Pharmacy to Patient Advocacy | Claudia Cometa, PharmD

Transcript Disclaimer: This transcript is generated using speech-to-text technology and may contain errors or inaccuracies.

Mike Koelzer, Host: ​[00:00:00] Claudia for those who haven't come across you online, introduce yourself and tell the listeners why we're talking. 

Claudia Cometa, PharmD: My name is Claudia Cometa. I am a pharmacist by trade and although I don't work in a traditional pharmacy setting now I still maintain my multiple state licenses. And I graduated back in oh three.

So worked for over a decade and a half ish, um, mostly in clinical pharmacy. So mostly in ambulatory care, I worked alongside physicians and outpatient clinics. I also managed some anticoagulation clinics. So I, um, had that as most of my experience. And I sort of switched courses after my father was diagnosed with lymphoma in 2016 and became his advocate.

Nobody else in my family was really medically trained to do it. And so I took on that role, um, happily, but also. Found out a lot of things about the medical system that I think I was either blinded to, or didn't open my eyes to, or didn't understand, realized how deeply broken it is and decided that I am better utilized in this world to function as an advocate for others as I advocated for him.

So, um, yeah, I'm here to kind of just explain my experience. Hopefully inspire others to think a little bit outside of the box, as far as transferable skills, as we are pharmacists and have many of those. And, uh, it doesn't have to look like somebody else's journeys. What was 

Mike Koelzer, Host: the main thing lacking in your care for your dad?

Claudia Cometa, PharmD: So, what I saw along his journey was, you know, it would almost look like neglect. Although I actually trust in my husband's a physician. So I trust in the caliber of person who chooses to go into medical school. And I believe that as a whole, they're going into it for the right reason. They're intelligent, very capable, hardworking, strong ethic type of people.

But I, the system itself is not supporting them to be able to be the providers that they can and should be. And so there is, there's a lot of. You know, shortcuts. Um, I saw him go into the pulmonologist office and I saw, you know, the fellow evaluate him, say, you know, report on the, on the default template of the soap note, that all was well.

And his lungs looked clear when he really didn't actually listen to his lungs. And then I saw the attending come in and sign off on what the fellow did. And then I saw him go into, um, get a chest tube two days later. And so these things just continued to go on and on and on as I'm watching and paying attention.

And I'm watching an inaccurate documentation of his weight being put down to 300 pounds when he was actually on a good day, 170. And you know, when you're in the middle of chemo and that's weight based, that's a problem. And so, um, just error after error. Even with my oversight, even with my extreme oversight.

So it was shocking to me, honestly, because I always, you know, I think we as healthcare professionals pride ourselves on being detail oriented. And although we also realize that we're humans, we do the best we can to pay attention to all the details. And I think even as pharmacists, you know, we take the type a up even a notch further.

And, and if so, it was shocking to me how much was going wrong. That almost 

Mike Koelzer, Host: Sounds like the game is like a telephone. I mean, so you're saying that the first guy went in with the soap notes. That's, that's the acronym for, for subjective objective, something or other. Yeah, assessment plan. He didn't even do those.

And then the next guy comes in and, and thought he did 'em and 

Claudia Cometa, PharmD: didn't do 'em. Yeah. What happens with documentation and electronic medical records in an outpatient setting? Well, inpatient two, but in an outpatient setting is the tech gurus on the other end of, of creating these amazing, um, electronic medical record systems, um, produce them so that they can be efficient.

Part of their efficiency is an auto population of what you are typically saying. So, okay. You know, lungs are clear to auscultation and, you know, yada, yada yada, and that will auto populate. You have to be the person to go in and say, that's not the case with this patient. Um, and so it lends itself to problems because of the auto population of what is normally being.

Stated in that specific scenario, 

Mike Koelzer, Host: It's kind of like when you put your name in something and it pulls up your past computer stuff and it populates everything, but that's a problem. And I imagine that's the upper echelon coming down and saying, hurry up, let's get this going. We're gonna auto populate this, but they don't go through every question like they should.

Right. They assume that if a is here, that all the rest are gonna follow and that's not the case in the real world. Right. 

Claudia Cometa, PharmD: Right. And it's really easy to go through your chart and just, okay. Okay. Let me just put a few notes. All of this auto populates and you don't go [00:05:00] back and actually fix the things from that auto population that do not apply to this patient.

Well, then you're the fellow, the attending pulmonologist comes in after you, assuming you did what you said on that auto populate chart. 

Mike Koelzer, Host: They're not assuming that it's all auto populated. They think you went through and looked 

Claudia Cometa, PharmD: at. Correct. Yeah. So they assume that that's accurate. And I mean, ultimately you're a pulmonologist, you know, like if you don't listen to lungs, that's probably a problem.

yeah. Right. You have a very niche job. So, uh, you know, I had a very long conversation with the attending. Uh, you know, it went a little 

Mike Koelzer, Host: bit ugly. That's okay. When it's your family? Well, it's okay. A lot of times, but it's okay. When it's your family, for sure. 

Claudia Cometa, PharmD: Yeah. So, um, you know, and it was a, it was a difficult year, but you know, what I would say is I needed to see all of that to see really what was going on because, you know, I would, I would sit and I would manage my anticoagulants and I would feel like I'm doing a good job and, you know, hooray for, for clinical pharmacists.

And I, and I believe that we do a, a, you know, I think pharmacists in general do really fantastic work. Um, you know, we're just one part of a system that is overall extremely broken. And I just felt that my, um, my skill set, my knowledge, my passion, um, and my, my hope to help others. Through that very difficult situation.

As I'm looking around the ICU bay, you know, I'm looking from room to room and I'm thinking who's helping this person. And who's watching out for this person's chart? And who's looking at this person's labs and who's questioning these things for these patients nobody's there. So, um, I just decided to, to change courses, I still maintain my pharmacy licenses from the states that I've practiced, practiced in.

And so, um, it's not a, a renunciation of pharmacy, but more a, just an expansion of what we're able to 

Mike Koelzer, Host: do. If you are a pharmacist up there, you probably wouldn't have had the chance to see this stuff in your dad's notes. Cause the pharmacist, I take it, maybe you don't look that deeply and. If you weren't a pharmacist or in the medical profession, you may not have had enough skills to know that something was being passed over.

You might not know the guy was doing auto fill or something like that. Is that right? So 100%, both of those would've been missed even as a pharmacist and even as a family 

Claudia Cometa, PharmD: member, is that right? 100%. Yeah. If I was in, you know, in the pharmacy looking just on paper, I might have caught the 300 pound error only because I know he's not 300 pounds.

Right. But if I was a pharmacist, not knowing the person personally, I, would've no idea that, that, you know, that that was an error unless I, you know, was able to look back and see a pattern of like, okay, I'm pretty sure you didn't gain 130 pounds in a week. Right. So that's probably an error. But other than that, you know, no, I wouldn't have been in the office to know that that documentation and that auto populate note was inaccurate.

There would've been no way for me to know that. And as a non-medical professional, there would've been no way for me to know any of that. I would've had no way to know. Really anything that I caught, I wouldn't have known what questions to ask what to look for to even look at the online portal, to know that that a, um, error was made in his weight.

So, no, I wouldn't have known any 

Mike Koelzer, Host: of that. Well, you might have had a premonition or an inkling maybe as a family member, but probably not, but you might have picked up, like if someone had a stained shirt that wasn't changed in a day or two, but you're not gonna pick up that other stuff. 

Claudia Cometa, PharmD: Yeah, it's a, it's a lot.

And it's so much that it's so overwhelming for me as a healthcare professional, to see it, I can only imagine how overwhelming it is for the person who's sick, who can't really even process, you know, more than five words during an appointment because they aren't feeling well. And then they're also supposed to somehow be so proactive in their care that they have to know everything to be able to catch errors.

I mean, the assumption is I am going to the authority who has systems in place to prevent these errors and knows enough to help me. I don't, I shouldn't have to do all of this. You know, it's like if I'm buying from Amazon, I shouldn't have to worry about whether my two day prime, you know, you, that's your job as the company, you know, it's your job as the healthcare professional, as the physician to provide me this level of care in a safe way and so on.

I, you know, so it's, it's a lot, it's a lot and people don't realize, um, how, how really broken it is. 

Mike Koelzer, Host: If you don't know, you don't know, but I think a lot of people may not have all the skills that you would have, but they'd have some of them just to know that something doesn't seem right. They maybe even can't put words to it.

Yeah. When you say it's a systems problem. Whenever I think of the system, I always think of the man. I don't even know who the man is, but I always think of the man, you know, like the upper echelon, like managers and the owner of the hospital and things like that. Now, I suppose someone else could argue.

They could say no, the system is just when a lot of people get together and there's no real manager, but the system breaks down kinda like the telephone game. I was mentioning in your mind though, when you talk about the system breaking down, is there any place and not that we're here just to throw a blame around we're here because you're a solutions person, but where does this start breaking down 

in 

Claudia Cometa, PharmD: your mind?

So many places I would argue that there are few places that it's not broken, broken down. Um, you know, where did it begin? It's hard to say it's kind of like chicken and egg, but I'll say that it begins. [00:10:00] As early in the training of medical professionals as the schooling, you know, I think about the culture and medical school.

