When you have an appointment with a doctor, do you bring an advocate with you?

Too many people would have to say “no” to this question.

For lack of an advocate many of us will leave the visit without remembering clearly what the doctor told us. Especially in situations in which we feel anxious about what may be wrong with us, it can be hard to concentrate on the medical response.

“Having another set of eyes and ears can make all the difference,” says Gail Gazelle, M.D. She strongly advises bringing this kind of advocate to the doctor’s office with you.

This Boston-area doctor specializes in care management, another kind of advocacy in which in which nurses and social workers have been involved for many years. Doctors, however, have moved into this work only recently and fewer than a dozen nationwide are said to be active in it now.

That is my reason for writing about Gail Gazelle and the unusual role she has chosen in her medical practice.

In her brochure “Don’t Leave the Hospital SICKER Than You Went In,” Dr. Gazelle explains what an advocate can do for you.

She lists six basic functions: 1) making sure you are treated well; 2) acting as a sounding board when new issues arise; 3) serving as a second pair of ears to take in information; 4) paying attention to details; 5) ensuring that errors are not made; and 6) seeing that things come out as well as they possibly can.

This advice makes sense to me and, in fact, I put it into practice. Whenever an appointment looms as more than routine, I call on my spouse to come with me.

Not everyone, however, has this advantage. Many people cannot find a relative or friend available for this role. In such instances, Dr. Gazelle recommends contacting a nurse or social worker who can take on the task.

Unfortunately, however, many people cannot afford to hire such a professional. They may have to think about turning to other candidates, such as members of church communities or neighbors. For help in finding someone, I recommend your Council on Aging or local home care agency.

Dr. Gazelle herself offers patients a different kind of advocacy. She aims at helping patients make the most of the available medical help.

She does not criticize other doctors, nor find fault with the care they offer. Rather, she takes it upon herself to deal with the challenges of a health care system that is incredibly complicated. Her effort is to facilitate communication so as to make coping with these complexities easier.

“The premise of all my work,” she says, “is that people should be empowered, really partners, in all processes of health care.”

She wants the individual patient to be treated as the most important person in the world. But it’s complicated getting care. “We don’t feel active when we go to see a doctor,” says this physician about the obstacles to patient-centered care.

In order to empower patients, Dr. Gazelle makes it her practice to go to their homes. There, she believes, people feel freer to talk openly about their condition. “I want a practice in which patients are in the driver’s seat,” she says.

Unlike physicians who offer expensive concierge services, she charges 200 dollars an hour on a sliding fee scale. Patients should know, however, that insurance does not cover this service.

Unlike the doctors of my boyhood, she does not actually treat patients in their homes. Rather, she listens to them talk about their needs, gives them advice about their situation, and then smooths the way for them to get the care they need.

“A lot of my time is spent in getting to the doctor,” she says. As a medical colleague, she has leverage that others simply do not have.

As an example of the difference she has made, she tells of a woman who had recently gone through surgery. When she was recovering, a cardiologist told her: “Your heart stopped in the surgery.”

Naturally, this news upset the woman and made her wonder what should be done in response. She appealed to Dr. Gazelle who, on her behalf, investigated the circumstances.

First, Dr. Gazelle discovered that the person who reported the stopping of her heart was, not the surgeon himself, but only a junior fellow. Secondly, when she reached the surgeon, he explained that the woman’s heart had stopped for a very short time and the incident would not have any serious consequences.

This enterprising physician takes as a motto: “get the care that meets your needs, not just the care that treats your disease.” At a time when many patients experience the health care system as forbidding, it’s good to find someone from the medical profession focused on helping them get the best from it.

Further information about Dr. Gazelle and her work is available at the website mdcanhelp.com.
Richard Griffin