8 Things a Proxy can do to Obtain Good Care for the Patient

If you have been named in someone’s medical power of attorney, living will or other advance directive, then you may be referred to as the person’s proxy, agent, attorney-in-fact, surrogate, or representative. They all have the same responsibilities – you a have been named to make medical decisions for someone else. Sometimes, you may not be formally named in legal document but called upon to make decisions for a close family or friend who is in a medical crisis and cannot do so himself or herself.

One of your responsibilities is to make sure the patient has access to good health care. Here are 8 things to do to make sure you achieve that objective:

1. Prepare in advance with the individual. Learn what is important to your loved one in making health care decisions. Do this before he or she loses the ability to decide.
2. Talk about beliefs and values regarding living, and dying. Talk about spiritual beliefs.
   
3. Make yourself and your role known to the medical staff. Make sure the advance directive is in the medical chart and medical personnel know its contents. Keep a copy yourself, handy, to show to people involved in the individual’s medical care. Keep in touch with these people.
   
4. Stay informed about the person’s condition as it changes. Medical conditions change. Members of staff at the hospital do change. Identify the person who can best keep you informed of the individual’s condition. Stay involved and be flexible. Read the medical record every day.
   
5. Push to make someone responsible for overall care. Usually there are many medical personnel involved in the patient’s care, none of whom wants to take full responsibility for the entire patient. Insist that one person be given overall responsibility to manage the patient’s care and provide the necessary continuity during the entire period of care.
   
6. Keep the family informed, if appropriate. You may have the legal authority to make medical decisions even if family members disagree. It is however easier when there is consensus among loved ones. Good communication can foster consensus. But you may also need help in resolving family disagreements. Ask for the facility’s patient representative or ombudsman, social worker, clergy or spiritual advisor. Or ask for the ethics committee or ethics consultant.
   
7. Anticipate transfers. Make sure when the patient is moved from one section of the hospital to another, or to a different facility, that you know the treatments to be continued or begun after the transfer. Meet with the medical team or head nurse to ensure that they are aware of the ordered treatment.
   
8. Advocate on the patient’s behalf and assert yourself with the medical team, if necessary. Some medical people may not be as comfortable as others with your involvement. You may disagree with the doctor’s recommendations. It is hard to disagree with medical professionals and institutional authorities. Be tactful and assertive. Insist that medical issues be explained to you in words you can understand. If their resistance becomes a problem, or if you feel you are not being heard, ask for help. Ask for help from the facility’s patient representative or ombudsman, social worker, clergy or spiritual advisor, ethics committee or ethics consultant. Be a squeaky wheel, if need be.
   
9. Retain the help of a private care manager if you are unable to work with the medical team on your own. A care manager usually has an advance nursing or social work degree. She or he can help you understand the medical record, attend care conferences, and advise you if the care is deficient or inappropriate.

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