I mean, I, I basically, you know, my husband and I have been together forever since high school, so we've been through both, all of it. So I've been through medical school. I know what type of physician he's an anesthesiologist now, so, oh, anesthesiologist. Okay. Yeah. Um, you know, but, so I, you know, I went through the whole process with him and I saw the types of, you know, the culture that is promoted in medicine.

And it's very similar in parallel, honestly, to the schooling I had in pharmacy school. So there is, um, you know, an underlying assumption, um, you know, in this current time that we're in, that medications are there to solve all problems. And, um, it is very medication heavy. Uh, so in pharmacy school we used to role play and I've talked about this on my podcast.

We used to role play, you know, if somebody comes in and wants to. Take a supplement. Here's how you're gonna tell them not to. Here's how you're gonna tell them that the FDA doesn't regulate that. And this isn't good for you, but here, this other drug is really great for you. So, um, how about you ask your doctor for this instead?

So, you know, we role play these things and there's this indoctrination of the way that we should think as pharmacists in a very similar and paralleled way in medical school. You know, there's just, there's this indoctrination of the way that you should think as a doctor and you D you diagnose X condition, and here are the medications that you would prescribe for X condition.

And again, you know, you don't supplements are not, you know, this is all quackery. You're never gonna recommend acupuncture or chiropractor. These things are all, there's no science to back that up, you know? So you're indoctrinated into thinking. In a very specific way you're molded into this system. Okay.

So as you, you know, you come into, into the field, you know, I, I just wanna help somebody. I had this amazing experience as a kid, you know, where my mom was diagnosed with something scary. And I just wanna be that person to help others. You know, they come in with amazing stories of why they wanna help others.

And then this molding starts to happen through school. And then you go into residency and there's just this, you know, you know, work until you can't, you know, breathe or see or anything anymore. Like, you know, don't, you know, you don't get to eat lunch, you don't get to go to the bathroom. And so, you know, and, and that, that makes you tough, you know, that makes you strong.

And, um, so there's this just indoctrination of mindset around what, you know, a healthcare professional is what a physician is, a physician just pushes through, you know, um, and the system isn't here to support you, you know, you're here to support your patients at all costs at the cost of your own self care.

Right. So you don't, I mean, no, I, I didn't usually go to the bathroom when I worked, I worked in retail a little bit and, um, bathroom was a luxury. So, um, So, you know, there's just this continued verbiage and culture that surrounds medicine. And ultimately we are not meant to sustain a life of not going to the bathroom and not hydrating ourselves and not taking care of ourselves.

And then being able to somehow pour into our patients, we can't do it. It's just not even, it's not human to do that. Yeah. So eventually we break down as people, the system continues to support this, this culture that isn't sustainable and everything breaks down. And then of course, outside of just the culture of that, then there is the.

A whole problem with, you know, the payer system and insurances, you know, making decisions, insurances, fueling, and informing the decisions that go into the costs of things. You know, there's big pharma, you know, there's just a lot of things and I'm not against all of that. I think there could be roles for those things.

Obviously there are life saving medications, so I'm not saying that we should renounce all medications. Um, but there are so many pieces of this that, that have problems and so the entire system, 

Mike Koelzer, Host: I think the enlightening part, well, to me, and I think what we all have to understand is even if schools change, let's say schools changed overnight and didn't force us as hard, or let's say the upper ranks didn't push as hard.

Our comrades. May push us as hard just because that's the culture. And that could last for another, you know, 50 years until some of that dies out. We can find fault in our own profession. We're all pushing each other. 

Claudia Cometa, PharmD: Probably 100%. Well, we've all been indoctrinated, right. And as it gets a little bit, you know, even in medicine, it's like, it gets a little bit easier for the residents cuz there's new rules about how many hours you can work, you know?

Well then the old school docs are like, well in my day, you know, in my day you're sissies then. Yeah. I mean, we, we didn't even, you know, we walked 10 miles in the snow before we even got to work at 5:00 AM or what, you know, whatever. And we worked, you know, we worked 36 hour shifts. You guys. Get off in 24 hours.

That's insane. You know? And so, it trickles, so you're right. It will take many generations to start to shift and it is shifting because there are much, much more tolerable rules right now for medical residents than there were when my husband was a resident. And when he, when his dad was a doctor, I mean, you just would sleep in the hospital for a week.

Like, so it, it has gotten better, but it will take many [00:15:00] generations to, to wash that out 

Mike Koelzer, Host: when you get. Upper level saying not these words, but you know, you guys are sissies. You're not doing, we did it almost seems it goes underground then where people are like, well, we'll do this private hazing like they do in the fraternities and stuff, you know, because we're not gonna be called sissies by those guys.

I don't know how you would force extra work on yourself. But when your parents and grandparents are saying that stuff to you, you gotta say, well, it's still tough because we do this, you know? So you gotta find something to make it sound like you're not taking care of yourself, I guess, you know? Right. You can be as miserable as they were.

We'll show you . 

Claudia Cometa, PharmD: Yeah. Well, and this is, this is a much larger societal problem. I mean, what is, you know, glamorized and encouraged and yeah. Acknowledged and validated is. Working yourself to death. There's, you know, if you have openings on your schedule and you might be taking, you know, 15 minutes to meditate or to take care of yourself, what, like, what are you doing?

Are you even, you know, a productive member of society? And we, so this is a much larger societal issue, but, but it's even more exaggerated in, in the medical field. 

Mike Koelzer, Host: You're with your dad. Your dad is getting sicker. When did you then make the move to this? Was it a look back at what your dad went through or was it during that situation that you said, I'm gonna try to broaden this out and make a bigger impact 

Claudia Cometa, PharmD: on this good question.

We moved back to Florida from Washington state in 2016, and I didn't immediately seek a job when we first moved. And it was very shortly thereafter that my father got diagnosed. And so I kind of, you know, we just made some budgetary changes and, um, I, I kind of just took that on as my full-time job for a little bit.

And then I just realized I was driving back and forth. So they, my parents lived in Orlando, which is two hours south of where I live. And so I would drive back and forth just constantly, um, trying to be at appointments and et cetera. And, um, you know, one day it was probably. uh, three quarters of the way through that year, it was pouring.

I just remembered it was pouring down rain and all of a sudden it was like, just this, I have to do this for somebody else. I know, like I knew already at that point that the likelihood that my father would make it through was very low. And I was like, okay, well, when this, you know, when this chapter is over, which I know I'm gonna go through some, you know, pretty deep grieving process over it, what am I gonna do with his legacy?

What am I gonna do with the knowledge that I have gained? What can I, how can I serve others in the way that I served him? And so it was like, I have to do this for others. I don't know what that looks like. I didn't even know to call it a patient advocate. I don't think at really any point in time I labeled it as I was being his patient advocate.

Yeah. Um, I was just helping him on his journey. And so I was like, I just know that this is what I'm supposed to do. I don't know what that looks like. I just know that that's what feels right to me. And so, uh, you know, it, it was. I had moved forward, very imperfectly because at no point in my pharmacy training was I taught how to start a business or, and I mean, that is shifting a little bit, you know, there's there's pieces of, of pharmacy school that kind of at least expose you to that.

But I had zero exposure, zero knowledge of how to start a business. Um, especially when it wasn't technically pharmacy. I mean, I'm not really functioning as a pharmacist. So, um, you know, I just was like, I don't, I don't really know how to do any of the backend stuff, but I know what I'm doing as far as the trenches.

And so I'm just gonna ask my sister to help me build a website who's in tech. You know, I just, I was just being resourceful and I moved forward very imperfectly. When 

Mike Koelzer, Host: you moved to Florida, you were two hours away from your dad. Mm. Why did you choose that area instead of not right up close to him, because how many times a week were you going back to see him or going down to see him?

Claudia Cometa, PharmD: We were called back to Florida. We actually were fine in Washington state. We were, uh, but uh, my husband trained here in Gainesville and the hospital here called him back. They were expanding and they, we got the call and we were like, all right, well, this is, this must be the sign that we gotta go back.

Mike Koelzer, Host: Yeah. So at that time you're saying, well, being two hours away is better than two days of flying away, almost for 

Claudia Cometa, PharmD: sure. 100%. Yeah. I was not working during that time, which was fantastically timed, um, and very, you know, divine intervention type of thing. And I also acknowledge and validate that I was blessed that my husband had a job that would be able, that would be able to support that I realized.

And you know, that not everybody has that yeah. That flexibility in their financial space. Did you 

Mike Koelzer, Host: have enough. With your dad legally, were you like his legal medical power of attorney and all that stuff? Were you all that 

Claudia Cometa, PharmD: already or not? Yeah, so my mom was, but she was always there with me, so we kind of left it for her to, to sort of be the decision maker and then I just kind of took over.

So I was at the appointments more than she was. And, and at, by, you know, by about a month everybody pretty much had my picture PLA plastered everywhere. They knew that they were to call me. I mean, it was like not no question that I was the, um, the, the force running the show. And, um, a lot of times they didn't necessarily like that, but, you know,

Mike Koelzer, Host: Was that hard for you ever to know that you had to be the bulldog sometimes. Did you always take pride in it? Did it ever affect you like that? You were pulled between saying, [00:20:00] I've gotta say this and do what's right for my dad and these people might not like that. And what were your emotions with that?

