“The practice of medicine is an art, not a trade; a calling, not a business.” — William Osler
It began in the 1970s, the decade of human rights – the rights of minorities, of women, of pregnant women, of children, of the physically and mentally disabled. Inevitably, the rights of medical patients came into focus, with New York’s Mt. Sinai Hospital leading the charge. In 1967, it created the country’s first Patient Representative Department. Five years later, in 1972, the American Hospital Association, drawing on a preliminary brief on patient rights prepared by the National Welfare Rights Organization, adopted a Patient Bill of Rights. At decade’s end, in the service of such rights, Sarah Lawrence College established the first master’s degree program in health advocacy.[1]
Patient rights, embracing hospitals, managed care, HMOs, and group insurance plans, gained traction throughout the 1980s and 90s. In 1990, Harold P. Freeman, a surgical oncologist at Harlem Hospital, introduced the notion of “patient navigation” in the hope of eliminating barriers to screening, diagnosis, and treatment of minority cancer patients. Four years later, Nancy Davenport-Ennis founded the Patient Advocate Foundation; its mission was to provide case management services and financial assistance to Americans with debilitating and life-threatening illnesses.[2] In1996, Congressional passage of the Health Insurance Portability and Accountability Act (HIPPA), with its emphasis on doctor-patient communication and the protection of sensitive patient information, shored up these private initiatives.
By century’s end, the medical landscape was filled with patient helpers: patient advocates, patient experience specialists, patient navigators, healthcare educators, and, most recently, patient relations departments. Summit Health, the product of the merger of Summit Medical Group and CityMD in 2019, established a patient relations department sometime after the merger. Cigna Healthcare waited until February 3, 2025 to establish its patient relations department. Well, better late than never.
Perhaps. The very concept of “patient relations” is problematic for several reasons. Notions of patient advocacy, navigation, and education have a strongly dyadic connotation: the assumption is that a particular patient is in need of assistance, and that someone with the requisite knowledge is available to advocate for the patient, to help the patient navigate a maze-like hospital or health plan environment and acquire information on how to proceed. It may involve issues of evaluation, testing, and/or diagnosis, along with the pros and cons of different treatment plans. According to the Journal of Patient Experience, some 70% of health care organizations now have a senior executive devoted to overseeing this cluster of patient advocacy services.[3]
Patient relations, on the other hand, is amorphous. There is a patient, yes, but with whom or with what is the patient relating? A physician? An office staff? The relations department itself? Or perhaps the relation in question is with a hospital, insurance company, or health plan in general. Or perhaps none of the above.
In the case of my unhappy saga with the Summit Health Patient Relations Department this past September, the answer is the final option: none of the above. I am a diabetic, and the saga began with the office staff of the endocrinologist who supplies my insulin. Having barely avoided running out of insulin, and anxious to reestablish my regular three-month supply, I placed three phone calls, morning, afternoon, and closing time, to the provider’s office. Each time, I indicated that I needed to speak with my physician that day about an important matter. But I heard nothing – not from my physician, not from a medical colleague or member of the office staff, and not via the health plan’s patient portal.
The reason, it turned out, was because, unknown to me, a “patient relations” staff member, responding to a complaint from a member of the office staff about the tone of my phone calls, advised the physician not to return my calls. The patient relations staffer herself would take care of the matter at hand.
But the promised contact never happened. I only heard from the staffer by phone four days later. She had tried to reach me sooner, she averred, but the office phone system was being upgraded and was apparently down at the time she placed the call. The notion of trying again from a “live” phone apparently never occurred to her. Withal, having finally contacted me by phone four days later, the human relations staffer listened to me, and then proceeded to the point of her call: She informed me that concern had been expressed about my behavior (viz., my phone manner) in requesting a return call from my physician. Absent so much as an allusion to the reason I sounded agitated, she added, gravely, that I may have acted inappropriately.
A call from the department manager a few days later was more conciliatory in nature. She suggested there had been “miscommunication” on the part of the office staff, adding that the office staff required further training on how to respond to patients who called the office in a less than happy state of mind. And she acknowledged as well that it would indeed be upsetting for an insulin-dependent diabetic to have barely avoided running out of insulin and not reassured that his regular supply of a life-sustaining drug had been reestablished.
