Sociologist offers insights on health navigators, finding wider lessons in personal stories Date: 05/12/15
By Mary Otto
Trying to help her sister Veronika, who is disabled, with a dental emergency, Elizabeth Piatt found herself negotiating a labyrinth of personal feelings and Medicaid paperwork. The job of getting Veronika the care she needed was fraught with challenges. Piatt emerged from the experience with new insights into the Medicaid system that serves America’s poor, and a new sense of compassion for the patients who struggle within that system.
Piatt, an assistant professor and chair of the Sociology Department at Hiram College in Hiram, Ohio, also came out of the experience convinced of the need for a better network of health navigators to help Medicaid patients find care and services.
Piatt shared the story of her journey in a piece entitled “Navigating Veronika: How Access, Knowledge and Attitudes Shaped My Sister’s Care” that was featured in February’s Health Affairs.
In this Q and A, Piatt offers further insights, and she offers some tips on exploring a personal story for its wider lessons.
Q. Your account of the search for care for your sister was truly harrowing; the missing paperwork, repeat trips to providers, delays in seriously needed care. You observed in your piece that some of the difficulties had their origins in factors that are common in the lives of poor people: transience, unreliable phone and mail service, disabilities. If Veronika had a professional health navigator from the outset, tell us how the experiences would have differed?
A. The way that I envision navigators—being people from the communities they are serving, or who have embedded themselves in those communities—I think these wouldn’t be barriers that they are now; navigators would have better relationships with patients and be more effective at tracking them down, if that was necessary.
Q. At what point in helping Veronika get care did you realize that the challenges the two of you were facing might tell a larger story about the health care system? Can you tell us more about that realization and how you thought through it?
A. I actually started thinking about it when I was sitting in the waiting room at the clinic at Metro Health, waiting to be called back for that first appointment. I was just struck by the contrast of her experience with my own—the overcrowded waiting room, the noise, the frustrated staff. I started taking notes right then, so I wouldn’t forget those feelings/experiences because it made me angry.
Q. You make this point near the end of your piece: "What navigators can't do is change health care professionals' attitudes and behavior toward poor patients." Any further thoughts on the divide that often exists between providers and poor patients, particularly those with complex needs? Have you heard of any innovations or models or educational approaches that might help bridge it?
A. More medical schools are doing things like teaching empathy. At the medical school where I teach, we have a course where we use literature and patient narratives to help students think about how they will “be” as physicians. One of the things we talk about is interactions with patients that may frustrate them, or patients who they don’t like. I think talking about these kinds of things will help physicians in training be better prepared to recognize those attitudes and set them aside so that interaction with the patient isn’t hampered by them.
Q. Since your piece appeared, have you heard from readers about their own experiences with navigators or their own insights into the navigator model?
This has been limited. I’ve had the opportunity to talk with some nursing students about their reactions to the idea. They seem really open to it because they have started to see the problems that I identified in their clinical experiences and see navigation as a solution to many of these issues.
Q. Can you share a little wisdom on exploring a personal health care story for its wider lessons?
A. One thing I learned through the process of writing about this is that I needed to really be honest about what I was thinking and feeling and not be afraid to make that part of the story. It was in that space that I “found” the wider lesson. It wasn’t until I started to write about my own feelings about my sister that I had my final “aha” moment: navigating a complex system is only part of the issue. We really need to be talking about and examining our own attitudes toward the poor to address disparities in care.
For reporters who are interested in learning more about health navigators, Piatt included a useful list of resources as a sidebar to her article.