Did that hurt you? Did it empower 

Claudia Cometa, PharmD: you? Yeah, so my mom's side is Italian and that's oh, there you go. That's kind of, that's kind of in us. Um, so that part was not difficult for me. However, if that's not, you know, if that's not a personality type, somebody sort of claims that can be very difficult for you, for sure.

It really is that the loudest person wins, it's unfortunate, but the reality is, the system is so overburdened and overloaded. You kind of have to speak up. And, um, so, you know, I started out pretty nice. I'll, I'll always start out with a very amicable relationship. I like to have a good relationship with them.

My medical team, but I also realized that there are times when things have to get a little bit more aggressive and, and many times it did. I ended up firing both hospital systems in Orlando and, and moved him up to Gainesville. And if I, you know, it, it doesn't really matter if I had done that earlier, but, you know, I, I wish I would've been able to talk him into that earlier, but he was wanting to stay in, in the area and, and Orlando just wasn't serving him.

But, um, but you have to be willing to, as a, as a person advocating for yourself and as a person advocating for a loved one, you have to be willing to part ways with a medical team that isn't serving you and a, and a facility that isn't serving you. And I think that's hard for people because they feel a sense of, you know, loyalty.

This person knows my chart, this person, you know, and it's hard to reestablish with somebody and it just seems overwhelming. Um, but. You know, you really have to get into a mindset that this is like any other service, it's any other, anything else that you're purchasing as a consumer, you're purchasing a service.

And if it is not serving you, you have to be in the mindset to be able to switch. Is that like 

Mike Koelzer, Host: changing a legal team where you have to make a big thing, or when you say you fired them, is there anything official for that when someone's in the system? Or you could just say, instead of going here next.

We're not gonna go there. We're gonna go up to Gainesville. Is it official or do 

Claudia Cometa, PharmD: you just go? I think it's respectful to let the provider know that you're leaving. You would, you have to, no, you could just not show. Um, I don't, I don't think that it's in anybody's best interest to have, um, just a, kind of a that's what all my 

Mike Koelzer, Host: former girlfriends did to me.

Claudia Cometa, PharmD: there was no chart though. I'm just, just a memory. Just, just your heart in your head. hopefully 

Mike Koelzer, Host: No, I don't know. It hasn't come out yet, but God only 

Claudia Cometa, PharmD: knows you could just bail. You could just GO but you know, just like when you, you know, if you leave a hospital, it's never a good thing to have in your chart that you just bailed and didn't show up to an appointment or gotcha.

You know, um, you wanna have some documentation that, you know, I'm just letting you know this isn't working out. I've chosen to move providers. The reality is, a lot of people treat it just like you said, they treat it like it's gonna be a breakup. It's gonna be this big thing and there's gonna be this animosity.

And the reality is, it is the providers. It's not that they don't care. They don't have the time to be putting any energy into worrying about why you moved on. I mean, maybe, maybe a newer practitioner who doesn't have a big, you know, patient panel might spend a little bit of time thinking about it, but it's not, you don't need to worry about that.

You just, you respectfully, we are leaving, we're moving to a different hospital system. I'm moving to a different provider and I'm just letting you know, please document that on my chart. So it's not like she just fell off. I mean, she had this appointment and you know, that's just, and that, that doesn't look good for anybody.

Doesn't look good on the insurance side. It just doesn't look good. So, yeah, but it, it's not a big thing it's not, and I think that's part of the, and I'm glad that you brought that up because I do think that people think it has to be this big scene and it, it's not a scene at all. It's just, you know, I, I'm letting you know that this isn't this relationship isn't working out and it ultimately is a relationship.

And just like any other relationship, if it's not working out, you just move on. 

Mike Koelzer, Host: I grew up kind of more as a people pleaser. And I still kind of have that in me. Believe it or not everybody says, how can that asshole be a people pleaser? Just those two just don't line up for me, but there's a difference in telling somebody this relationship isn't working out versus we've chosen to.

Take a different road with this because on the first one, it's more like, oh, the relationship didn't work out. What happened? And the second one, if you say, and you said it just a minute ago, like we decided to go with a different system or something like that. One is almost a little bit more personable.

Like the relationship broke down and one's just like, we're moving. Do you think it's important to actually say that the relationship didn't work out? Or can you just say no, we're, we're just moving and let them think that it's because you've decided to move closer to family or this and that.

Do you think it's good to express yourself as much as you feel comfortable with? 

Claudia Cometa, PharmD: I would never want them to think that there, that everything was going well. And the only reason that we're moving is because we're moving away, that they need to know that there was somebody who was dissatisfied. Now what they wanna do with that, I will say close to a hundred percent of the time.

Nothing will happen with that. It will just get documented. The physician, you know, most likely will send this note. You could send the note via a portal to the actual physician, which will be seen by the nurse, but. The times that a physician will actually read that and somehow process it and worry about it is probably zero.

So it's not, it's not, it's more just for documentation that the clinic knows like, oh, okay. What happened to that person? Oh yeah. Okay. They're gone somewhere [00:25:00] else done. Like there will be close to zero hard feelings. They won't care. You know, it's not that they don't care cuz they're not caring people.

It it's, there's a million other patients you're, you know, they're, they ha they're so overloaded that if you decided to go get care somewhere else, there's not gonna be an exit interview. I mean, there, it's just not gonna happen. Um, and that's an unfortunate thing because that would actually be nice. If somebody said, Hey, this person decided to leave, let's go to this department and see if we can find out what went wrong, cuz then maybe we can improve.

I mean, that would be like some kind of utopia compared to what's happening now, but I wouldn't lie to make it seem prettier or less, um, harsh. I would just say, you know, yeah. I haven't been happy, honestly. I haven't been happy with the care there. I've decided to move my care and establish my care elsewhere.

It's not a relationship that I think is serving either of us. So I'm moving on and whoever's taking the message will say, okay, thanks for letting us know. and that will be the end of that. 

Mike Koelzer, Host: Yeah. They don't care. They don't care. Yeah. I mean, I see it as a, you know, independent pharmacy when I'm dealing directly with the people.

That's one thing and I've known their family for years and stuff, but the people don't care. They just want to chart it correctly and move 

Claudia Cometa, PharmD: on. Right. Right. And you, and you want the chart to be accurate cuz you'll, you'll be shocked at how many inaccuracies, you know, will be in there about what you've said or didn't say, and you'll be like, what I didn't what I don't, you know?

And so you, you want to have that documented correctly about why you 

Mike Koelzer, Host: left. You're a couple hours away from your dad. You're doing more and more of this. So when do you make your first move to say, I could do this for somebody else. I know you were, you said you were kind of thinking how this might impact others.

When did that thought get stronger? 

Claudia Cometa, PharmD: So he passed away April 15th of that year. And I honestly, you know, the beginning of April started to make sense. Small plans, you know, I just started to say, okay, well, what, you know, what name would feel good to me? Um, you know, I, I just took very, very small baby steps because I knew that I was gonna need some space to grieve, but I also felt as, you know, the default type a that I am, that I wanted to get the ball rolling, even though it was rolling so slow, but I wanted it to at least start going in the right direction.

So, you know, what name would I like? And what would I like my, you know, like colors to represent to somebody, you know, I, I was really into sort of just this, this piece, this sense of peace around. The whole process and the journey, cuz I really had very little peace in it. And so did my dad. So, um, so I just, you know, small, small changes, small, small decision making, you know, like, okay, I'm gonna, okay now I'll look for the URL to buy and okay now I'll, you know, small steps and then after he died, I took off, you know, at several weeks to just kind of like breathe through that.

And then once I kind of felt ready to, to take on some clients, I, you know, made sure that my website was live and that I had a contract in place, you know, that, that I legally needed. And um, you know, I, I got onto a nationwide database where people, if they were to search, you know, um, health advocate or patient advocate, or they even knew to, to use those words, um, they would come across a database and I, um, was, was vetted and put on that.

And um, so pretty quickly I was able to help another family in a tough situation and, and the, the. It was so fulfilling to me to be able to do that and to be able to get that family back to a state of wellness and know that, okay, that's awesome. Now, you know, this, this, you know, gentleman's adult son and grandchildren are able to have more years with him, you know, even if I played a minor role in that.

And so it, it, it really kind of moved me from this internal, let me just sink into my personal grief, into like, let me do, let me serve the moment in a better way and, um, be able to give back. So 

Mike Koelzer, Host: I bet even things like choosing the colors and the name and all that was almost therapeutic in your grief slash you know, acceptance process and all that.

You're kind of like thinking through things and yeah, 

Claudia Cometa, PharmD: very much 

Mike Koelzer, Host: so. How mature is the patient advocate industry? Is that new and how is the healthcare industry? Are they accepting of that person in the medical team? 

Claudia Cometa, PharmD: Yeah, it's still very much in its infancy. And, um, you know, it kind of trickles there's, there's some patient advocates who, you know, say they've been sort of doing advocacy since, you know, maybe 2009, you know, 2010.

Um, but it, it hasn't really become like, it just recently became a board certification, you know, which I, I honestly, I like haven't even done it cuz I have a little bit of a, a sense of, um, exhaustion over how many letters we need to have after our name, to, to say that we. Qualified to do something. So I have not done that just because it's not important to me.

I know the work that I do, but there is a certification board and that's very recent the last couple years. Um, yes, a state board, you can be a board certified patient advocate. It's not a, it's not a state, it's not a licensure, like a state pharmacist, licensure. It's more just a cert certificate, kind of, yeah.

