Being your own patient advocate; important and nearly impossible

In 1963 Stanley Milgram published an article describing his now famous experiment examining human obedience and authority. During these experiments, Milgram recruited unwitting participants to deliver a shock to a "victim" in another room. The "victim," of course, was part of the experiment and was not harmed. In the room with the participant administering the shock, was an authority figure, clad in a white coat, urging that participant continue. This after all, is what he signed up for. This urging came amid pleas of pain to stop from the "victim."

One of the most stunning finding in these experiments, were that 65% of participants delivered the final 450 volt shock and all participants delivered shocks up to and including 300 volts. Equally stunning was the preliminary, albeit informal survey Milgram conducted before the experiment. Out of all survey respondents, almost no one said they would carry out such an clearly malicious act, even in the face of authority.

This experiment shows us exactly why being your own patient advocate is nearly impossible.

I work in the healthcare industry. I know that you want to be scheduled for the first surgery of the day, because you have the highest odds of the operating room being the cleanest. I know that most hand hygiene protocols require clinicians to use hand sanitizer when entering a patient room and then donning gloves. I know that many hospital acquired infections come from inadequate hand hygiene. I also know the importance of skin health and protocols to prevent pressure injuries.

Despite all of this, when my wife and I found ourselves in the emergency room at 10 pm in need of an IV treatment for dehydration and severe nausea, everything I knew and everything I advocate for, evaporated in the face of authority.

Now, that authority was not trying to persuade me in anyway. And certainly was not trying to make me follow orders. However, authority comes in many shapes and forms. We can perceive authority by associations, by professional titles, or by attitude. As a result, though a person may not be trying to influence us, we often do not questions the actions of these authority figures.

When the doctor walked in the room, I did not question his lack of hand hygiene practice. I was stunned, but said nothing when he coughed into a non-gloved hand and proceeded to examine my wife's abdomen.

I was paralyzed and outraged, mostly with myself, when the nurse began an IV with no gloves on. Yet I said nothing.

Despite everything I know about the statistics, policies, best practices, and potential harm that these care providers may have unknowingly been causing, I said nothing.

It is hard to reflect on the experience and I can blame many factors. Ultimately the failure is mine. But I share all of this to relay how difficult, if nearly impossible it is to be your own patient advocate.

Not only are we faced with the towering authority of a doctor who toiled away in medical school and residency for years to become an expert in human health, but we are also faced with the social challenges that come with challenging someone in public. Or in private for that matter. When was the last time you told a stranger they were doing something wrong? Likely an awkward situation.

So instead we remain silent, in the face of social discomfort and medical authority.

How do we create an environment where patients can comfortably speak up and be their own advocates, or where they don't need to?