Patients and their family has certain defined rights which hospitals and medical practitioners need to fulfill. Some of these rights are legally enforceable and a patient can approach consumer court or higher court, if those rights are infringed. Other rights are derived on ethical ground and can affect the image of healthcare provider and its relationship with patient community. Besides legalities, almost all healthcare accreditation programmes gives a lot of importance to protection of patients’ rights and not fulfilling the same may lead to denial of accreditation. While it is important for healthcare providers to fulfill the rights of patients, some of these rights are complex to understand because of the unique and complex scenarios that occurs in healthcare frequently.
This post attempts at simplifying those rights with respects to its scope and intent and guide the healthcare providers on what needs to be done to fulfill them. The rights discussed here have been referred from charter of patients’ rights by consumer guidance society of India, code of ethics regulation by MCI and NABH accreditation standards.
1. Right to be explained about his/her health problems and treatments
This is one very important right which also has high significance in legal matters. It requires that a patient is informed and explained about all such thing which will enable him/her to take an informed decision about his/her healthcare. This could be further divided in following
1.1. Patient shall be explained about his/her disease or health condition in detail. This means that patient is made aware of his/her diagnosis, whether provisional or final, with an explanation of the diagnosis in a simplified language that the patient can understand. This also includes informing patient about reason why a specific diagnostic test is being ordered for him/her.
1.2. Patient shall be explained about the proposed treatment for his/her condition, including the side-effects and expected benefit from it.
1.3. Patient shall also be explained about the alternatives to the proposed treatment (if any), including its risks and expected benefits
1.4. Patient shall be informed about the progress in his/her health condition and change, if any, in the proposed plan of care
How to fulfill this right?
· The most important part of fulfilling this right is to have a strong policy and procedure of obtaining a written consent from patients. The consent taking process should be specified to ensure that patient receives all required information.
· Importance of fulfilling this right must be emphasized and its legal implications must be explained to all doctors
Special situations pertaining to this right
· In situations where the patient is not competent to make decisions, such as patient is unconscious, mentally unstable or of minor age, this right should be fulfilled by informing the patients’ family member (next of the kin) or guardian or custodian (like jailer in case of prison inmate, custodian of the orphanage etc.) who would be taking decision on patient’s behalf.
· If the patient is not competent to make decision and is also not accompanied by a family or custodian (for eg. In case of unidentified patient brought in an unconscious stage and needs a surgery for which a consent is required), two doctors can jointly give consent in good faith of the patient. This consent also must be documented.
2. Right to be involved in decision making process about his/her own care
This right flows from the earlier right of being explained about illness and treatment. This requires that after explaining all relevant details about illness and treatment, patient’s views and preferences should be taken into consideration and treatment plan should be modified accordingly. For example, if a patient with knee joint problem who has been proposed knee replacement surgery, wants to avoid it for as long as possible, the treatment plan should be modified to provide relief from symptoms for as long as possible before actual knee replacement is carried out. This also gives following additional rights to the patients
· Right to take a second opinion (and even multiple opinions)
· Right to refuse treatment at any point of time
· Right to get discharged against medical advice (DAMA)
· This being a part of the earlier right, incorporating this requirement in the informed consent policy will be required to fulfil it.
· Besides this, informing patients that they have these right is also an effective way to honour this right
· A policy and process on handling DAMA should be there in place
3. Right to know his/her doctor’s credentials
If asked by the patient, it would be obligatory on part of the hospital or the doctor to provide the full credentials of the doctor who would be treating the patient. The details of doctors that could be asked include, qualifications, institute from where obtained, specialization, years of experience and any other professional details. However, the information that are irrelevant to doctor’s professional credibility or are private information about the doctor may be denied. For example, details of past patients treated by the doctor, HIV status of the doctor, his/her family or residential details are irrelevant and may be denied to the patient.
How to fulfill this right?
· Have a credentialing system through which updated credentials of each doctor empanelled with the hospital is maintained.
· A brief profile of all the doctor highlighting important credentials should be maintained on website, brochure or pamphlets which can be handed over to the patient who request for it
4. Right to know an estimate of the cost of the treatment
Cost of treatment is an important information for patient to decide whether or not they would like to get that treatment done. It is obligatory on the part of healthcare provider to provide as best estimate of the cost of proposed care, as possible and at right time. If there is any change of care plan which can affect the cost, patient should be again informed about the cost implications.
How to fulfill this right?
· Written estimate must be given to all patient at the time of admission. The hospital must fix responsibility to someone for working out estimate and communicating the same to patient. Hospital should also have a standardized pricing of services for all its patients.
· Have a standardized form in which estimate can be given with important details.
· Have a system in place to ensure that change of estimate is communicated to the patient on time
· Have a system in place to communicate daily or interim bill with the patient
· Evaluate the estimates being given by comparing the same with the final bill amount and make improvements in the process
5. Right to confidentiality of personal and health related details
All data and information collected from patient, whether personal or related to his/her healthcare should be kept confidential and used only for the purpose of providing healthcare. There could be numerous situations which could lead to breach in confidentiality. Such as, keeping medical records in open where any one can easily access it, displaying identity of the patient outside the room or by providing information about patient on phone to anyone without confirming his/her relation with patients etc.
How to fulfill this right?