Kind of like a BCP kind of a thing. So, um, so it's, you know, [00:30:00] it's becoming more established, it's becoming more accepted, more acknowledged, more validated, um, more credible, but there still is. No. So like to take the certification test, you don't have to have any specific degree. You don't really have to show any certain amount of hours of patient care.

Like you really could just take it. Um, and so a lot of it goes into ethics of patient care and stuff. So it's not nearly as niche and specific as a pharmacy exam. But, um, but so it, so the door is open to the background of the person that goes into this type of a field. So there are many like administrators who become patient advocates.

There are many nurses, I would say nursing is probably one of the bigger fields that end up going into this pharmacy. Very, very small, very, um, low percentage of pharmacists are currently in this space. Um, you know, and there's some patients who become patient advocates, you know, that they have had such a complicated lengthy journey that they just wanna get into the space to help in whatever capacity that is.

And so you've got just this amazing pool of people who. I have come into this for very genuine, authentic reasons, usually based on personal experience. And, um, you know, the trick now is there's not a lot of awareness, right? Like we're having this conversation, but there's not a whole lot of awareness yet.

It's getting, it's getting heightened a little bit, but there's not a lot of awareness that I'm even as a patient able to type in the like, oh, let me search for a patient advocate. You know, there are some hospital systems and facilities that employ what's called patient advocates, maybe nurse navigators.

But the, but the fact is, they are employed by that facility. So there's gonna be some bias. There's gonna be some protection of the facility and of the staff there. And that's different from a private patient advocate. 

Mike Koelzer, Host: When does the. Profession gets so big that there's, it's already there, that there's already patient advocates, but now you're like, no, we're the patient patient advocate.

You know what I mean? And then pretty soon let's say someone in your position says I'm getting good at this. And now I'm gonna have, you know, 500 in my own patient advocates and so on. Well, ultimately, you know what happens? It turns into a bigger business and then someone like you has to come along and kind of like it.

Be better than the person that was like you, that now has 500 employees and not doing the same job that you do. So is that like a never ending cycle or where does it stop where we say, no, I'm really your advocate. Where does that stop? 

Claudia Cometa, PharmD: Yeah. You know, so the patient advocate and nurse navigators and those types of titles that are within bigger organizations and hospital systems are intended to kind of, you know, be the, the point person, you know, like if I can't get ahold of my doctor and I, you know, I'm going through a chemo regimen or something.

And so they're kind of the point person, but. They are not going to be the person who's going to say, oh, you know, this isn't, this isn't going well. Or, oh, you noticed you noticed an error or, oh, oh, you wanna leave this system? Let me help you navigate to the next system. I mean, ultimately their interests are of their employer, which is that system.

And so they can help you navigate within that system, but they're most likely not going to, um, be the first ones to point out errors in their own system. You know? So there's just gonna be some biases that there's no way to help that. Um, there's gonna be some conflicts of interest there, although they serve an amazing purpose.

So I don't wanna downplay that there are, you know, countless people that I've interviewed on my own podcast that are like, if I didn't have that nurse navigator, so they serve an important purpose, but a private patient advocate, like what I do and what others do is I have no interests other than yours.

I have no goals other than the goals that you tell me and. I, I don't, I have no problem speaking up to this facility or that facility or moving you to a different facility because my only interest is yours and I have no bias. I have nobody, I have no boss to speak to, you know, I work for myself and there's just a love, there's a different level when that's the case.

And, um, You know, people really appreciate that now, you know, will in the future, some national conglomerate, you know, eat up all the, you know, start to employ all the patient advocates and it becomes this big business. I don't know. I don't know. I don't know what the future of that holds because in anesthesia, you know, what the, these things happen over the years, you know what there's, there's private, there's, um, there's private practice, anesthesia groups and national groups start eating those groups up.

And, and, and that, that can happen. I don't know if that will happen in this, this space. I think we're still far out from that. There's not a whole lot of interest on the big business side in, and us little patient advocates. Will that change maybe, um, maybe that will change, but there are, um, there's so many of us who like having the flexibility of making those decisions.

And that's a lot of what we disliked in the box that we were in, in our, in our jobs. Um, so, you know, like I don't have anybody to report to of what, you know, can I, can I say this or can I, you know, proceed in this direction? I just do what's right for the patient. That's ethically, still sound. And that is in their interest.

Yeah. 

Mike Koelzer, Host: And there, and there's some companies that have pulled that off, or I haven't checked lately, but like consumer reports, you know, they, when you think of them, they always, that's their first thing. Like we're, unbiased, we're private. We don't take any of this and that kind of thing. So if a company does that, right, it doesn't necessarily [00:35:00] have to be small to do that.

Right. It can get bigger as long as their let's say privacy is the main thing, as long as they put that forefront in their ideals and in their marketing or communication, you know, they can probably still maintain that, I suppose. Yeah. 

Claudia Cometa, PharmD: Yeah. And I, you know, I think that absolutely it could, you know, and there's not always a downside to something getting bigger, you know, if we had, if we had some, a lot of, you know, when I first started this and I started looking at the websites of a, of a bunch of patient advocates, just to kind of get an idea of what everybody was doing and where everybody was from and what was going on.

A good 60 ish percentage at that time of the websites I clicked on were no longer in existence. So there is, there is this side of, okay. You know, um, we're so small, we're still so much in our infancy that a lot of us can't survive if we don't have another source of income in our household. Um, you know, so, so we wanna stay small, but we also realize that the financial stability of, of this, you know, it's fester famine, like any other business that you start, you know, like there might, there are months when, when I've got a, a handful of, you know, good amount of clients and there's months when maybe it's a slow month and I don't have any clients.

And so, um, you know, can that person survive? Do we need a bigger system to support that? And I, you know, we'll see how it plays out, but, but it is difficult to, to have this, you know, be your only source of income. I see a lot of patient advocates who are, who would, would change the life of so many people, but they cannot financially survive if this is their only source of income.

So it's, you know, it's tough, and that's, uh, true of, you know, any, any industry, you know, it's hard starting out. 

Mike Koelzer, Host: So. I've typically liked to get heating and air conditioner guys or lawn sprinkler guys or something who are not with these bigger companies that in my paranoia I think that they're always out to screw me, you know?

And then a year later they're not there anymore because he's got a bad back or something came up with his family or something like that. So that's, that's when you start wanting a little bit bigger structure of a business and maybe marketing and you know, someone for the book works and all that kind of stuff, then you start wanting that bigger company again.

So it's hard for an individual to do that on their own. Certainly mm-hmm what kind of stuff do you do? You might not tell the patient 

Claudia Cometa, PharmD: Well, interesting that you ask that because there's not a whole lot. Honestly, there's not a whole lot that I am afraid to tell them. I think it's actually really important that they know that on my intake form and their, their sort of, you know, onboarding form is listing all of their physicians.

And that is actually a routine practice that I'd check on the licensure of their physicians, you know, that's public information. And so it's not like it's difficult to find, but they wouldn't know to look that up. And so I look to see if there's any disciplinary actions on that, um, on that person's license.

And, um, I would say there hasn't been any that I have found that has been an existing relationship with a physician, but there have been patients who have said, Hey, I'm considering this XY, this stem cell treatment. And this is the doctor who is saying that. And then when I researched that position, who they were looking to potentially establish with, I'm like, uh, I don't know about this.

Let's, you know, this is what I found. So I have no problem telling them that there's not a whole lot that, I mean, I'm a pretty open book. I think it's important for them to know exactly what's going on because, um, They've already gone through a system that largely is not as transparent as it should be.

And, they're not hiring me to be another person that they've already seen. They're not hiring me to be a clone of what's already happened. They're hiring me because nothing's gone. Right. And they don't know what else to do. And so I really respect that and I respect that they can handle the fact that I need to tell them what's going on.

Um, now, you know, there's times when I'm, I'm listening for, um, they may think that, you know, Oftentimes the assumption is that this doctor, um, you know, isn't treating me right, or this doctor, um, doesn't care about what happens to me. There's a, there's a lot because the system is so broken. Um, the assumption immediately is the provider does not care about me.

And I tried to explain to them that, you know, here's the situation I get that, that's how it feels. I really do understand that cuz I was there. Um, but these, you know, on, in large part, these physicians don't go into medicine because there's some amazing pot at the end of the rainbow and they could care less about caring for people.

I mean, of course there's always gonna be bad apples anywhere, but. You know. And so when I, once I start getting involved and I start talking to those physicians and providers, I realize often that there's just been a disconnect. There's been, you know what, the way that somebody may have approached saying something might have seemed to the patient or the patient's family member that, you know, we just don't care.

And we have no options when really I'll get a completely different story just in my approach and the way that I'm able to interact with that provider. And so a lot of times come well, I mean, all the time, communication ends up being a factor, whether it's the primary factor or one of the factors, but at no point, I can't honestly think of any time when I have discovered something [00:40:00] or I.

I am fully transparent. If I find out that your physician has a disciplinary action, you need to know that you need to, because it's gonna be hard for me to make the case to you that a different medical team might be in your better interest. If you don't know that that's, what's ha that that's what went into my assessment.

