Saturday, December 25, 2010

Patient Advocacy and Knowledge Management

This Christmas morning I am reading a blog post by Jacqueline O'Doherty titled, Dissecting the role of a patient advocate.

She writes as if she has real power in the decision making process. It seems to me that a patient advocate is in the midst of a very complex set of participants in which there really is no centralized power. I am thinking of dynamic models of complex adaptive systems that tend over time to switch between multiple patterns called "attractors." The situation was in one attractor prior to the patient's unexpected massive stroke. Then the entire system shifted into a very different attractor. The system has a life of its own, so to speak. No one is really in charge.

Jacqueline O'Doherty writes that she called a meeting attended by every doctor and other major caregiver. She writes that this meeting allowed everyone to understand and be on the same page concerning the patient's diagnosis and prognosis. I remember "calling" such a meeting once years ago when I was a patient advocate for my father. I was only a teenager and found myself alone in a room with perhaps eight physicians and other care providers. I was his family. To the best of my ability I spoke his preferences and values when he could not speak them himself. They took time to explain the situation to me from their professional perspectives. It was quite an amazing experience.

As I think about what Ms. O'Doherty has written I realize that patient advocacy is more than knowledge management. But it seems to me that knowledge management is a major part of it. I don't think it is possible or practical to always call a meeting. Otherwise, physicians and other providers would spend most of every day sitting at a table. It is like a dance in which the music sometimes suddenly changes. It is not a square dance with a caller. I keep remembering Mary Parker Follett writing about supervision and authority. In her view, it is not about which of us leads. It is about how we respond together to what we face. But to understand how this scales up to large numbers of medical providers, insurance companies, administrators, and family members (plus the patient, of course) is quite a challenge.

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