The other day I had the honor to accompany one of my clients through a difficult hospital journey. I say honor because I really feel that way, no sarcasm intended. I’ve really honed on my model of telehealth advocacy (my term) over the past few years, which enables me to help people all over Israel, but it also means that I’ve never physically met over 95% of my clients.
Occasionally, a case comes up where I realize that my actual presence is crucial, and sometimes, the client doesn’t have anyone else around who can help them in this way. Some events really demand the presence of an advocate; you just need someone who understands the system, the bureaucracy, and the small nuances of what to say, and what not to say, to help the client receive the medical care they need, in that moment.
That is why I found myself in a hospital corridor at 8 am, a hospital, that is, frankly, still in the 1970’s, at least externally.
But after a few hours, I had my first epiphany.
You cannot judge a hospital book by its corridor cover.
The colors may be drab, the murals wildly out of date, and even the cafeteria stuck in a time warp, but often, the medical personnel are experienced, professional and super knowledgeable. Despite the cramped conditions, the doctors were patient and offered quality care.
I find that this happens often in Israel, that the externals of fancy brightly lit hallways and state of the art imaging equipment are lacking, especially once you leave the center of the country, but the medical staff is dedicated and professional. Those of us who come from abroad often confuse bright lights and shiny machines for quality care.
As the day progressed, I spent my time between hours of waiting, coupled by moments of intense information exchange with the staff.
Which brought me to my second epiphany of the day, which is a lesson I have already learned over the years, but needed to be reminded about.
Everything is in the timing. Know when to ask your questions and gently push, and know when to shut up and wait.
My husband actually pointed out this cultural gap to me years ago. I used to go in to the auto mechanic shop, hurried, impatient and demanding efficiency and excellent service. I usually had a child waiting for me somewhere, my cell phone was ringing, and obviously I didn’t have time to wait in a dingy dark garage while the mechanics chatted with each other and ignored me. I would grow more and more impatient, calling out ‘excuse me’ in Hebrew over and over again, only to be continually ignored.
My Israeli born husband explained to me that the way to actually get better service was to pretend that you didn’t care, that you had all the time in the world, and who cares when you were actually served. So now, when I need a mechanic, I amble in to the garage, (even if I’m actually in a super rush) look around casually, even avoid eye contact with any employee, looking as if I could care less whether anyone would approach me. The funny thing is, it works. Every time.
Advocating for someone in the hospital is often like my garage experience. The more stressed you are when you approach the nurse, or secretary, the less they can actually hear you. The more rapid-fire questions you aim at them, demanding immediate answers, the less communicative they become. So when in the crowded manager’s office, I brought up my questions gradually, as if almost disinterested in whether I would get the information or not, always with a smile and a ‘thank you’.
All this led me to my third conclusion of the day, a statement that I have made repeatedly whenever I give on lecture on navigating the healthcare system.
‘No’ is just the beginning of the conversation. Even within the medical system, negotiation is possible.
Now, I’m not saying that when you go to buy medication, you should say to the pharmacist, “I know the price is 60 shekels but I’ll give you 35 for that package of antibiotics.” Obviously, that will not work.
But often, as was in the case of my client, there are many items that are not set in stone, decisions that are made in the moment, and you can insert your best interests into that dialogue.
For example, the doctor had suggested eight procedures for the client, but when reviewing, I realized that two procedures were not crucial and that if we assumed some payment from the kupah in the future, and I convinced the secretary that it would be paid, the price was significantly reduced.
This does not mean that every medical situation should be approached like you are bartering the price of apples, but it does mean that you should mention your concerns, your questions, and always ask if things can be done a different way.
You may be surprised at the answers.