What Is a Patient Advocate?
Independent advocacy in healthcare

Transforming Healthcare Coaching Podcast — Episode 74: What Is a Patient Advocate? Dr. Angie Ingraham, MD, MS, FACS, BCPA, in conversation with Dr. Lillian Liang Emlet.

Introduction and Guest Welcome

​[00:00:00]

Lillian Liang Emlet: Hi everyone. Welcome to this week's Transforming Healthcare Coaching podcast, and I am super excited to welcome my dear friend, colleague, former surgical intensivist, researcher, academician, now turned patient advocate and entrepreneur and business owner, and really changing the focus towards what's really most important making sure that healthcare is delivered in a safe and efficient way for all of our loved ones and

for ourselves in the future. So without further ado, I just wanna let Dr. Angie Ingraham introduce herself and then we'll get into it.

Angie Ingraham, MD, BCPA: Thanks, Lillian. I'm really excited to be here and thank you for inviting me to come and talk to you and have this conversation and to share my story with all of your listeners.

Dr. Angie Ingraham's Background

Angie Ingraham, MD, BCPA: My name is Angie Ingraham. I'm a former trauma surgeon and [00:01:00] intensivist. I trained at University of Pittsburgh with Dr. Emlet. And as she mentioned, I did two months ago officially open my own independent patient advocacy business. and I'm sure as the course of the podcast comes along we'll we'll share that transformation and that transition as well.

Lillian Liang Emlet: Awesome. Thanks so much for joining us.

Personal Story: Father's Battle with Brain Cancer

Lillian Liang Emlet: So your journey to being a patient advocate was sparked by your very personal experience alongside your father through his battle with brain cancer. I'm curious if whether you'd be willing to share a little bit of that story with us so that we can help understand what really drove you to found true North patient advocates.

Angie Ingraham, MD, BCPA: Sure. Absolutely. I am in Madison, Wisconsin and my father at the time was living in Chicago with my sister. He was 69 years old.

Lillian Liang Emlet: Otherwise

Angie Ingraham, MD, BCPA: healthy. He had literally, his only condition was AFib. And he got diagnosed with a glioblastoma, with brain cancer. that was actually [00:02:00] the end of September.

So the anniversary is coming up. And in five months he had passed.

Challenges in the Healthcare System

Angie Ingraham, MD, BCPA: And we unfortunately found that even with all of the resources and knowledge and finances and time and privilege that we had. We struggled to navigate the healthcare system, and that was for a variety of reasons. We went to three different chairs of neurosurgery in Chicago. We got three different answers. We had issues with insurance approvals to the point of having his surgery canceled. And we only got that done because I knew his primary care doctor. were a lot of issues with transitions of care. He got transferred from a hospital to a rehab center. during COVID, he had COVID. We found out four days later his glasses didn't make it with him to that rehab center. so there were just, I have a whole notes page of the opportunities for improvement in coordination of his care and communication regarding his [00:03:00] care. And it really was this experience, this personal experience that led me to make this career transition. Because. I know, and I saw that other families were going through the same things that we were going through. The very kind of short story I'll say is know, he had a functional MRI scheduled for the day before his surgery. So his surgery was scheduled on the Thursday. He had his MRI scheduled on a Wednesday, Tuesday at three o'clock.

We got a call saying that his MRI was canceled because we didn't have prior authorization. His PCP was a girl I went to medical school with. I'm texting her, I'm keeping them on the phone. We got it moved to the afternoon and we ended up getting the authorization and he got a scan. But then I sat in the waiting room and I heard them say that same phrase to other families.

It was like on repeat, and I was like, those patients and families don't have someone sticking up for them and going to bat for them to get their scans going and getting those done. And so it really became [00:04:00] this eye-opening experience of, we all on the provider side know that healthcare is broken, but I don't think we fully have a true understanding of just how broken it is.

Lillian Liang Emlet: Yeah. And so thank you so much for sharing all of those things and it's funny to think about the fact that it'd be fine if it was maybe one little minor thing, right? It could be a little human error. Something just falls through the cracks, but you just gave a litany over months, multiple times of different types of errors.

Angie Ingraham, MD, BCPA: Yeah.

