Advocating on behalf of our patients

Patient advocacy is such an integral part of a physician’s work and responsibilities. It is recognized officially as one of the seven CanMED roles and unofficially as a core competency of being a physician. In the past, I had always witnessed or delivered patient advocacy in a way to help fight the inequity in our health care system. Today, I experienced something different.

I had the opportunity to work in the fast-paced Dermatology clinic. Having multiple learners in the packed schedule left the staff little time to catch her breath from one appointment to the next. My last patient was a lady in her late 50s suffering from a recent flare-up of her “old eczema”. She said she had been referred to a Dermatologist previously but only had a “5 minutes appointment” with the specialist and was prescribed some topical steroid creams to use. However, she did not have the chance to talk to the specialist about her concerns regarding steroid side effects, so she only used it sparingly in the past several months. When she did use the topical ointments, she got temporary relief from them but had little improvement in her symptoms overall. She also since had been using her own DIY cream to soothe her skin, which she was quite proud of. Ultimately, she was happy about the topical steroid ointments and wanted to have another prescription since she’d just ran out of them.

When we examined the patient, her rashes resembled the typical eczema presentations in certain areas, but there were also large sections of severely inflamed papulosquamous rashes over her trunk. The most “efficient way” of handling this appointment would be to agree with her previous diagnosis and prescribe more of the steroid creams since the patient was satisfied with her treatment. However, my preceptor didn’t dismiss the patient’s unusual presentation and suggested a punch biopsy to delineate the pathology further. She then spent time addressing the patient’s concerns regarding steroid side effects. At the end of the appointment, the patient agreed to step up her steroid to a higher potency so that her therapy would be more effective and understood that a shorter duration of steroid therapy would translate to fewer side effects.

What my preceptor did today demonstrated a form of health advocacy that rarely gets complimented. She was not happy settling on delivering patient care that would be regarded as “just good enough”. Even when our patient was content with her symptoms being sub-optimally controlled, my preceptor believed that she deserved better care by trying to pursue further investigations and spent the time to address her concerns. It’s worthwhile noting the everyday heroes in our field and celebrating their devotion and dedication to patient care whenever we can.
-AX