So there's, there's few, there's not many times, um, you know, what I would say more often than not happens is when I'm listening to what they're telling me, and I actually start digging in, I start to see the disconnects and I, and I, and I tread lightly on that. You know, I don't wanna say, well, no, you have this wrong because you misunderstood.

Um, but rather, you know, let me, let me get involved in this and start to, to clean up this, this, um, communication journey and see if we can get a more, a little bit more clarity on what they're trying to say, what you are trying to say and why that isn't coming together. Um, but, but no, there, there are, I can't think of any times when I have discovered something that I haven't actually shared with them.

You're not 

Mike Koelzer, Host: coming in, probably when they. Claudia come on in. Hey, let me introduce you to all my favorite nurses and my doctors here. And this is, I mean, you're coming in because things. Gone wrong 

Claudia Cometa, PharmD: crisis mode. 

Mike Koelzer, Host: always right. Or practically, always, nobody says mom's got her, you know, stage one cancer. This is gonna get bad.

So let's line up Claudia and the doctor. I mean, you're coming in last right during the crisis. 

Claudia Cometa, PharmD: Yes. And that is what I hope to shift a little bit. I, it would be great if people had the awareness to say, oh, you know, I've just got this scary diagnosis. I anticipate a difficult journey. Let me have somebody alongside holding my hand.

Um, that does not, not what happens. And that's not the fault of the patient. It's just, people don't know that this even exists. What typically happens is they get to a point where nothing is going right. Who do I go to next? And then they're, then Google starts to like, okay, maybe they put in, you know, I need help on my medical.

I don't know what they put it, you know, but then, then some things pop up and maybe they start to learn that, oh, a patient advocate is a thing and then they start searching for a patient advocate. So it becomes a search in the midst of a crisis. And, um, it would be really amazing if we could move that pendulum a little bit earlier on in the process.

But, um, we're not quite there yet. And, and the majority of cases, but yeah, so I'm usually, I'm usually jumping in the fire. I mean, I'm usually like if you call me, there's usually a fire that needs to be put out. 

Mike Koelzer, Host: If you had to put out a marketing piece, let's say that someone says, Claudia, you cannot do a crisis.

You only have to do pre-crisis. What kind of marketing would you do? And what kind of things would you say? We're not gonna call it. Pre-crisis we're gonna call it. Everything's great. So let's get a patient advocate. What kind of things would you say about that in terms of the value that you would provide way early.

Claudia Cometa, PharmD: Yeah. You know, the way that I typically put it is we have learned many things throughout our life, you know, just based on society, what we're taught. We are taught to prepare for a lot of things. We're taught to prepare for interviews. We're taught to prepare for, you know, a lot of things, um, in life. And we don't think about preparing for potential health issues.

We hope for the best. And we, we all hope for the best. Yeah. Um, and we try to do the best to, to hopefully nourish our bodies. But the reality is there is a good. Potential that we will experience some type of a health crisis in our lifetime or a family member will and, or a family member will. And what are we doing to plan for that?

You know, so we go into our financial advisor's office and we say, help me prepare for retirement. Am I prepared for retirement? You know, and they go through all their numbers and they figure out if you're prepared for retirement, if, if you're, if you stay on the path that you're on. And so we are projecting already into our, you know, if we're in our thirties or forties, we're already projecting into our retirement years in our sixties and seventies about our money situation and at no point outside of purchasing life insurance.

And maybe if you're lucky enough to know about long-term care insurance outside of those two you're, there's not a whole lot of preparation you're preparing like, okay, if I die, I'll leave a lump sum of my, my, my money to my family. If I need a, he, you know, a healthcare facility to help me or an at home, you know, I'll purchase some long term care insurance, but that's it that that's literally it.

So, um, what about the rest of it? You know, what about. Your navigation through the system. When you have nobody in your family who is medically trained, you know, what about the fact that you don't, you know, you, you don't know how to navigate this system and you don't know if you're getting the best care and you don't know the questions to ask, um, great that you're ensuring yourself, but what are you doing to prepare beyond ensuring yourself?

And so there have been a very small amount of times when I've had people call, which is fantastic. Hey, I just wanna know what you do, cuz I would really love to know that I could depend on you if something happened and I'm like, that's amazing, you know, that's, cool's amazing. Yeah. What about 

Mike Koelzer, Host: the section then between, alright, we just got mom back from the doctor and we just found out today our wonderful doctor came up and, and [00:45:00] sat us down and told us this devastating news.

There's no problem though. What about that area there? And this is more of a, from a marketing, you know, business standpoint, we talked about like this. The future. What about like the present, but everything's going well, but we have a diagnosis. I imagine there's steps there that you would be able to help with too.

Like you say, finding a doctor and doing this kind of stuff, right? 

Claudia Cometa, PharmD: Yeah. You know? Yeah. What I like to say is pre-crisis yeah. Pre-crisis I use the acronym plan, you know, like what, what is your, what is your provider? Who, who is your medical team? And maybe, maybe you're so early on in the process that you like only to have your primary care doctor and you don't need anything else right.

This minute. But if you, who is your provider list right now, and what prospects do you have? Are you living in some rural town where you have no access to an endocrinologist or a cardiologist? And, and if so, what's, what's the closest way. Is it two hours away? You know, how far is this person, if you needed to see a specialist and were you able to get to that person?

And, and, you know, it's good to know that before you need to know that, um, I have had clients come from very rural towns that have had to seek. Hospital systems well outside of their area, because the care was so poor. And then subsequent to that, they made informed decisions to move because this no longer serves me.

This it's great to live out in the country, but, um, it may not help you when you need a, a medical, a good medical team, because the reality is, is, you know, most, most medical professionals who are like at the height of their career are not going to work in a rural town. Now, there are always going to be exceptions to that rule, but at the height of their career, they're going to work in academic centers.

Um, maybe as they start to retire and they're slowing down, they move out, you know, to the country and, and, but at the height of their career. And, you know, maybe, and maybe, you know, maybe that's not important to you, but I would argue that if you need good medical care. You know, you're gonna get better medical care by going to providers who are at the higher end of their medical career, but in any case, um, so you know, P is sort of the provider.

What's your provider pool right now? Who is your provider right now? Do you feel good about that provider? Is it a good solid foundation for you? And do you have access to specialists? If you need them? Maybe you never need them. Awesome. But. Let's think through that first and then L and a are like your liabilities and assets just as you would talk to a financial advisor, you know, what are your, what are your medical liabilities and what are your medical assets?

You know, what, how, how is your situation right now? Do you have the insurance in place? Do you have a polypharmacy concern right now that you didn't know is a concern? You know, what are some of your liabilities and what are some of your assets, you know, do you have, um, relatively great positive family history?

And do you have access to all that you need? You know, and to just kind of pair that out and then N is just your needs, you know, what would be your needs? Do you. You know, I have a pretty strong cardiac family history. You don't have that right now. And you don't have anywhere to go to get a cardiologist, you know, what might be your needs.

And so that, that can be talked about well in advance of any problem. so, um, yeah, I mean, the, it does not have to be when waiting until crisis 

Mike Koelzer, Host: mode, we've got this hotel in town where they made this really fancy sign. It was called, uh, oh, let's just say it was called, you know, weeks in or something like that.

Really fancy sign. I'm like I said to my wife, I'm like, what the hell does that say? It's purple and black. It can even make it out. You know, what does that say? About a week later I drive by and this thing is in. Dark black letters on white. And it says weeks in, and it's just like the gaudiest simple sign.

And I'm picturing this fight at the hotel between management. And one of 'em says, what the hell did you do with that sign? I can't even read it. And the guy said, I'll show you a sign, you know? So he comes out with this just, you know, Goddy sign, but I know everybody's professional, but in my mind I'm always thinking what if I piss someone off?

Yeah. They're gonna be professional still, but what if it gets worse instead of better, you know, that kind of thing. So that's why the communication things are huge for me with that said, though, I imagine you're also helping with insurance. Problems and insurance fights and prior authorizations for stuff and getting in that mess too, or not.

Claudia Cometa, PharmD: You know, I did a lot of that as a pharmacist and I have no problem, um, fighting with insurance. If the client is coming to me with a sole need of insurance fighting, I typically will find somebody else who 's their thing. Um, I'm good. Good for you. I just don't. I, yeah. I mean, this is the thing when you own a business, you know, like that's not, um, that's not where I look to primarily help.

And I don't think my knowledge and skill set fits that perfectly. Now I have fought with many, an insurance company. I have no problem doing that. That's not my thing. So if that pops up in the middle of a, of a medical crisis, I will help, but that will not be my primary focus. 

Mike Koelzer, Host: Can you like to piece that out to somebody if that popped up as a huge thing during this association with somebody?

Claudia Cometa, PharmD: Yeah. So there are plenty of, you know, I was mentioning that directly in the beginning, there are plenty of other patient advocates who like to focus [00:50:00] on billing and insurance and more power to them because that's not something I love. But if that comes 

Mike Koelzer, Host: up Claudia, in your association with someone, can you still be like the gatekeeper?

Do you have anybody that can help you while you're helping a family? You know what I mean? Like yeah. Do you ever get some of those people kind of like underneath you or you like to sub it out to them and then bring it back in? 

Claudia Cometa, PharmD: Yeah, I would sub that out now, you know, there is a business model in which, um, a person could, it's kind of like a general contractor, right?

