PHCAs 

In an earlier version of this website, I postulated that patients (desperate for advocates) would express the need for a new kind of healthcare service; and that doctors (frustrated by their inability to be advocates) would find a new way to fill that need. The doctors would eventually create a new kind of healthcare professional, which I named the Personal Health Care Advocate (PHCA).

In the intervening years, the appearance of retainer practitioners has given physicians frustrated with "traditional" medical practice a much less radical approach toward regaining their role as patients' advocates. Maybe it is for this reason that PHCAs have not yet made an appearance in a big way.

There are still two reasons you should keep PHCAs in mind, however.  The first is that there is at least a reasonable chance that the healthcare system will succeed in making the practice of retainer medicine illegal, and then doctors will no longer have that outlet for their professional frustration.  Becoming a PHCA might then become their only remaining option, short of becoming florists, deep-sea fishermen, or authors. Second, and possibly more importantly, there is absolutely no reason to wait for doctors to invent this new profession. Experienced nurses, for instance, and even savvy non-professionals, would make fabulous PHCAs.  (Indeed, my emphasis on PHCAs being former physicians is primarily an attempt to find something useful for disaffected doctors to do.)  If patients make their needs clear enough, sooner or later somebody will step in to fulfill them, even if doctors do not.

The PHCA model

PHCAs would provide individual patients with an opportunity to retain their own personal advocates - professionals who work for them and them alone, and who place their interests above all others on matters related to their healthcare - just as they might retain an attorney on legal matters.  In fact, on the simple premise that patients have just as much right to a strong advocate as do accused felons, PHCAs would model themselves not after the medical profession, but after the legal profession.  

Accordingly, PHCAs would not practice medicine.  Instead, they would practice medical advocacy, doing whatever is necessary to guard the rights and welfare of their clients in all their interactions with a hostile healthcare system.  

A mission statement for PHCAs

Their mission statement might read something like this: As PHCAs, we will perform the same service within the healthcare system that attorneys perform within the legal system. We will become our clients' advocates and advisors, assuring that a dedicated and knowledgeable professional is representing them, protecting them, and advancing their rights and welfare within the healthcare system.  Our relationships with our clients will be built on trust; we will hold their confidences in private, will assiduously avoid conflicts of interest, and will work directly for them, and for no one else.

This mission statement establishes several things. It establishes that PHCAs serve in an advisory and advocacy role aimed solely at protecting the rights and welfare of their clients. It establishes that PHCAs will model themselves after lawyers, rather than doctors. (For instance, "client" is used instead of "patient," both to reinforce the "attorney-client" paradigm, and specifically to reinforce the notion that PHCAs do not practice medicine.)  It establishes a fiduciary relationship between the PHCA and the client, assuring that the PHCA will always act with the client's best interests in mind.