Lillian Liang Emlet: Administrative primarily and adding to one of the, yet again, many more stories of physicians now speaking up against the prior authorization and the hoops that we have to jump through with insurance companies for care that is, cancer related. This is not plastic surgery elective, voluntary cap pay cash kind of care.

This is emergency where time is of the essence for surgical management.

Angie Ingraham, MD, BCPA: Yeah, absolutely. And it's also, and his [00:05:00] oncologist and his oncology nurse were fantastic. They had worked together for 30 years. She knew how to get things done in the system, but it's also, it is in cancer and cancer is an area where we actually have a lot of navigators and things.

You think about, I always think about my emergency general surgery patients where there's no one, there's someone with chronic pancreatitis or pancreatic necrosis, that is going through that long hospitalization and IR drains and IV antibiotics and all of those things. There's not a navigator for that group of people. So in some of these areas that we have, cancer or transplant like bariatrics, we have more advanced kind of navigation for patients and their families, but there's a lot of gaps still in those areas and in other less organized areas of medicine.

Lillian Liang Emlet: Yeah, so it just goes to show the fact that in so much of our care, it really is, you're on your own and then you start to wonder, it's no wonder that [00:06:00] people have mistrust all along the way from entry point to exit point, because everyone just feels like a number. And that even includes all of us in healthcare, and I can only imagine what it must been like to be the primary care provider.

Your friend who you're texting who has to drop everything in between other patients and be interrupted for an administrative emergency and you just think about the ripple effects of, there's so many other people where then when we task switch and when we stop concentrating what we're doing, we provide inferior care.

And it's no wonder that patients pick up on this. They understand they were busy, but what they don't understand is who we're busy with. 'cause we really can't talk about it, right? Like we can't talk about in the hallways, we can't talk about anyone except in our private offices. And so we've really felt have been muffled for so long and so thank you so much for finding a different way forward to be able to express and do something different with that.

Angie Ingraham, MD, BCPA: Yeah, and I think the other thing I would add to that too is that it's not just the [00:07:00] hospital or in the acute medical or outpatient medical setting.

The Role of Patient Advocacy

Angie Ingraham, MD, BCPA: The other thing that's been very enlightening in being an advocate is that it's truly across the continuum of care. And so I think sometimes we think, okay, we've done our discharge planning or whatever it is for this hospital stay. But that's the one of the joys of being a patient advocate, is that I'm following that client from the hospital to the short-term rehab, to their assisted living. And I'm helping with all of those things too, because that's where a lot of transitions break down.

I have a client, I've had a client where. Trying to organize her, going from her rehab to her assisted living and trying to get home health set up so that she can have her dressing changes so she can have her PT so that she can have her nurses come out and check on her that she needs, that's another whole transition. That same client. We, again, in the [00:08:00] hospital we don't see these things 'cause they're outside of our hospital walls. She got denied. So she was in a short-term rehab stay. And there's a thing called the notice of Medicare non-Coverage. that means is that her Medicare Advantage plan that you don't need skilled nursing and therapy services anymore. So we got that letter on a Tuesday, you have until Wednesday at noon to file your appeal, which the lay person is supposed to file the appeal to try and get the coverage, and the next day is when the cover stops and they go to private pay. And

Lillian Liang Emlet: Huh.

Angie Ingraham, MD, BCPA: I went and I did research on Medicare plans and then went to the Medicare website and grabbed all the texts and everything.

I'm like, oh, we're gonna get this appeal. We got denied because 75% of 'em get denied. And so she lost her skilled nursing coverage for her short term stay. She went back to her assisted living. Four days later she fell and was back in the hospital like so this is also where [00:09:00] as a physician it was, it's so enlightening because we, especially for US physicians who primarily work the inpatient side, We don't always see all these other things that are going on. And we think o readmissions are because of poor, patient compliance or all of these things when it's really, they just don't have the things that they need because the system is set up against them.

Lillian Liang Emlet: And I think the reality is to the fact that we need to have case management, that we need to have all these levels of administrative support of the clinical insurance administrative divide. And now in addition, you're gonna explain to us like why also patient advocacy is needed,

Is pretty crazy to think that you need this much

teamwork to try to even navigate the system in general.

