A colleague of mine, Dr. Alan Weder, has recently begun to offer his services as a medical navigator to patients and their families for an hourly fee. He is a retired University of Michigan Medical School faculty member. In a previous note, I discussed how so-called "navigators" have begun to crop up as staff members in physician offices (see: Yet Another Type of Healthcare Professional Who Focuses on Patient Support). Dr. Weder is also offering to serve as a navigator but one who is independent of any caregivers and working solely on behalf of the patient. I personally think that such advice can be very useful but, obviously, the quality is highly dependent on the skill set of the physician-navigator. There are also for-profit physician navigator companies advertising on the web but I can't vouch for their quality (see, for example: Your Medical Navigator). In a previous note, I commented about how difficult it was to say "no' to physician recommendations; this is relevant to the emergence of medical navigators (see: Teaching Consumers to Say "No" to Physicians' Recommendations). Here is an quote from it:
It will be extremely difficult for most consumers to say "no" to their physicians. The knowledge and experience in diagnosing and treating disease lies with the physicians we consult for problems. Such a scenario rarely lead to "no". However, try substituting the word "maybe" for "no" in response to a physician's recommendations. This "maybe" approach allows the patient to seek more information to determine whether the recommendation is appropriate. Don't attempt this in the pressure-cooker environment of a doctor's office.
Seeking the services of an independent physician navigator provides another source of information for a patient and family. Here are a number of interesting points I learned during my discussions with Dr. Weder:
- In the contract that he presents to his clients, he states that he is not providing medical recommendations but rather advice about "navigating" through our complex health system and explaining the therapeutic and treatment options.
- He told me that one the most valuable services he has been able to provide is holding conference calls with patient family members who may be scattered around the country. Such calls focus on the medical decisions that need to be made by the patent and family. One sibling is frequently the primary caregiver for an ailing parent but other siblings understandably want to be part of this decision process.
- He has not yet encountered any hostility from physicians directly involved with the care of his clients. Indeed, he said that such physicians seem to be grateful for his efforts because they reduce the amount of time they need to spend with their patient in order to arrive at complex decisions. He notes that most physicians are accustomed to a patient's desire for a "second opinion" although this does not necessarily square completely with the role of a physician navigator.
- He also told me that he has not yet encountered situations in which he has had serious misgivings about the quality of care being delivered to his clients. The two of us agreed that, if such a situation were to arise, a physician navigator might strongly suggest the need for a second opinion from another physician or surgeon without commenting further.