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Clinical Ethics and Patient Advocacy

The Power of Communication in Health Care

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Abstract

In recent years, the rights of patients have assumed a more pivotal role in international discussion. Stricter laws on the protection of patients place greater priority on the perspective and the status of patients. The purpose of this study is to emphasize ethical aspects in communication, the role of patient advocates as contacts for the concerns and suggestions of patients, and how many problems of ethics disappear when communication is highlighted. We reviewed 680 documented cases of consultation in a 10-year period of patient advocates’ activity at a big German university hospital with 1,300 beds. On the basis of this extensive material, the article will focus on the intersection of the advocate’s work with the problems of patients in hospitals. Deficits in the level of communication between health care professionals and patients were frequently uncovered. Patients primarily complain about the lack of dialogue and empathy. Middle-aged patients consulted the patients’ advocate disproportionately more often. Measured against this baseline, the group of 65 and older complained less frequently. Besides complaints the advocate was asked in more than one-third of all cases for information about medical matters, hospital regulations or administrative problems. Patients obviously see the advocate as a well-connected and ideally unbiased contact person for uncertainties concerning their malady or a potential stay in hospital. Those seeking help often set hope in the information given by the voluntary patient representative. It should be highly recommended for every German hospital to establish the position of a patient advocate. Furthermore, patients can profit from regular exchange between the advocate and the Ethics Committee, also, to help ensure that their rights are taken into account and implemented in an ethically desirable context.

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Notes

  1. The Picker Institute, founded in Boston, MA, in 1994, with a subsidiary in Germany as of 1999, determines the willingness to recommend clinics on the basis of standardized patient questionnaires about the care during hospital stays. The questions can be grouped into 11 relevant factors or subject areas. These factors are variously assessed by the patients with respect to their willingness to recommend a clinic. A brochure with information read on 10.10.2012 can be downloaded at http://www.pickerinstitut.de/download.php?f=bb58a9ea3571bdde6fba3c658761b48e.

  2. To protect privacy, the names of all patients have been changed.

  3. The guardian was introduced because of the limited physical, not mental, condition of the patient.

  4. The right to self-determination (respect for autonomy), the principles of justice (equality), non-maleficence and beneficence.

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Acknowledgments

The research group “Clinical Ethics and the Patient’s Perspective” would like to express its gratitude to the Staedtler-Foundation Nuremberg for the financial support of this study. We thank the patient advocate Dipl.-Ing. Rudolf Frank and the Data Protection Officer of the University Clinic Dr. Manfred Brunner for access to the carefully documented files. Further we would like to thank President of the University Prof. Dr. Karl-Dieter Grüske and Chancellor Thomas Schöck, the staff department Quality Management, our Colleagues of the Professorship for Medical Ethics, PD Dr. Christian Stumpf and Yang Jiao for their support.

Conflict of interests

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Authors and Affiliations

  1. Glueckstrasse 10, 91054, Erlangen, Germany

    Inken Annegret Emrich, Leyla Fröhlich-Güzelsoy, Bernd Friedrich & Andreas Frewer

  2. Institute for History and Ethics of Medicine, Charité University Hospital, Thielallee 71, D-14195, Berlin, Germany

    Florian Bruns

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  1. Inken Annegret Emrich
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  2. Leyla Fröhlich-Güzelsoy
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  3. Florian Bruns
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  4. Bernd Friedrich
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  5. Andreas Frewer
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Corresponding author

Correspondence to Andreas Frewer.

Additional information

Inken Annegret Emrich and Leyla Fröhlich-Güzelsoy have contributed equally to this study.

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Emrich, I.A., Fröhlich-Güzelsoy, L., Bruns, F. et al. Clinical Ethics and Patient Advocacy. HEC Forum 26, 111–124 (2014). https://doi.org/10.1007/s10730-013-9225-1

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