Angie Ingraham, MD, BCPA: Yep.

Lillian Liang Emlet: simply because, people just can't do the right thing with clarity and transparency. There are layers now, right? There's like your individual bedside nurse, your individual physician, you in [00:10:00] long-term care, in outpatient care and inpatient care.

Your actual care team has an invisible layer of people around them

Angie Ingraham, MD, BCPA: Yeah.

that

Lillian Liang Emlet: are actually doing a lot of this troubleshooting and the fact that we've fabricated an invisible construct around true caregiving. It's no wonder that there's so much distrust and mistrust and it's hard and get disentangled.

So as frontline regular clinicians, we speak up as much as we can. We advocate through our national organizations, through the policy arms of major healthcare professions. And yet. We're still stuck in the system.

Angie Ingraham, MD, BCPA: Yep.

Lillian Liang Emlet: and so I'm curious, how is patient advocacy work then? How do you get one?

What is it? How do you even have someone be on your side? It's a whole new, it's a whole new world.

How to Become a Patient Advocate

Angie Ingraham, MD, BCPA: Yeah, no, and I honestly didn't know about patient advocates when I was a practicing, clinician initially. So I found out about patient advocates because at UW University of Wisconsin, we're actually very lucky. We have something called the [00:11:00] Center for Patient Partnerships. Which was set up by Meg Gaines, who's a retired law professor who had ovarian cancer. And she struggled navigating the healthcare system and she said that this is wrong, I can do something about it. So she actually sent up the center where nursing law, social work, medical students go and learn how to be. They get a certificate in patient advocacy and they do pro bono work under supervision. So I had actually gone to the center for help with my dad because I was trying to figure out if I was gonna switch him from Medicare Advantage to a traditional Medicare plan. That was my first introduction to patient advocacy actually being a profession, a career. there is not a licensure for patient advocates.

So you can practice advocacy across the United States.

Lillian Liang Emlet: There

Angie Ingraham, MD, BCPA: is a board certification for patient advocates. So the patient advocacy certification board was established in the 2010s. The current president is actually a former anesthesiologist and there are about 1300 board certified advocates in the [00:12:00] states. you don't have to be board certified. I encourage people to get board certified. It helps to grow our profession. A lot of it is surrounding the ethics and responsibilities of being a patient advocate. And then there are four or so and national patient advocacy organizations. They all have directories as well.

It's very much a field where we are educating both the public as well as providers and the healthcare system and insurance companies and things on what patient advocacy is and what profession is.

Lillian Liang Emlet: Interesting.

Angie Ingraham, MD, BCPA: Yeah. And there are I would say a fair number of patient advocates are private pay.

So that's how my business is set up is a private pay service. There are four codes that CMS approved in 2024 to allow for reimbursement for patient advocacy services. a somewhat kind of complicated system and process, and there's some ethics and ethical challenges related to that [00:13:00] because, part of being an independent patient advocate is that I truly am independent.

I work for and my allegiances to the client, they are the ones that pay me. And so there are concerns if there's insurance or someone else paying for my services. Am I, can I truly be be independent?

Lillian Liang Emlet: Yeah, no, that makes sense.

Differences Between Independent and System-Based Advocates

Lillian Liang Emlet: I'm curious, how is it differ or not differ in terms of the patient advocates that we find inside our healthcare systems, we often have advocates that help. Patients whenever there's disagreement or concerns or strong emotions with the current care team are they different?

Are they the same or different way to practice?

Angie Ingraham, MD, BCPA: Yeah, I think, so there's several things that are same, several things that are different. I think a lot of times in the description that you're saying, it's often like patient relations or things like that. And some of what advocates do is, be. They're people are coming to an advocate often because they are having some kind of struggle.