Like everyone, you pay me and I pay them. And, um, I just, I haven't chosen to do it that way as a general contractor approach. There's nothing wrong with that. Um, I think people do that and it works just fantastic. I would rather that person have a direct relationship with that's just the way I approach.

Doesn't mean it's right or wrong. Um, but there are people who do the other model, which is, you know, I'm the, I'm the overarching, um, you know, general contractor and I will connect you to that person, but ultimately you still pay me. I will pay that person. 

Mike Koelzer, Host: You also have it where you could still remain the patient advocate and they could actually hire out almost like another billing person yeah.

To help. So they could almost have like two of you or three of you, right? 

Claudia Cometa, PharmD: Yeah. They certainly could. Um, I haven't really come into a situation where that's been necessary. Gotcha. Because if they come to me right out of the gate with, I have this billing issue, I already know that I'm not the person, normally they're coming to me and it's like, okay.

I, you know, I always do an initial consultation, kind of a discovery call. That's free. So I'll know right out of the gate, like I'm, you know, a great choice, but I also I'll let you know that there's a lot of people that you could choose from. Here's what I, here's how I would approach this scenario.

Perfect. If down the road, some insurance glitch comes up and I can manage it. Awesome. I will still do that, but if it's, if it's huge, like, you know, now we're uncovering hundreds of thousands of dollars of medical care, you know, then that's not gonna be me. Most 

Mike Koelzer, Host: of the times you're coming in as a medical issue and the odds of a huge insurance thing popping up out of the blue pretty low after already, this are probably low.

Yeah. You probably know a lot of that already. Yeah. 

Claudia Cometa, PharmD: So, um, yeah, so it, you know, I usually know right out of the gate, if, if it's somebody that I should connect with another advocate who is more focused on billing issues, um, which is why that discovery call is so important, because sometimes, sometimes, you know, they're calling me and it's like, I, I just need transportation to my doctor's office, you know?

And I'm like, I can absolutely find you that that's not me, but I can, I can find you that. So yeah. What about that 

Mike Koelzer, Host: chunk that time period then when things are starting to wrap up, let's say, unfortunately, someone has died. Do they ramp? Do they ramp down because of hospice and stuff. And when do you finally end your asso?

Um, I imagine you never end the association, but when do you start to the curve starts to flatten out for 

Claudia Cometa, PharmD: you? Yeah, that's a good question. Um, I'm gonna, um, knock on lots of pieces of wood that none of my clients have died. Um, but that doesn't mean that, you know, I've necessarily, um, been the sole person saving their life.

It just means that maybe I've guided them to the care that they needed, but I have had plenty of time. The goal, honestly, is for them to be able to reclaim their own voice and start to manage this at some point. So that's my, I mean, I kind of look at it as a coach, right. I mean, if I'm gonna get a business coach, I shouldn't 10 years from now still be talking to that same business coach.

Like at some point I should have been able to, to take the reins. Right. And so the goal is okay at the beginning. We're gonna, I'm gonna hold your hand as much as, as much as you need. And as much as you want me to, and then I'm gonna slowly start to sort of retrain your mindset of, okay, I can ask, oh, I can ask questions and, oh, I, I could look for another doctor.

And so we're just chipping away at some of these things that we have learned and we need to unlearn. And then eventually we're to the point where maybe we are in a better state of health and we're just kind of smooth sailing, um, to the point where they think they can, man, they feel good managing it, but they know they can also call me at any time.

So if some, if they're a huge bump along the road, they know they can still call me. Um, and you know, and I can kind of walk them through it, either walk them through how to handle it, or I can get back into the handholding mode if necessary. But the goal is not to have me. You know, I should not be micromanaging this forever.

Um, gotcha. Not because I wouldn't be happy to do that. I would love to help people, but I, but I think he, the best way I can help people is to help them to start to know how to advocate for themselves. 

Mike Koelzer, Host: Do people ever come to you with different goals? Like one person might say, my goal is to get the best care and things like that.

Do you ever have a thing where I don't know. I can't even think of an example. Someone said I've been a real jerk to this medical team and I wanna let them know that this was just stress. And I understand what they're doing now. And I wanna repair this. I can't even think of the question. Is there ever a goal besides the goal of that? At first, I was gonna ask because you don't take them till they're ending their death.

You know, I thought some people might say, look, I want the goal to be no more friction. And I just wanna die in peace. You've already explained your goal is not to do that but to lift them up. Are there ever any different goals 

Claudia Cometa, PharmD: in that? I haven't had anybody come to me with that sort of palliative care goal, but that's, um, that may be because what they're [00:55:00] looking for at that point is more of a death doula, which is a fantastic, amazing service.

Um, they may not come to a patient advocate for that reason. They may come to somebody who is more in tune to, um, the needs and services surrounding the dying process. But in, so what I typically do is in my intake and onboarding process is I ask people to tell me there are three goals. And I think what, what often happens as, as happens with us, I think in a lot of facets of life is, oh, well, nobody's asked me that before, you know, so I think they take a little bit of time to really think through, oh, well, what do I really want?

What do I really want? You know, out of this, out of this venture with a relationship with Claudia and. um, they actually do end up getting relatively specific, you know, maybe it's, um, I want to, you know, make sure that I have a, a good medical team here, but that I'm also seeking out as many options as I possibly can that are maybe outside of my area that I didn't know about, you know, maybe it's this very rare condition.

And I feel okay with what I got now, but I feel like there may be something out there that I don't know about. And so they start to get more specific and that's really helpful to me because I might come in and I might have some goals based on what I think could, you know, be helpful. But if that's not their goal, that's not serving them, that's not serving them.

The medical system is kind of built around the medical system, knowing what goals should be, you know, that's what it's built around. And that's part of the reason why it doesn't serve as well as it could, because, you know, um, Oftentimes, we do things out of, um, you know, abCYA, you know, AGA you know, we're we're and that's unfortunate.

It's the reality though. There's, there's, you know, all kinds of reasons why litigation is so high in the medical profession. So a lot of the decision making that we make can be out of. Um, okay, well, um, you know, here's what I would wanna do from a humanitarian standpoint, but okay. But then if I do that, then would I get sued later because I didn't do this, which is standard of care.

And then how would that hold up in court? And so, you know, all of these things were like, I just wanna know what your, what is, what is your goal? You know, what is, what do you want out of this? And, um, and once they're given this space, like somebody actually asked me that, you know, I think back to when my dad was sick and the only person who ever actually asked him, how are you dealing with this was a, was a registered dietician that I got to talk to him at one point who wasn't even really part of his medical team.

It was just like an ancillary appointment that I made for him. And I'm like, you know what? Nobody's actually asked him, how are you doing? You know, they'll ask. You know, how are you doing with the side effects or how, you know, but how are you doing as a person that's going through chemo? You know? So, um, that's kind of how I feel is giving them the space to say, what do you really want?

You know, and you're allowed to have a say in that 

Mike Koelzer, Host: I'm in grand rapids, but rural from here, let's say 20 miles. I have some friends who are physicians and they say some of those people, 20 miles from here, don't live not in the city for a reason. Some of them want a different life of not being as whatever, uh, for better, for worse, not being as open with their healthcare, privacy and not wanting this and not wanting that, yes, there can be totally different angles of someone saying, look, Claudia, here's this crisis.

And I'm trying to get to Mayo, you know, to do all this kind of stuff or whatever, whatever, you know, clinics. And so on that you mentioned, and someone else says, no, I want the best that can be done in this little hospital, you know, or something like that. Yeah. You know, they have different goals.

That was interesting when you mentioned mm-hmm 

Claudia Cometa, PharmD: academic institutions. Yeah. Academic hospitals, 

Mike Koelzer, Host: and at the top of their career, doctors want to be there. Why, why is that 

Claudia Cometa, PharmD: medical school and, and residency is insanely rigorous. I don't think that that's in question, but you, you kind of like, can't appreciate that unless you've actually seen somebody go through it.

It's very rigorous. And so, um, when you get, when you're done, you don't necessarily, well, let's just take anesthesia for example, because that's, that's in my world. Um, you could go to a very rural place where you are doing anesthesia for colonoscopies all day, and there's nothing wrong with that.

That's needed but you aren't going to come from your rigorous training. And as you exit your, you know, as you exit your training and you're kind of like, you know, getting to the peak of your career, you aren't going for bread and butter cases that, um, are super slow and, and don't challenge you. You need to be challenged because if you start going that route, That's your route.

Like you can't go back, you can't go back to rigorous because your next employer is gonna say, well, you've been doing bread and butter cases in a rural town. You're not gonna go now, do you know about a heart transplant? So, so, you know, you've got this sort of journey that, um, a lot of providers, and of course there's always gonna be exceptions, but you've got this journey that a lot of providers, you know, physicians will take.

It's like, okay, well, I just got out I'm at the, you know, I, I know the most I'm ever gonna know. I took my board, you know, I'm I'm book. I was book smart as I can be, and I wanna go out and, um, and be challenged in the cases that I do. And then you go through this, you know, this part of life, that's sort of, you know, you peak of your career.

And then maybe, you know, maybe, I don't know, a couple decades down the road. You're like, I think I'm ready to start slowing down. [01:00:00] And, um, you know, maybe I wanna move out to the rural areas and it's not that those doctors are bad. They're not bad. They're still great doctors, but they're, you know, they're, they're on the tail end of their career.