And then the pièce de resistance. On September 26th, the morning after the department manager’s effort at conciliation, or at least shared responsibility, I received a letter dated September 20th from the “Summit Health Patient Relations Department,” absent any personal signatory. The letter came from the patient relations staffer who had called me several days earlier on a disconnected phone line. It began, “I have tried reaching out to you,” and then, flying in the face of her manager’s remarks the preceding evening, she became nakedly accusatory. Now, simply because I had made three phone calls requesting a callback from my physician, and absent any relational exchange about the matter at hand, I stood guilty of behavior both “inappropriate” and “disruptive.” The second paragraph reads:
Please know that as an employer, Summit Health has a responsibility to provide a safe and civil environment for our employees and providers. We take this responsibility very seriously. In the future we ask that you be courteous to all whom you encounter. Any further disruptive behavior could result in your discharge from this office.
The unsigned letter makes serious allegations that are unfounded and potentially libelous. It threatens me with expulsion from the endocrinology office simply because I placed three phone calls to my physician’s office on September 18th, asking each time that the physician call me back about an important matter. Apparently, in some preternatural way, three brief phone calls, during which I neither raised my voice nor used inappropriate language, impeded the work flow of the office. The letter elides the particulars of the situation, skirting entirely the reciprocal obligation of physicians and staff personnel to be responsive to patients, especially patients who reach out in times of need. I subsequently learned that the letter I received was in fact a template, and that equally impersonal letters of rebuke had been sent to other Summit patients who, for one reason or another, elicited the disapproval of an office staff member. All such letters were simply signed, “Summit Patient Relations Department.”
Taking the signatory of the letter at face value, I stand accused of “disruptive behavior” by a patient relations department that was uncomprehending of relationality, especially the relationality that inheres in doctor-patient-office staff interactions. Absent any relational engagement of the particulars of doctor-patient-staff interactions, what exactly is the raison d’être of a patient relations department?
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A broader issue that arose in my exchanges with the patient relations manager concerns the prerogative of a patient relations department to intrude into the doctor-patient relationship. In this instance, it was a matter of advising a Summit physician not to return multiple phone calls from a patient in distress. When I posed the question directly to the manager, she replied that patient relations personnel were not medically trained and could not interfere in strictly medical matters. By implication, intrusion in ostensibly non-medical matters (as to patient “behavior” and the like), was entirely acceptable.
But, how can a medically untrained administrative employee determine what is not medically relevant when a patient asks, repeatedly, that his physician return his phone calls? In point of fact, I sought to discuss several salient medical matters with my provider; it wasn’t simply a matter of reestablishing a regular supply of insulin. How could the young staffer who advised my physician not to return my phone calls have known this? It would be another four days before she herself felt impelled to contact me, this time on a working phone system.
In this instance, and no doubt in countless others, a patient relations department was relationally destructive: It pulled a health plan physician, a corporate employee, still further away from the physician’s Hippocratic obligation to privilege the patient’s needs above all else, viz., above office protocols, electronic monitoring of time spent with each patient, office staff sensibilities, et al. In the mantle of “patient relations,” the doctor-patient relationship was flattened by the iron fist of corporate bureaucracy.
And here’s the rub. In my case, there was no “behavior” at all. There was no action involving others, no unannounced visit to the office, no contentious confrontation with the physician or a staff member. There were three brief phone calls, pure and simple. Yes, the calls conveyed a mounting sense of urgency and, by the third call, exasperation. I regret that my tone was upsetting to endocrinology office staff. But it should not have been.
Patients call their doctors for any number of reasons. Sometimes they are happy, sometimes confused, sometimes upset. Often they are simply calling to schedule or reschedule appointments. In this instance, my tone was entirely appropriate to the circumstances I related. Why else would the department manager volunteer that the endocrinology office staff needed instruction on how to handle phone calls of a nonroutine nature? Why else would she remark in a subsequent conversation that, had she placed three phone calls about an important matter and received no response, she would have felt the same way.
What have we here? My experience suggests that, at Summit Health, patient relations is profoundly nonrelational. A letter of rebuke was sent out before the letter writer, the “Summit Health Patient Relations Department,” had even made contact with the patient. Nor did anyone in the department, including the patient manager, even mention the plight of an elderly diabetic fearful of being without insulin. It was simply a matter of “behavior” in placing phone calls that betrayed frustration and, in the final call, anger.
