What’s a Bad Outcome? And Where Does the Fault Lie?

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What’s a Bad Outcome? And Where Does the Fault Lie?

Scenario: Joan, age 75, living in Ft. Lauderdale, was diagnosed with Stage IV Ovarian Cancer.  Joan’s daughter, Beth, who lives in Kansas, contacts Maxine, a private patient advocate and RN who works in Ft. Lauderdale, to help her mother.  Joan, Beth and Maxine have extensive conversations about the care Joan will need. The decision is made that Joan will need surgery and chemo.  Maxine is hired to oversee the care since Beth lives so far away. The surgery goes well.  The hospital stay is typical. Joan is discharged from the hospital, but three days later begins to show signs of an infection at her incision location.  Sure enough, it’s a staph infection which is already running rampant through her body.  Joan dies less than a week later. A bad outcome – no question about it. And now Beth is furious, an emotion only heightened by her grief.  Further, Beth blames Maxine for the loss of her mother because, after all, Maxine is an RN, a private advocate, who was expected to make sure her mother came through her diagnosis, surgery and chemo so she could go on to lead a quality life for many years to come. ……………… This scenario is an extreme, I grant you.  But bear with me while you see how it influences every step you take, every conversation you have, as a private health advocate. And how one simple focus and communication point could have changed the entire scenario for Maxine and Beth, too.  Because not only does Maxine need to deal with Beth’s anger now, but she has to worry that it may result in a lawsuit. (Not to mention that Maxine is probably upset over losing Joan, too.) What could Maxine have done differently? Maxine could have managed Beth’s and Joan’s expectations.  She could have consistently reminded them about what her role as an advocate means, how it does – or does not – affect outcomes. Examples: Beth hired Maxine knowing that Maxine is an RN.  But at no time did Maxine explain that as an advocate, she does not perform any clinical tasks,…


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