Free Clinics

A patient advocate works closely with doctors to thoroughly understand their patient’s condition in order to advocate effectively. A patient advocate initiates necessary follow ups. A patient advocate ensures their patient fully understands treatment plans. A patient advocate educates their patient about their situation and aids them to make informed decisions about their care. For a patient with adequate medical care this advocacy guarantees quality care and a smooth recovery. What about a patient who does not have medical care available to them?

Founded in 1993, the CommunityHealth Clinic has served more than 1.8 million Illinois residents are without adequate health coverage and 1.3 million of those live in the Chicago metro area. Like the vast majority of the uninsured, most of Community Health’s patients are from working families.  CommunityHealth has become a leader among other Chicago land free clinics and even clinics nationwide. They offer comprehensive medical care to the uninsured with more than 750 volunteers including a staff of physicians, nurses, nurse practitioners, dentists, and pharmacists.

In addition, CommunityHealth offers free primary and specialty care, preventive health screenings, vaccinations, diagnostic testing and services, case management and educational programs on-site to all their patients. Their specialty care program now offer programs such as audiology, cardiology, dermatology, nephrology, counseling/social work, and much more.

CommunityHealth believe that they must act as the voice of the uninsured in general as well as the patients they provide care to. Thus, raising awareness for the uninsured, educating communities in Chicago about the services offered at CHC, and influencing public policy are considered top priority for Community Health.

In numerous ways CommunityHealth along with numerous other free clinics are active advocates for the uninsured – the most vulnerable type of patients.

Advocacy in the Community

Where does patient advocacy take place? Where should it take place? The health care field is increasing as new physicians, nurses, surgeons, and medical students enter it all determined to ensure the safety of their patients; to heal their patients. But in reality this healing takes place in the community before it can continue at a hospital.

Community initiated and community based, The Center for Ethics and Advocacy in Healthcare is a nonprofit organization that supports the north suburban families in Chicago. Since 1988, The Center has been answering, and responding to family crisis, helping families make wise decisions for their healthcare, teaching the community how to make effective decisions, working to change public policies in our healthcare systems, and much more.

The Center believes that advocacy starts when a patient is respected and appreciated for being unique. They refer to each patient’s uniqueness as human dignity. Knowing that human dignity is comprised of a body, a mind, and a spirit, The Center places invaluable integrity on a patient regardless of their physical capacity. However, human dignity can be compromised by lack of autonomy, the ability to make self-decisions regarding your healthcare. Thus, The Center strives to preserve patient dignity and their quality of life teaching their community to value their mission: “when we are weak, then we are strong.”

M. Margaret McDonnell, Founder/Director of The Center, offers one-on-one help to numerous families living around The Center who may not know where to turn with their questions. Ms. McDonnell aids families make decisions with respect to surgery, treatment options, and more. She reaches out to her community by visiting homes, hospitals, and nursing homes providing comfort to various patients and their families. Her work takes place on the streets of Techny, IL and addresses such questions as: “How can we live and die as whole human beings? How can suffering and death be integrated into the full spectrum of human life? How do love and justice intersect in a world of scarcity?”  

Finally, she trusts that the presence and the advocacy of The Center can help foster human dignity in each patient and family in the ever expanding healthcare system.

Patients and Advocates Get Involved

According to Duane Roth, author of “A Third Seat at the Table: An Insider’s Perspective on Patient Representatives”, our nation is taking a fresh look at “medical care, advances in the health sciences—from genetic sequencing to stem cell technology—“ and taking new opportunities “to make health care better, faster, and more cost-effective.” However before this can occur, we must reconsider our current strategies on health care innovation; specifically the area of regulating new products. At this point federal agencies, like the Food and Drug Administration, together with product development companies discuss and negotiate the regulatory approval process of new products.

Patients, as well as their families, are immensely affected by these approval processes. Roth states that “their [patients] lives and their quality of life hang in the balance.” Thus patients stand in a unique position because they are able to evaluate both the risks and benefits of existing and upcoming medical products. And so, Roth believes that the time has come to involve patients in the regulatory approval processes. Patients will serve as “mediators” and assist regulators and companies discover new ways for “fostering innovation, building public trust, cutting costs, and addressing quality-of-life issues.”

Patient representatives became prominent in the late 90’s as the AIDS epidemic surfaced. In the 1990’s the FDA summoned patient representatives to serve on advisory committees that assessed products made for life-threatening illnesses. Although patient representatives were consulted to partake in committees, Roth writes that they made up less than 10 percent of the committee. Even today they face struggles as they attempt to influence “product decisions.”

