Name: Theresa Brown
Credentials: PhD, BSN, RN
Brief Biography:
Theresa Brown, RN, is a clinical nurse and an opinion columnist for the New York Times. One of her columns,
on health care reform, earned Brown an invitation to the White House, where President Obama quoted her in
defense of the Affordable Care Act. Her present focus at the New York Times is End-of-Life care, which
dovetails with her clinical work in home hospice nursing.
Her first book, Critical Care: A New Nurse Faces Death, Life, and Everything in Between, chronicles the
challenges facing a first year nurse while exploring the deep connections forged between people in the
hospital. Her second book, One Shift: One Nurse, 12 Hours, 4 Patients’ Lives, will be available Sept. 2015.
Brown has written for CNN.com, the New York Times blog “Well,” American Journal of Nursing, JAMA, Scrubs
Magazine, and the Pittsburgh Post-Gazette. She has been interviewed on “Hardball,” “20/20” and NPR’s Talk
of the Nation. She has received numerous awards from Schools of Nursing and speaks nationally on topics
relating to nursing and health care.
Title of Presentation: The Four “P’s” of Patient Advocacy: Polite, Persistent, Punctilious, Pushy
Brief synopsis of presentation:
When I give talks, people not in health care often ask me, what would you advise to get the best care possible
in the hospital? I’ve summarized it in the “Four P-words”: Polite, Persistent, Punctilious, Pushy.
I will begin the talk by briefly discussing how modern health care works, that it’s a sea of constantly shifting
priorities and gross inefficiencies. People care, but they are often overworked and distracted by
documentation requirements. How do you best penetrate the mess to best advocate for another?
Next I will review each word and explain why it’s important. “Polite” is first because being polite means that
people are more likely to really listen to you. We may think that the louder you are the more attention you
get, but that doesn’t mean it’s the right kind of attention. The devil is in the details in hospitals—you don’t
want staff so distracted by your aggressiveness that they ignore what’s most important.
“Persistent” is the companion to “polite.” Being polite does not mean being a doormat. It may mean asking
the same question over and over again with a calm smile and sincerity, but also an obvious determination to
keep asking until the question is answered. I expressed this idea in my first book as “Be polite, but when
necessary be a pain in the ass.”
I picked “Punctilious” in part because it’s a fussy word. It means, pay attention to the details, which translates
into, as much information as you can offer—including med list, history, and treating MDs—presented as
clearly as possible, can really improve and expedite care. Products such as the “Patient Passport” (more P’s!)
can make keeping that information handy easier.
Finally, “Pushy” is your fail safe. This is the equivalent of calling a “Condition H”—if it’s a true emergency and
no one is listening, this is the time to raise your voice and insist, but again it’s important to be as clear as
possible. Yelling “You’re incompetent” will not get the attention you want if the real problem is, “My mom is
really struggling to breathe.”
To end I will ask volunteers from the audience to go through a couple of scenarios. They will have a script and I
will act out the patient. These scenarios will be based on actual experiences.
Questions?
Objectives to be covered:
1. Understand the complexities of modern health care.
2. Discuss the approach best suited to get results when care is less than ideal (4 P’s) or substandard.
3. Explain why some of the onus of accurate documentation falls on the patient and caregivers.
4. Show that clear communication is always the goal.
5. Demonstrate the downsides of being overly aggressive (though it’s easy to understand how modern health
care can be infuriating.)