They're slowing down, they're retiring. Um, you've got this crisis. You wanna be with somebody who is like, I like, I'm just packed with knowledge and experience. Let me approach this. That's, you know, that's how, how I would want 

Mike Koelzer, Host: That's interesting. . And when you say academia, is that always because they're studying and they're on the newest edge, would there ever be another hospital that's not associated with academia, but is still very progressive like that, or is it usually always associated with schools slash training slash academia institutes?

Claudia Cometa, PharmD: Yeah, so they aren't always necessarily like public institutions, like the university of Florida is, but, um, most of the time you're dealing with an institution that has some role in training the next generation, if, as long as that, oh, that institution has some kind of an, uh, you know, residency rotation, or, you know, they don't necessarily have to have a medical school, but as if they're.

Taking any role in training the next generation, they have to be at the top of their game because they have to teach all of the new things. All of them, you know, they're, they're constantly having to be at the top of their game and if they don't have to be at the top of their game, then they don't and that's okay too.

That's a, a, a decision that you make as a, as a professional of like, okay, well, you know, I'm kind of getting tired of that. Let me start to slow down by going here, but who do you want? You know, that's the question you have to ask yourself is if I've got this diagnosis, that's scaring me. I would lo I mean, I personally would rather have somebody who is at the top of their game, who is teaching the next generation, who is required to stay on top of this and, and who has robust research, right?

Like they're, they're, those institutions are doing the research. They are the ones coming out with the journal articles that the other doctors are reading. I would like to know who those people are. And I, you know, who's doing the research on my condition, you know, who's at the top of, of that world and where can I go?

And that's typically gonna be an academic institution. And if it's not, it's a private institution, that's got some kind of a role in training. The next generation did 

Mike Koelzer, Host: I use the wrong name? When I said hospice, is there a better name for 

Claudia Cometa, PharmD: that? Hospice is the service that is provided to people who have a terminal diagnosis and typically are, you know, X amount of months to the end of their life, you know, four to six months.

Um, and. Now there's also palliative care, which can go on for many years. Um, so that is still not fully understood. A lot of people pair those two together and they're not the same palliative care is assisting that person who maybe has kind of a, you know, a pretty serious diagnosis, but is not nearing the end of their life and may be able to utilize the palliative care service for many years.

Um, hospice is, is basically, you know, you're, when you, when you're told you're going to hospice, you're, you're, you're given a, a very terminal short term prognosis. Now what's that one that 

Mike Koelzer, Host: you mentioned 

though? 

Claudia Cometa, PharmD: Claudia death doula. So, yeah, so, um, you know, we kind of know of doulas it's D U L a, we know of doulas in the space of like midwifery and that kind of thing.

Um, but there is a great service that is taking on more heightened awareness too called death doula, which is so fantastic. Cuz just as, just as a, a, you know, a birth doula or, you know, a midwife would walk you through the birthing process, a death doula is walking you through. The death process. So if you know, a loved one is in the process of dying, there's a lot, we don't know there's a lot.

We don't know about a lot of things until we go through them. So, um, you know, what, what is this process gonna look like? You know, and who, you know, yes, I have hospice and I can call them and that's great, but there's so many other things that go along with death, you know, like what do I need to know about, um, you know, the financial part, what do I need to know about the actual death itself and who do I call, you know, who, how do I arrange for the service and the, you know, do I do cremation?

What are the pros and cons of that? And, you know, just so many, there's so many 

Mike Koelzer, Host: things kind of what you're doing, but just shifted, shifted after the crisis. And now you're looking at that side of it, right. Claudia, from a business standpoint, which it's always hard to talk about when you're just got done talking about death, but being our business of pharmacy podcasts from a business standpoint, what struggles do you have?

In the business where you say, cuz I know your, your sister was able to help the web. And we talked about maybe not having the support and having one person wearing all the hats and so on. But what are your biggest struggles now that you have to become a business person along with your 

Claudia Cometa, PharmD: skills? The flow of clientele is always, is always a struggle, I think for a lot of business owners, but this it's no different in patient advocacy and it, and I think even maybe heightened because, you know, if I were to start a, if I were to start a lawn care business, you know, especially in Florida, Like pretty much a hundred percent of this area is gonna have some type of a lawn care service.

So, you know, if I, if I differentiate myself a little bit, I'll I'll, I mean, I'll probably [01:05:00] have a decent client flow. I mean, cuz you've got like a hundred percent of people need lawn care, right. In the patient advocacy space, this is a luxury service that is not per, that is not covered by insurance. So, you know, you've got you, you're starting to par down, right.

You're starting to filter. Okay. It's the people who know to look for a patient advocate who know what a patient advocate is. And then it's the people who can afford patient advocate services because it's gonna be private pay. So you've got this like filter that starts to filter down a much smaller pool of people.

And so keeping that flow is, um, you know, it's a struggle for all of us in this space and. We are all very aware of that. A lot of, a lot of it is awareness, um, just that we even exist and that, and what the types of things are that we do and how we can help people. And then it's also the shift that I already mentioned, which is okay, I'll CA I'll call her, but I'll call her when I'm in crisis mode.

Um, you know, and then that's another filter, right. So it's great that I know that she's there. Okay. I have the financial means to, to hire her. But I'm, I don't need her until I, I have no other options. Um, and so you filtered all the way down to a very small percentage of people and we can help much further, you know, earlier in the process.

So it's just, you know, it's a lot of just this, you know, having conversations and people, knowing that there are people who can help you and you don't have to be in crisis mode. And honestly, it's much better if you call us before you're in crisis mode. So it's, you know, that's, that's a big, that's a big challenge.

Um, you know, and a lot of us, like I mentioned, the people that are going into this business, we aren't coming from an MBA type of a background. We aren't coming from, you know, corporate anything, um, maybe corporate pharmacy, but we're not, we don't come from a world of business. So we don't, we know what we know how to work in our business.

We don't know how to work on our business. Nobody has taught us that. And, um, we don't come into this. An excessive amount of money to be able to hire coaches. And even if we did hire coaches, we aren't, we aren't able to hire the, you know, the patient advocate guru because there isn't one, you know, we, we can hire somebody with general business knowledge, which is fantastic.

Um, but most of them don't know a whole lot about the healthcare space. And so there's, you know, there's a lot of barriers there, so yeah, those are some of the challenges. And are you 

Mike Koelzer, Host: always local, in other words, I imagine you have to have these face to face conversations while let's say without COVID you have to have these face to face conversations.

Is that right? Or am I missing anything that you are able to help somebody from, you know, calling you from Washington state while you're down in Florida? 

Claudia Cometa, PharmD: Yeah, I definitely help people outside of the area. Um, when I first started, it was kind of like, okay, this is well, well, pre COVID. So, um, you know, I, I wanted to have feed on the ground, but I, I slowly began to realize that, you know, people would call me from out of the area and sometimes, you know, all they really wanted was like an hour or two hour consultation with the family of here's the scenario.

I don't know how to approach this. How do I start to communicate effectively? And I can absolutely talk you through that. I also, um, have an electronic medical record system that allows for telehealth. So I often will meet and honestly, through COVID I, even if they were local, I would meet them through telehealth.

And so, you know, we can talk through, they can upload their labs, they can upload their documents, I can see it in their chart. And so, um, it's very much. I mean, I, and I can if necessary, I, and I have done this before. I can even be at the appointment on speakerphone. So you can literally bring me with your, with your phone, put me on speakerphone.

Obviously letting the physician know there are different rules in different states for recording without their knowledge. So I always just default to let them know I'm here. You know, like we're not, we're not doing anything that is like some secret thing. 

Mike Koelzer, Host: Um, you're not trying to spy on them or, or turn 'em into the boards or 

Claudia Cometa, PharmD: something like that.

Right. And you know what, I also do recommend to patients who don't necessarily want to pay for me to be in the room, um, to record it, if their physician is okay with that, you know, like don't do it without letting it, letting them know, but it it's helpful to have a recording, not so you can put it on TikTok and whatever, but so that you can just have it later to say, oh my gosh, I missed like half of that conversation.

You know, I don't even, I was so like he said, the words X, Y, Z, and it was. Won the wall after that. Well, now I can re-listen to it, you know, um, note taking is very helpful too, but, um, but a lot can be done remotely. Are the doctors open to recording usually or not? Um, I, what I, what I tell my patients is, um, if it is hard, no, without a very clear reason why, like this FAC you know, my facility has a hard stop against it.

You know, if it's just a hard, no, like, no, you can't record me cuz you know, then I that's, to me, that's a red flag. Um, because what are you saying that, that, what, what, why are you worried about what you're saying? You know, if I'm telling you like, I wouldn't, you like me to be able to review what you said, isn't a lot of the frustration on the physician side that, oh my, okay.

Now we're gonna, let me say the same thing again next time. Cause you didn't hear me the first time, you know, wouldn't it be really great if they could just hear it again. Um, so unless there's a really good reason, like the facility does not allow for that. Um, why is it a no. So I, you know, I say, you know, if it's a, no, you have to respect that, but start to that's a red flag.

Mike Koelzer, Host: Just because it's a facility overarching rule. Well, [01:10:00] that's a red flag if the whole facility is like that, and it might even be a red flag. If the doctor's saying it, it's like almost everything could be a red flag with that. 

