instead. Dermatology was the wrong specialty for the symptoms. “Did you talk to your client about other second opinion possibilities?” I asked. “Who decided he should see your friend?” She ignored my question. “Well – I went to the appointment with him so I think he should pay my bill.” (I expect you are beginning to see the problem here…) I asked what made her think he needed a dermatologist. She then described his symptoms, but never mentioned a conversation with her client, or any recommendations that might have…


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