They're having [00:14:00] some kind of challenge. And so whether it is a lack or at least a peer a seeming lack of, communication or some kind of disagreement or some kind of thing there definitely is a lot of that advocates do. I think there's also, it goes beyond that too because, so as an advocate, part of what I can do is I can help educate the client on their diagnosis. I can help look for second and third opinion. So again, I'm not tied to

Health system or one practice or one insurance company. I really can span everything that is available to that patient or to that client and their family. And I think that

Lillian Liang Emlet: my

Angie Ingraham, MD, BCPA: ability to be mobile with them through that is really where I see a lot of the differences coming between hospital based or insurance based navigators and what we do. And that is not saving. One of the things that I emphasize in talking to my clients as well as when I talk to providers or, case managers or [00:15:00] discharge planners, like I am not here to replace you at all, like a, I'm not serving as a physician,

Lillian Liang Emlet: Right.

Angie Ingraham, MD, BCPA: serving as an advocate. I'm taking that hat off and putting my advocate hat on, but also from, a social work or a, chaplain or a discharge planner or whatever I'm here to compliment, you know what you do.

I'm here to try to take some of the burden and the stress off of you because our social worker, I mean everyone

I try to convey this to the health of my clients too, like. Healthcare professionals are trying their darnedest like they are working really hard. And I know that everything doesn't always align. But like our social work, everyone, doc, there, there's just, there's so many patients to take care of. The acuity of our patients is complex and then you add on all the things that we've talked about. Like it's no wonder that there are these things and these stories that we hear about challenges in providing healthcare. So it, I really try to broach it as a [00:16:00] partnership. It's been interesting because again, like patient advocacy is

Lillian Liang Emlet: a new

Angie Ingraham, MD, BCPA: profession and a lot of people, I spend a lot of time explaining what my role is and I'm happy to do that. And just, letting people know that we're available and we're here.

Lillian Liang Emlet: Yeah, no, it's really great. It's great to have a, someone, I think of your caliber, someone who's been in surgery and critical care and really has seen the gamut of medical critical illness and surgical critical illness because. It gets so complicated with the different types of things that we can see in the entire gamut of care.

That sometimes it requires that, 30,000 view perspective to understand where are we with things and just know that you have a nice guide on the side to help everyone just slow down everything because everyone's coming at it from their own perspective.

Angie Ingraham, MD, BCPA: Yeah.

like you

Lillian Liang Emlet: said, the social worker, the physical therapist, the physician, the nurse, and everyone's got their own little micro agenda in that entire care team.

Angie Ingraham, MD, BCPA: Yeah.

Lillian Liang Emlet: And even the pharmacist, everybody's got their own perspective, but you can harmonize it all. [00:17:00] And so you're like a human extra brain for the family.

Angie Ingraham, MD, BCPA: Yeah.

Lillian Liang Emlet: it's very overwhelming. Even if you take all your notes all you want, even if you record everything, it's just still hard to take a 20,000 foot view and just be able to process it and know that you have someone who like, you know what, I'm not a hundred percent sure I'm now second guessing my decision later.

What do we go over and what are my options? Because I think a lot of it, especially, even with me, with my mom trying to understand insurance and what was covered and what was not, I'm grateful for. I think it was a navigator that tried to explain to me all the different options for shopping for the different Medicare plans and should I change what she had and she's had this for so long, and then now with this new bundle, like they gave you a couple options.

I can imagine that, maybe I didn't leave everything on earth. Maybe there were data I left behind on the table. And these are hard decisions to make quickly, relatively quickly because as care is about to be delivered, you need to have the right coverage ahead of that.

Angie Ingraham, MD, BCPA: Yeah. Yep. Absolutely. Yeah.

Real-Life Examples and Challenges

Angie Ingraham, MD, BCPA: And I [00:18:00] definitely am in the minority as far as being a physician who is an advocate most professional patient advocate are come from a nursing social work. There are some apps pharmacy therapy like physical therapy or, a mental health background.

So there, there's a growing number of physicians who are advocates. But I do think, as you were saying, like my. I do think I bring a different perspective because of my experience as a physician, but also my experience, as a trauma ICU EGS physician because I really was across all, at all facets of healthcare.

Everything from, ER to discharge planning, to outpatient to the or, all I've touched it all. And I think it's been interesting because. I have been fortunate to have some of my clients, have terminal diseases, and I have, I've had the honor of guiding people both when I [00:19:00] was a physician and even now as a advocate to think about goals of care. Or, in one instance it was, signed on a client who had an, had two activated powers of attorney. She has advanced advanced dementia, but no one had really had those kind of goals of care, discussion with them. And I am I'm. I ruffle feathers a little bit because I'm asking hard questions.

