Why Do You Have to Fight So Damn Hard?

We're constantly told to advocate for ourselves in healthcare.

Ask questions.

Speak up.

Get a second opinion.

Call the doctor's office.

Follow up.

Don't take no for an answer.

Be your own advocate.

And I understand why we say these things.

In fact, advocacy is one of the things I value most about nursing. Nurses advocate for the people in their care all the time.

But sometimes I find myself wondering:

Why do people have to fight so damn hard in the first place?

When advocacy becomes a requirement

There's a difference between encouraging someone to participate in their healthcare and requiring them to become its project manager.

We want people to ask questions.

Great.

We want them to understand their options.

Absolutely.

We want them to speak up when something doesn't seem right.

Of course.

But what happens when getting a question answered requires three phone calls?

What happens when a referral disappears somewhere between offices?

When one specialist doesn't have the records from another?

When an insurance company denies something your healthcare professional ordered?

When you're told to call someone else, who tells you to call someone else, who tells you to call the first person again?

At what point does "advocate for yourself" become another way of saying:

"You're going to have to fight your way through this."

There are literally people whose jobs are to help you navigate it

Healthcare advocates exist for a reason.

There are professional advocates, care navigators, social workers, case managers, nurses, and other professionals whose jobs include helping people understand and move through complicated healthcare situations.

That's not a bad thing.

It's actually a good thing that these resources exist.

But their existence should make us stop and think.

Why is this work necessary?

Why does a system built around helping people get healthy require so much assistance simply to figure out how to use it?

Maybe it's because healthcare is complicated.

Maybe it's because there are dozens of organizations involved.

Maybe it's because insurance, regulations, staffing, technology, communication, and bureaucracy all create friction.

Those explanations can all be true.

And the experience can still be exhausting.

We shouldn't confuse responsibility with blame

I don't think this means healthcare professionals aren't doing their jobs.

Most of the people I have worked with genuinely want to help.

The nurse wants to help.

The doctor wants to help.

The pharmacist wants to help.

The social worker wants to help.

The person answering the phone probably wants to help.

The system itself is, in many ways, designed with good intentions.

And yet...

People still fall through the cracks.

That's the part we have to be willing to talk about.

A system can be full of well-intentioned people and still be incredibly difficult to navigate.

Both things can be true.

"Be your own advocate" isn't always enough

There's something else that bothers me about the advice to simply advocate for yourself.

It assumes you know what to advocate for.

You have to know what questions to ask.

You have to know what information is missing.

You have to know when something doesn't sound right.

You have to know who is responsible for the next step.

You have to know when to push back.

You have to have the time, energy, confidence, and ability to keep pushing.

And not everyone has those things.

Someone shouldn't have to become an expert in healthcare administration simply because they're sick.

They shouldn't need to understand insurance terminology to know whether a decision can be appealed.

They shouldn't need to understand the referral process to realize that a referral never happened.

And they shouldn't have to become exceptionally persistent just to keep their healthcare moving forward.

So yes, advocate.

But let's ask a bigger question.

I will always encourage people to ask questions.

To understand what they're being told.

To speak up.

To seek clarification.

To participate in decisions about their healthcare.

Those things matter.

But I also think we need to stop acting like the solution to a difficult healthcare system is simply to tell people to become better at fighting it.

Because sometimes the problem isn't that someone failed to advocate.

Sometimes the system simply wasn't working very well.

And if we keep telling people to advocate harder, we may accidentally make the person responsible for fixing a problem they didn't create.

Healthcare should absolutely involve the people receiving it.

But participation shouldn't require a constant battle.

You shouldn't have to fight your way through a system that is supposed to be helping you.

And maybe that's the question we should be asking more often:

What would healthcare look like if people didn't have to fight so damn hard to get the help they were already supposed to receive?