Claudia Cometa, PharmD: Yes. Yeah. And I get that, you know, uh, you know, some facilities have just been sued more than others and, um, and it's not always, litigation is not always justified.

Um, so there can be lots of times when there are multiple lawsuits and it's just, you know, there was an angry patient who didn't get their way. And so I get that and because of sometimes the heavy litigation decisions are made like that overarching decisions, I would say the majority of cases, my patients have not run into that.

Um, occasionally they'll run into a hard stop. No, and I'll just say, okay, we're gonna take that as a red flag. Um, you know, if. This doesn't feel right to me. So, you know, ultimately I always tell them, this is your decision. I never tell a patient to fire a doctor. I just, I suggest that, okay, let's look at this as a red flag.

You're, you know, ultimately it's your decision to move on or not, but I'm just letting you know that there should not be a concern for you to be able to take this home, cuz it, you know, ultimately this is instructions to you that it, you know, even, even if you, even if you put this live on Facebook, you know, even, even if you did what with it, what they don't want you to do, what are they saying that they're worried about?

You know, this is not a HIPAA breach when you have shared it. So, um, you know, what, what is it that they're concerned about? 

Mike Koelzer, Host: You probably don't give the patient all that, right though. You don't say if it's, no, it means this, you, you just say, ask and then they come back and tell you, and then you get to think about it and so on.

Yeah. 

Claudia Cometa, PharmD: Yeah. Because each situation's different, you know, with, with anything else it's like, it might 

Mike Koelzer, Host: Just be, no, I'm not comfortable. I'm an old guy. I don't want it be 

Claudia Cometa, PharmD: recorded. And how they say it also, you know how they say it also, if it's coming from an immediate defense, it's like, all right, the defense approach is, is all right, that doesn't, you know, how did they say it?

What was the scenario? What was the context? You know? And let's make a decision based on 

Mike Koelzer, Host: that. It almost makes you think I could offer that to some patients. Like if I'm talking to them in the pharmacy for two minutes, I could say, Hey, I could record. You know, if you want me, if you ever want me to record now, I'll email it to you.

Something like that. Yeah. So Claudia, in your wildest dreams, you know, starting this up, do you always like this one on one? Or do you say I wanna be this where I've got all of these people doing this for me and you're up here. Do you ever have, not that you should, by any means, cuz most people in your position might say, no, I want to be one on one with someone.

And if I grow this, that's not gonna happen. Where do you fall in that? Are you always like one on one writing this out or do you picture having 20 Claudias working for you and you're doing this or 

Claudia Cometa, PharmD: that? Um, what I picture long term, which I'm also a very, I, I'm working really hard on my spiritual journey to surrender the need to make any of this happen because this, I, I didn't come into pharmacy school to do this.

So the fact that this is how it's, I'm very open to the way that I am. Um, the way that life's flow takes me. But, um, I do envision and, you know, as soon as I started this, I had pharmacists coming to me. Okay. So when are you hiring? And I'm like, I am not to that point yet. Um, so there's definitely not a shortage of pharmacists who would like a shift, but, um, I would, I would love to have an organization that has pharmacists and I would love to make it pharmacists only.

Um, just because I, I, I love the profession and I know that so many of us have a love for, for doing passionate work. Um, and so I would love to have pharmacists under me who take their own clients at no point. Do I wanna get to the point where it's a phone tree and today you have me and tomorrow you have, you know, Mary, and the next day you have Alicia and, um, you will still have your individual advocate.

But if, and when I get to the point where I cannot take on the patient load, I would love to say, okay, I have other advocates, but that you, you are paneled to that person. That is your person. Um, and because I don't, at no point, do I want this to look like a broken system, the whole point of it is to have that approach, that, that, okay, I'm sick of that.

I want something different and I don't, I don't want you to have to, um, you know, have a scenario where you feel like you're in the same position. So, that's what I envision, um, I also envision being fully happy doing it individually. Um, I, I would like to, to speak to larger groups to start to get the word out of how to start to advocate for yourself.

You know, even if you don't hire somebody, I think that there's a lot of messaging here that can get to people that, um, even if they don't hire a patient advocate. So I would love there to be a shift. And, you know, I have big lofty dreams, but I also have I also am okay. Uh, being just me, 

Mike Koelzer, Host: bam, this goes, and let's say you have X hours a week to work on this, or you wanna work on this?

Let's say it's 20 or 40 or 80, whatever it is, what percent would you like to still be? I'm Claudia, I'm working one on one with these people. Cause I like talking to the doctors and doing this and doing this versus I'm Claudia. And I'm working on the marketing and doing this for the people that are working in your.

Operation. What percent would you do both of those? Would you say I want it 50, 50 or no, I've always dreamed of doing this big administration thing. I want it, [01:15:00] 90 10. What percent would you be an individual versus working in a bigger company? 

Claudia Cometa, PharmD: I, um, really don't have any desire to do a lot of that work. If I got to that point, I would love to farm that out to somebody who's, who's better at doing that.

Um, you know, that doesn't involve direct patient care. I mean, I'll, you know, I do a little marketing here, there, but that's not my forte and it's not something that I'm, I would say that is my strength. And so, um, I would love to get to the point of farming some of that out. Um, I also would love to get to the point where I maybe 50% direct patient care and 50% making, making bigger waves on a bigger scale, you know, like a actually being proactive, like, okay, I would love to be a consultant, you know, to, to a physician's office to like start to pinpoint, you know, making big, because I see that I'm making.

Great strides in these individual people's lives, which is fantastic. But I also know that there are potentials to make much bigger impacts on other parts of the system. 

Mike Koelzer, Host: We wanna stay away from that administration 

Claudia Cometa, PharmD: stuff. I definitely do. Yes. We don't like that. I don't, and I don't want to dislike my business.

I mean, I get that. There's always, you know, there's always stuff we do that we like, I don't just, I don't enjoy doing taxes, you know, but I know I have to do them. I don't enjoy doing the bookkeeping, but I know I have to do them, but I would also love to send that to somebody who loves to do that. 

Mike Koelzer, Host: oh, that's true.

Yeah. You don't wanna just love that. You mentioned that it's a lot of nurses doing this. Do you ever see yourself talking business wise again? Do you ever see yourself being a consultant to others? Patient advocates that don't have the pharmacy know how, you know, you could teach all these, let's say it's 90% nurses doing this or something or non pharmacists.

Let's say you can teach 90% the right questions and the right things to look for. As a pharmacist doing that. 

Claudia Cometa, PharmD: Yeah. We, you know, we're all already kind of coming together in this space and identifying, you know, individual strengths and we almost like a, you know, almost like a co-op homeschool situation, you know?

Um, so yeah, and it's, and it's really great because, um, you know, I'm in a, in a smaller group where it's like, Hey, I have this situation. I haven't come across this. Um, you know, and there's always, you know, there's always those things, it's like random things come up, that patients need that we're like, oh, that's something new for me.

You know? And so, yeah, I think it's fantastic that we, I think it's actually a really great thing that we all come from different backgrounds and have different strengths because then we can really, um, help these patients and ways that we could not, could not do with only our skillset. So. 

Mike Koelzer, Host: Yeah, because someone could bounce something off of you and it might take you five minutes to answer and it might take them 50 hours to research it all and come up with the same five minute answer you have.

Yeah, absolutely. So Claudia, where do people listen to your 

Claudia Cometa, PharmD: podcast? So my podcast is called minding wellness. Um, you know, and, and a good branded person would have everything be the same name. And that's where, that's why this is not a skill of mine. That's boring. It's boring. So, um, minding wellness is my podcast name.

It's where all podcasts are found. It's also on my, um, website, but it's called minding wellness. The whole point of it is to how do we start being mindful of our wellness, like to bring it to the forefront and, and let, instead of making it like, oh, I'll think about it when, when you know, stuff hits the fan.

So the whole point of it is to start being proactive. So I've had guests talk about all kinds of things that I wasn't even aware of. Hypnotherapy that I would've normally said was quackery because of my conditioning and indoctrination into the medical system. Um, and so, um, you know, we've talked about the, I recently had somebody come on talking about the fashion industry and the, how the textile industry is contributing to a lot of the toxicity in our environment and on the clothes that we wear and stuff, you know, like we don't even think to, and these are things that I, I mean, I didn't think twice about the clothes that I wear.

I try to pick stuff that feels good against my skin, but I have, I'm not diving any deeper than that, into that industry. And so, so it's, it's all about just, just knowing a little bit more and the more we know the better choices that we can make for ourselves, it's not about becoming neurotic. I have no intention for anybody to listen and have now neurosis over all these topics, but it's like, oh, okay.

I didn't know that. I didn't know that hypnotherapy was an option. I didn't know about halo therapy. I didn't know. And, um, maybe it's something I wanna pursue. So. 

Mike Koelzer, Host: That's like my show Claudia, we can talk about anything as long as we don't talk about medicine. Yeah, we have enough to talk about that. Right.

You know, we wanna learn some things, so that's cool. Yeah. Well, Claudia, thank you so much for coming on. Yeah. And best wishes on things and what a nice Testament to your dad and the things that you're doing. So, uh, keep it up. 

Claudia Cometa, PharmD: Thank you, honor to be here. I think. Thank you so much for the invite.

All right, Claudia, we'll talk again. Thank you. All right. Thanks. Bye-bye.