But these are things too, that in healthcare sometimes I think we assume that somebody is having those conversations or they were already had and they're not being had. That's the other thing of doing this work. There are so many things that I think people assume have happened. Again not because of any ill intent or anything it's just

everybody's busy and patients are complicated and, but yeah, it's been rewarding to have these conversations, but they're tough conversations to have.

Lillian Liang Emlet: No, and it's one of those things where I think it's hard to know who to trust, what you've just described really is the [00:20:00] complexity of care across different locations and time points and with teams changing all of the time. And really it's really rare to find, identifying with one person as your

clinician anymore.

And and even though you may identify one particular person on the team, it's pretty rare to be able to get that for most people. And so having one person who can synthesize that, so I guess that leads into, your academic career, you did quality improvement, you did research, you've done all kinds of academic things that were highly complicated to improve how care is delivered From the physician academic perspective,

Curious how those skills are now translating into what true north advocacy, patient advocacy is gonna be doing, and like how you see redefining patient advocacy and all the different things you can do now because of your history with managing complexity before.

Angie Ingraham, MD, BCPA: Yeah I studied inner hospital transfers and my academic career and acute to acute transfers. Going from a critical access hospital to a major academic medical center. And some of the [00:21:00] most rewarding work that I did in that was my qualitative research where I put together

stakeholder panels of referring providers, accepting providers and the transfer center or the access center nurses, and just to have all of them together in the same room and talk to each other and to be able to empathize and realize what the other person is experiencing on the other side of that transfer call was like awesome. And so I feel like that's a lot of what I'm doing now in my advocacy and it's really great. We actually, I just came this morning in Dane County, which is where I live. There's actually a transitions of care coalition that's gathering together. And so we meet every month and it's all the major medical centers, all the assisted livings select long-term care, home health home home care agency, so non-medical care. and we're coming together and so much of it is around communication. How does the status of the [00:22:00] patient, who is, let's say, in assisted living they go to the hospital, how does the hospital know what their normal is? We were just talking about that today, and they had developed a sheet to say this is, Mrs.

Jones and this is how she normally is, so that

Lillian Liang Emlet: there

Angie Ingraham, MD, BCPA: is that disconnect and people can have a good understanding of kind of what her baseline is, for example. So yeah, I, and I love that I still can use some of those kind of research skills and question asking and inquiry that I developed in that, and now I can apply it in a different way.

Lillian Liang Emlet: That's super exciting. Just makes you just realize how much the non university based and non-healthcare system based work when we partner with the community to be able to do things is really important and you, and obviously inter-agency. One would even argue that the insurers really need to care about this because it helps everyone if we can find a better way to not be in our own zone and our own perspective and to think about, and I do [00:23:00] hope that all insurance companies who are hearing more and more stories of physicians

explaining now for the public pretty explicitly on social media about how their workday is impacted, how other patients are impacted, how the patient's case is impacted by all of these prior authorizations and the timing of it. I think no one would ever mind, if the timing of these authorizations in his chart review happened, like weeks ago, whenever we

booked the surgery that we felt medically necessary, even if it's an emergency to expedite in a more seamless way, rather than emotionally putting a family through the rollercoaster. 'cause I, because I know, I think the hard thing is whenever we have to disclose that these things are delaying or potentially causing things to change and I can't imagine what it must be like, to be the like you said in the radiology suite to have to say that again and again.

And again, and we worry about the moral injury of all of our healthcare professionals, and we don't want to be complicit. And yet [00:24:00] we don't know any other way.

Angie Ingraham, MD, BCPA: Yeah. Yeah. And also, you just think about or time is valuable. So if my dad hadn't gotten his MRI that next day, that whole, majority of the day, that was blocked out for his surgery. If that hadn't happened it's not always easy to find people to fill in those slots.

It's just inefficiency on

Side too. And inefficiency for the surgeons or, whoever is involved.

Lillian Liang Emlet: Right.