Roth predicts that if patient representatives actively participate in the discussions and negotiations for the regulatory approval processes as mediators, they will serve as catalysts “for making real progress on urgently needed products.” This is the right time to include patient representatives/mediators into the approval processes. This is the right time to improve “costs, payoffs in the therapeutic efficacy, procedural efficiency, and public confidence.” This is the right time to add a third seat to the table.  

Nurses: An integral Part of Advocacy

Vulnerability is the core condition that requires patient advocacy. Vulnerability caused by illnesses as well as risks natural in the healthcare industry, demand advocacy action for patients and their respective families. So who provides this advocacy and how?

           

For many decades the expression ‘advocacy’ has described patient-nurse relationships. Thus advocacy has become an obligation, a key nursing role. Many models for advocacy in nursing are derived from philosophical writings of Curtin LL, The nurse as advocate: a philosophical foundation for nursing, and Gadow S., Existential advocacy: philosophical foundation of nursing. Both authors base advocacy models on “patients’ right to self-determination” and “nurses’ role in assisting patients to exercise this right.” Soon after, more practical models stated that patients must be allowed to make informed decisions and that the role of the advocate was to provide patients with necessary information and support their choices.  However advocacy also consists of the relationship that exists between patients, nurses, and other healthcare professionals present in the environment.

           

Although many models have been constructed regarding the role of a patient advocate, they all vary in their own interpretation of advocacy in the nursing practice. This unclear definition and lack of consensus concerning the true meaning of advocacy, what it involves, demands research; research that will help achieve a well-rounded definition of advocacy while simultaneously considering the perspectives of individual societies on advocacy.

In 2008 a study was conducted in a university hospital in Tehran, Iran in order to gain more information on advocacy in an Iranian society. According to Ahmadi et al, authors of The Meaning of Patient Advocacy for Iranian Nurses, approximately 24 nurses working in various wards in the hospital such as neonatal intensive care, oncology, ophthalmology, and more were recruited for interviewing. The interviews encompassed a broad question, ‘could you describe one of your working shifts?’, and continued as nurses were also asked to describe their experience with patient advocacy. Each interview lasted for about 40-75 minutes. The results of the experiment showed five primary categories Iranian nurses considered part of their role as advocates. These categories were:

• Informing and educating

• Valuing and respecting

• Supporting physically, emotionally and financially

• Protecting and representing

• Promoting continuity of care

Additionally, data analysis indicated that nurses believe their patients lack appropriate knowledge about their medical condition, its diagnosis, services available to them and their families etc.

Granted that numerous studies such as the one described above have been conducted in order to reach an agreement on the definition of advocacy, further research is needed to better understand the nature, risks, and types of advocacy. This understanding is crucial for nurses as patient advocacy continues to become an integral part of their practice.

Introduction to Patient Advocacy

Advocacy is defined as “the act or process of pleading for, supporting, or recommending.” Consequently, patient advocacy would be defined as “the act or process of pleading for, supporting, or recommending [advice] to a patient.” Knowing that advocacy is the process, the means by which a patient is supported, it is important to ask why they are needed. The necessity for patient advocacy rises when due to illness an individual’s self-rule, in other words autonomy, and the ability to make sound decisions are affected. Unable to take crucial decisions in their health care, patients are left vulnerable in the complex system and often fall through the cracks. For example Suzanne C. Beyea, author of Patient Advocacy Nurses Keeping Patients Safe, states an advocate is most needed when a patient is undergoing surgery or is too ill to function as his or her own advocate. She presents a scenario in which a patient discovers his bone tissue had been removed during a surgery even though he had explicitly spoken to his physician not to remove any bone. Once this patient was sedated and in surgery, no one served as his advocate and his wishes were ignored.  Similarly, many other clinicians independently decide what is in the best favor of their patient instead of cumulatively considering the desires of their patients. Thus patient advocates plead for and support the choices of patients. In addition, the American Hospital Association has put forth a document entitled Patient’s Bill of Rights in which it clearly states that “activities must be conducted with an overriding concern for the patient, and above all, the recognition of his dignity as a human being." However, patients are not the only ones who need advocates. According to Kathryn Schroeter, author of Ethics in Perioperative Practice Patient Advocacy, patient’s family members also need an advocate throughout the perioperative time. Oftentimes family members are highly dependent on their patient’s health care provider, placing complete trust in their decision making. Advocates for family members make sure the family’s concerns, voices, and preferences are heard and abided by alongside the decisions of the physician.

After establishing what is patient advocacy and why patient advocates are needed, it is important to question and explore who is able to become an advocate and how, what ethical issues stem from patient advocacy, and what sort of political issues surface as well. Furthermore how do institutions such as clinics, hospitals, and advocacy centers deal with patient advocacy. In the upcoming weeks these aspects of patient advocacy will be discussed in further detail.