Assertiveness and Healthcare

Someone has to speak up on behalf of the patient.  Most of the time, that may fall on the patient to do that.  If that can’t or won’t happen, someone else has to do it.


Consider the following:

  1. Medical care is increasingly complex.
  2. Doctors are human, and fill the complete range from awesome to incompetent.  Some are highly skilled and fully current with developments in their field.  Some let their skills rust years ago, and a few never had them.  I don’t envy them.  Keeping current can require hours of reading every day and travel to medical conferences.
  3. The patient is the first person to know if treatment is or is not working, or if something is going wrong.
  4. As researchers at Johns Hopkins iterated this week, medical errors are the 3rd leading cause of death among Americans.  Estimates of the number of deaths from medical errors annually range from 250,000 to 440,000 Americans.

I’ve seen some of these errors.  My wife has an iodine allergy, and virtually every nurse with whom she has had contact has tried to swab her with iodine at least once.  In her case, any contact with iodine causes anaphylactic shock and she stops breathing.

Breathing is something we tend to take for granted, but it really is a nice thing to be able to do, best understood by those who have had problems doing it.

I’ve had to step in as her advocate.  I make sure admissions and staff know about her allergy and look at the color of substances being applied to her skin.  She isn’t bashful about speaking up, but sometimes she can’t see where the nurse if working.  What she can’t do, I can.

Which brings me to two key concepts: the second opinion and the healthcare power of attorney.

(A)  Second opinions.  Often, medical mistakes have to do with errors in diagnosis, and the wrong diagnosis can delay treatment past the point when treatment can be effective.  Second opinions are also valuable regarding the preferred course of treatment.  As in the case of a friend, one doctor may recommend immediate surgery when another doctor has three or four options that should be tried first.  Because surgery itself can have lasting side effects, it often should be considered as a last resort and not the initial course of treatment.

The second opinion should come from a physician in a different practice and preferably affiliated with a different hospital.  You don’t want personal relationships or conflicts of interest mucking up diagnosis or treatment recommendations.

If doctors disagree, it may be necessary to seek a third opinion.  That’s OK, too.   Your life matters.

(B) The healthcare power of attorney.  Someone needs to speak on the patient’s behalf if the patient cannot or is too timid to do so.  This representative must be someone who is trusted, who knows the patient well, will listen to the patient, will be present to observe the patient’s condition and issues, who will respect the patient’s decisions regarding directives and living wills, and has the willingness to “kick ass” when needed.

Whether in a relationship or not, everyone needs someone in this role.  Regardless of your current health, bad things happen to good people.  On average, each American can expect to cede 9 years of life to illness or injury.  If nothing has happened yet, be thankful.  However, to expect that nothing will is sheer arrogance — if you’re that lucky, how many winning lottery tickets have you purchased?

What do you call someone who won’t speak up for him/herself or have someone else do it?  Deceased.

I don’t want you to go that way.



American Association for Justice.  “Medical Errors.”

Hospital Safety  “Hospital Errors are the Third Leading Cause of Death in U.S., and New Hospital Safety Scores Show Improvements Are Too Slow.”  23 Oct. 2013.

McCann, Erin.  “Deaths by medical mistakes hit records,”  Healthcare IT News.  18 July 2014.

Johns Hopkins Medicine.  “Medical errors now third leading cause of death in United States,” Science Daily.  4 May 2016.

Commission on Law and Aging, American Bar Association. “Giving Someone a Power of Attorney For Your Health Care.”  2011.

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