Angie Ingraham, MD, BCPA: Yeah, it's just wild.

Lillian Liang Emlet: Yeah.

True North Patient Advocacy: Mission and Vision

Lillian Liang Emlet: And so I'm curious for those who are interested in sort of the mission and the vision of true North, I'm curious whether you wanna say a couple words about why True North over other patient advocacy groups or individuals?

Angie Ingraham, MD, BCPA: Like as far as like how I chose the name or tell me more.

Lillian Liang Emlet: Yeah. Yeah, I guess so. You know how you chose the name and what is the philosophy of your particular organization in terms of how you deliver patient advocacy and whether, can anyone work with you across the country or just, how do they even [00:25:00] begin to investigate what True North is all about?

Angie Ingraham, MD, BCPA: Sure. So my philosophy on this is that like I really want to be that person for other clients and families that I needed for that my dad needed. That's like the whole kind of like mission behind all of this. in like the name, it's twofold. One is, it's like, it's my own true north.

So like I had my own career path where I, the combination of burnout and my my experience with my dad. I was like, I don't know if I wanted, being clinical in medicine anymore. I definitely, I had been on the RO one train and I was like, I don't wanna do that anymore. so it was also finding my own true north and what is for me professionally and from a career standpoint. And then it is, helping my clients and their families find their own true north. What are we working towards? What's right for you? How do we

Lillian Liang Emlet: encourage

Angie Ingraham, MD, BCPA: you to voice that, to identify it first, to know what you want, and then to voice that as far [00:26:00] as your healthcare. And then, yeah, the, really for me, it's all about, try to strive for service.

Like I want my clients and families. you have to build trust, really quickly. And it also is setting expectations, like to do advocacy work. There's a lot that goes into the upfront work of thing. There's a lot of time and effort that goes in and they don't always see what I'm doing right away. But I always tell people, you can always call me because, know, there are some advocates that limit their working hours. At least for right now, if you're in the ER at two o'clock in the morning I want you to call me, right? Because that's when you need me. I've been on Q3 trauma call.

I can handle being woken up in the middle of the night, to go back to sleep pretty easily. But it's also easier for me to then to be there and with you real time than it is to try to catch up

Lillian Liang Emlet: after

Angie Ingraham, MD, BCPA: the fact. And I can be a [00:27:00] better advocate for you if I know what's going on as it's happening.

Lillian Liang Emlet: That's really incredible because I have to admit, I've never I personally have not experienced having a patient advocate with our family meetings or the care are that, you know so far, but I can only imagine how reassuring it is 'cause it's scary to go to the er and it's scary to have an unplanned visit and it is really overwhelming.

And so just the idea that you have someone on speed dial, it's like really providing VIP concierge services for it's almost like having a healthcare professional in your pocket, right? To be able to just know that you're not alone navigating all of this insanity that is healthcare and

a healthcare scare is often usually the wake up call for all of us, right? So I think it's not surprising that for most people through the pandemic that were touched by the COVID pandemic, or that had their own health challenges or have battled health things in their family have caused people to want to enter into the healthcare field to try to make a difference, help other people and continue to be in this caring [00:28:00] profession.

And so it doesn't surprise me that, with your talent and your skill that you would find a different way to be able to help make things better. 'cause you're really trying to bring the whole team to function and just to be a neutral, it's almost like you're a coach for the experience. A coach for the experience of being a healthcare user and user and deliver in this crazy US healthcare system.

Angie Ingraham, MD, BCPA: Yeah. Yeah. Several reactions to that. One is like I'm gonna meet, potentially sign on another client tomorrow, and she's a widow. She doesn't have any children nearby. Her closest relative and her POA is a niece who's in Arizona and she has Parkinson's and some early dementia.

And so one of my main roles is gonna be to go with her to her doctor's appointments so that I can then, write a summary, communicate back to the needs. help them prepare for these doctor's appointments. 'cause we all know that, they're, the appointments are getting shorter and shorter just because there's so many [00:29:00] more patients to see. And I do think that also I definitely see my role and I experienced this with my dad of we always, as much as we try, and this is me speaking from having been on the provider side of things. As much as we try and we think that we're delivering coordinated care, it's not always as coordinated as it can be.