My experience suggests that at Summit Health, patient relations is simply an arm of administration, charged with keeping patients in line, literally and figuratively, so that the wheels of office practice coast along smoothly and, of course, profitably. But patient relations – as opposed to practice administration – is interpersonal and interactive, often messy, always time-consuming. If Summit Health is serious about patient relations, it should assemble teams of professionals capable of engaging the messy interpersonal issues that enter into doctor-patient-staff relations.[4]
Such a staff would include the very type of professionals who emerged from the patient rights movement of the 1970s and 80s – trained health educators, trained patient advocates, trained system-wide navigators. I wonder if any members of the Summit patient relations department have completed training programs in health advocacy. I wonder if any have been certified by the Patient Advocacy Certification Board or the Professional Patient Advocate Institute.[5] Who among them has training in healthcare ethics, with its core subject areas of patient autonomy, malfeasance, and beneficence? Absent such training and the professional identity it cultivates, patient relations staffers are incapable of representing distressed patients when it matters most, viz., in the face of insensitivity and rank incompetence that leave patients muddling through medical purgatory.
Some insurers and health plans provide patient advocacy without the encumbrance of patient relations departments. Aetna, for example, provides patient advocacy through “Aetna One Advocate” (A1A), an integrated clinical and service support program launched in 2018. It provides health concierge services and a network of member advocates for plan members. The network comprises teams of nurses, pharmacists, and others available to patients in need of support.[6] In 2023, Elevance (formerly Anthem) launched “My Health Advocate,” a support model in which plan members are assigned a personal advocate to represent their interests when problems arrive. Via connection with a single person, navigation and advocacy become “simple, guided, and intuitive.” [7]
At Summit Health, judging from my experience, patient advocacy is not even a component of patient relations.[8] Far from it. But absent a commitment to patient well-being through patient advocacy, patient relations is no more than empty rhetoric, a sop to data-obsessed marketers intent on giving health plans the mere semblance of patient-centered caregiving. In short, if patient relations is not about patients in relation to their caregivers, including the failure of caregivers and support staffs to act beneficently on behalf of patients, then it is about nothing.
[1] Saint Michael’s Medical Center, “They’re a Hospital’s Best Kept Secret. How Patient Advocates are Changing Health Care in N.J.” 14 July 2022.
[2] “About National Patient Advocate Foundation” (https://www.patientadvocate.org/learn-about-us/about-npaf/).
[3] Melanie A. Meyer, “Qualifications and Skills Required for Patient Experience Positions,” Journal of Patient Experience, 7:1535-1542, 2019, citing J. Wolf , The State of Patient Experience in 2017: A Return to Purpose. Nashville, TN: Beryl Institute, 2017 (https://theberylinstitute.org/product/the-state-of-patient-experience-2017-a-return-to-purpose-2/),
[4] On the evolution of doctor-patient relations in the 19th and 20th centuries, including the changing meaning of the knotty, messy, time-consuming issues mentioned herein, see Paul E. Stepansky, In the Hands of Doctors: Touch and Trust in Medical Care (Santa Barbara: Praeger, 2016; Montclair: Keynote Books, 2017pbk).
[5] Samna Ghani, “What Does a Patient Advocate Do? (Duties and Salary),” 19 March 2025 (https://www.indeed.com/career-advice/careers/what-does-a-patient-advocate-do).
[6] Aetna, “Care Management Support for Individuals and Families” (https://www.aetna.com/individuals-families/health-insurance-through-work/care-management.html).
[7] Elevance Health, “My Health Advocate: A Trusted Health Advisor” (https://www.elevancehealth.com/annual-report/2023/my-health-advocate-a-trusted-advisor.html).
[8] There is, be it noted, a “Summit Health Advocates,” a private fee-for-service advocacy firm located in Seattle. It provides the type of personal advocacy that Summit Health, as best I can determine, does not provide as a member service. The Summit Health Advocates website does not stipulate any relation with Summit Health, with headquarters in Berkeley Heights, NJ. See “Summit Health Advocates” (https://www.summithealthcareadvocates.com/services).
Copyright © 2025 by Paul E. Stepansky. All rights reserved. The author kindly requests that educators using his blog essays in their courses and seminars let him know via info[at]keynote-books.com.
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