And we faced that with my dad. So my dad went into surgery. He was induced with his anesthesia. I don't know exactly what happened. I think he went into some RVR. He had one round of chest compressions. They aborted a surgery, he got admitted to the ICU. Then it literally was, and so he had the worst delirium I've ever seen. we were in that ICU for a week and it was cardiology and neurosurgery debating on how long he had to be on heparin and when they could take him off and redo the surgery. And it was like we had no plan. So I like Cardiology nurse to be in the room together and like [00:30:00] we are figuring something out because we were just in this limbo.

And it's not because 'cause people are male and they have ill intent or anything. We just, it's, we do healthcare providers. Now that I've seen it on the other side as a patient and I've had this experience in talking with other physicians or health providers who've had their family members, have a healthcare issue.

We don't see our own blind spots. And part of the, what patient advocate can do can be to help to shed some light on those.

Lillian Liang Emlet: Yeah, and it's really, interesting. So much of, I think primary hospitalist care and primary critical care is trying to harmonize all of the voices in many ways. And so sometimes palliative care gets involved to do the similar thing on the team side and at the same time, it's still, from the patient's perspective, it's still not good enough.

Because it's just not clear. And you'd like to see all the stakeholders actually say something rather than all being [00:31:00] hidden behind one person, one poor, resident physician who's delivering the message on behalf of like 15 other team members.

Angie Ingraham, MD, BCPA: yeah

Lillian Liang Emlet: it's not fair to that person and it's not fair for clarity.

And so it's nice that someone just speaks up on behalf, and I think a lot of times most family members can't even voice that. They're not, they don't know what they don't know.

Angie Ingraham, MD, BCPA: Yeah.

Lillian Liang Emlet: Yeah.

Angie Ingraham, MD, BCPA: Absolutely.

Lillian Liang Emlet: They don't know what that icky feeling is.

Angie Ingraham, MD, BCPA: Yeah. And different systems are set up to do

Than others. At University of Wisconsin, we actually had a critical, what do they, nurse communicator role. So it was actually two former ICU nurses, and I think they actually did some bedside care still in the ICU, but their whole job

Lillian Liang Emlet: Right.

Angie Ingraham, MD, BCPA: was to make sure that families were kept in the loop.

They helped to arrange all of the multidisciplinary and family meetings to, herd the cats

In the room together so that the families were up to date and they are invaluable. But not all health systems fund that position.

Lillian Liang Emlet: Right.

Angie Ingraham, MD, BCPA: and so then, [00:32:00] it's left up to, whoever on the ICU team to try to do that.

And, but then the patients are sicker and, all of those things.

Lillian Liang Emlet: Yes and just goes to show, I think the theme of our podcast today really is there's just so much communication that's necessary and having more people at the table can help slow down and bring greater clarity for all the communication that's needed and the emotional support and the factual support.

For, but from all perspectives.

Angie Ingraham, MD, BCPA: yeah. Yeah.

Lillian Liang Emlet: And so on this podcast we also talk a bit about leadership.

Leadership and Advocacy in Healthcare

Lillian Liang Emlet: And so I'm just to conclude, I'm curious what lessons in leadership and hope that you'd be willing to share with our listeners who are all healthcare professionals themselves. Because they also are trying to advocate for their patients, their families, and their team members and each other.

I know you know so many students and you. About to become fellows who they really see themselves as advocates fierce advocates from their perspective. And yet this is, this episode would suggest that maybe you might need even more people at the table, which is a challenge to, I think, to some people's [00:33:00] identity, right?

As a clinician like that is often you're like, I'm here to, I'm like the one warrior savior to make this work and you get really upset when something doesn't fall through.

Wondering if you have any words of wisdom in terms of what leadership really means when you have such a complex team that has to be navigated.

Angie Ingraham, MD, BCPA: Yeah, and I think that touching on the advocacy piece, like I hear this all the time too even from my friends who are social workers or nurses who now are advocates who are now professional patient advocates. it is something that as a healthcare provider it advocacy is like part of that position. And part of that role and part of what you pride yourself in doing. At the same time, I think that what we've talked about a little bit is that the advocacy that patient advocates do is also slightly different, I think, in terms of like leadership, I think in [00:34:00] people who are in those leadership positions it truly is just trying to be a model for, the trainees as much as you can and for everyone in healthcare, and I know it takes time and effort and extra thought, but it really is that if this was your mom or dad, what would you want? And like it's trying to again, anticipate those unknowns. And whether they're known unknowns or unknown, that the whole it's trying as best you can to slow down to be there and I get it that it's like easy for me to say and hard to do because everybody's exhausted and you wanna go back to your own family and you wanna, not be doing your notes at 10 o'clock at night. But trying as much as you can to build that system around that patient. And I would say you know as much as you can, especially if you're in a leadership position. there are patients and advocates want to help the system. If you reach out to and you can look on the [00:35:00] national directories of professional patient advocates.

If you are in a healthcare leadership position and you're looking to figure out how to improve your healthcare system, reach out to your local patient advocate because they, we want to partner with you. And it was like, so it was ironic what my dad had gotten his his MRI, we had other issues with radiology at this health system.

We got the survey, right? You always get the

Lillian Liang Emlet: Oh yes.

How

Angie Ingraham, MD, BCPA: is your experience? And so my dad wasn't at a point at that point where he could fill it out. So I filled it out and I

Lillian Liang Emlet: was

Angie Ingraham, MD, BCPA: very thoughtful in being objective in filling out the survey. And at the end I put I'm a physician. I wanna help you like with this, please call me. And I left my cell phone number.

Lillian Liang Emlet: Wow.

Angie Ingraham, MD, BCPA: never heard from 'em. It's like engage, engage with the patients, engage with the families, understand what they're going through because in the end, you're gonna be able to deliver higher quality care. You're gonna end up having better [00:36:00] transitions of care, fewer readmissions all of those things.

If we can engage patients and their advocates more.

Lillian Liang Emlet: Really great words of wisdom to conclude our episode. I do think especially this day and age of AI controlling so much of data and how things will operate. While it's great for efficiency and it's a great first shot, at the end of the day, every human just wants a human. And I think all of us being willing to be not afraid of someone, like cross checking, because I do.

I can't imagine that it's a little weird. Feeling for some people to be like, I have to let someone into my life to, to make sure everything goes okay.

Angie Ingraham, MD, BCPA: Yeah.

Lillian Liang Emlet: That is a big leap of trust. And then I think the other, from the, healthcare system and the clinician perspective is like we're adding another person to the team.

This is so confusing.

And the reality is if we just slow down and just, it's not always about hurry. It's about quality.

Angie Ingraham, MD, BCPA: Yeah.

Lillian Liang Emlet: quality of this, of all of these really high risk moments. Of just making the things move smoothly. As it is, you've [00:37:00] already pointed out many ways how nothing runs smoothly and how all of this attention switching causes us greater inefficiencies for everyone, which is not good

Angie Ingraham, MD, BCPA: yeah,

Lillian Liang Emlet: for anyone.

Angie Ingraham, MD, BCPA: Right exactly

Lillian Liang Emlet: What do we have to lose? But to then, take a chance on something like patient advocacy. Awesome.

Conclusion and Contact Information

Lillian Liang Emlet: So how can people find you and work with you? Because I'm sure there's lots of people who are listening who are either going through something themselves with their elder care or family member, or just a file away in the back of their mind to when to reach out to you.

Angie Ingraham, MD, BCPA: Yep. So I have a website it's truenorthpatientadvocate .com and you can schedule a free 30 minute discovery call with me. So that's my kind of like intake process. I talk to you either the client or their family about what their struggles are. Am I the right advocate? Because there's a whole host of advocates out there.

So if I don't think that I'm the right fit, or I can offer the services that you need, I can direct you in the right way. I am also LinkedIn on my personal profile. You can reach out to me that way. I'm working on my business, social [00:38:00] media. It's not there yet but it'll get done.

Lillian Liang Emlet: Thanks everybody for listening, and we'll see you on the next episode.

Angie Ingraham, MD, BCPA: Thank you so much for having me. I really appreciate the opportunity to be here and to share my story.