· Having a detailed policy on confidentiality specifying all precautions that must be taken to ensure confidentiality
· Restricting access of medical records only to the healthcare providers and to the patient. Access to others should be given only with patients’ explicit consent
· Policy of not disclosing patients details over phone or to any-one else other than those identified as the patients’ family members or guardian
· Control and safeguards on accessing information on HIS
· Use of patients’ information for publicity, promotion of hospital etc. should be done only with explicit consent of the patient
· Staff should be oriented that patients’ details should not be discussed in public areas or with people who are not related to the patients’ treatment
· Ensuring that patients’ details are not displayed or kept in areas where it could be seen or accessed by unauthorized personnel. Examples include displaying patients full name in waiting areas or discarding filled registration forms in general waste bins etc.
· Maintaining medical and other records of patients in a secured area and destroying these records in a manner that prevents its unauthorized retrieval of information from it. For example medical records should be shredded after its retention period and not sold off as scrap papers.
6. Right to be respected for special preferences, spiritual and cultural needs
Patients may have certain personal preference based on his/her belief system or living habits. Some examples include, eating only vegetarian or Jain food, wearing certain ornaments that they might consider lucky to them or listening to a specific chants every day.
Similarly, patients may have spiritual and cultural needs. For example, praying and worshipping requirement as per the patient’s religion, following of rituals specially on occasions of birth or deaths, or observing some religious practices on occasion of festivals etc.
The hospital must respect these individual preferences, habits, spiritual and cultural needs and should try to accommodate or allow as many of them as possible. However, restrictions can be put on those practices which has a reasonable risk to the health and safety or if it can cause inconvenience to other patients in the hospital or if it can affect the functioning of the hospital.
How to fulfill this right?
· Sensitise your staff through regular sensitization programme, on respecting patients’ preferences, spiritual and cultural needs
· Have clear policy on what kind of needs could be honoured. For example, can patient be allowed to have non-vegetarian food in hospital? What kind of rituals will be allowed to be performed in case of births and deaths? Etc.
· Have a guideline for staff on how to respond in case of patients’ expressing their spiritual, cultural or preferential needs.
· Unique situations arising, should be brought to a multidisciplinary committee, who should then discuss and issue directives. (Refer list of committees required in a hospital)
· Identify what needs are frequently expressed by your patients and have arrangements for fulfilling them. Some examples could be designating a prayer room, availability of a Pundit, Chaplain or Moulvi to attend to dying patients, provision for preparing Jain food in kitchen etc.
7. Right to privacy and dignity during medical procedures
While performing healthcare functions, such as examination, investigations and treatment, there could be situations where patients’ privacy and dignity could get compromised. For example, undressing whole or a part of body for physical examination, conduction of PV examination, provision of certain therapies etc. Similarly, situations such as patient discussing his/her disease with doctor or being counselled for family planning etc. requires privacy.
Hospitals must ensure that adequate privacy is provided in needed situation and patients’ dignity is maintained throughout his/her care.
How to fulfill this right?
· Having adequate infrastructure arrangement for privacy, such as bed side curtains in multi-bed ward doors and windows that can be closed when privacy has to be provided, providing adequate change rooms where needed and restricted entries in areas of privacy such as labour room, procedure room etc.
· Clear policy on situations where visual and hearing privacy must be rendered to patients
· Guidelines to doctors, nurses and technicians on how to provide adequate privacy including hearing privacy
· Privacy and dignity shall also be maintained during restraint of a patient
· Privacy and dignity shall also be maintained during restraint of a patient
8. Right to protection from neglect or abuse:
There are instances of patients being abused or neglected in healthcare settings. For example, delay in attending the patient despite being urgently called by patient/relative, talking rudely to patient if he/she frequently calls for help or harassing the patient for procedural matters. This right requires that healthcare organizations put into place measures to prevent and to deal with such happenings. This right also entails that patients are not discriminated on the basis of their background or setting in which they are receiving care and are provide medical care as per their clinical condition
How to fulfill this right?
· Having a clear policy documented and communicated to staff conveying the message of ‘No tolerance to abuse or neglect of patients’. The policy must explain what constitute abuse/neglect with examples
· Having a mechanism for capturing such events. Patient feedback, anonymous feedback from staff, monitoring rounds etc. can be some of them
· Having a disciplinary policy and procedure in place to investigate and decide repercussions, when an occurrence of any abuse/neglect comes to notice.
· Making a policy on provision of uniform care to all patients and specifying elements that must be the part of uniform care.
· Making a policy on provision of uniform care to all patients and specifying elements that must be the part of uniform care.
9. Right to complain and receive the response on their complaints
Patients can voice there complain to an appropriate authority and can expect a response on their complaint
How to fulfil this right?
· Have an adequate mechanism in place for patients to loge complaint without any apprehension. Some of the mechanisms include, having complaint drop boxes at various locations, displaying a phone number and/or email id on which complaints can be sent, capturing complaint through feedback mechanism etc.
· There should be a designated authority who should receive all complaints for review and further processing
· Each complaint must be processed through relevant department/authority or committee.
· A response must be sent to the patient about the action taken or not taken with reasons, within a defined timeframe
10. Right to die with dignity
The right to die with dignity is the latest addition in rights of a patient (and for all citizens). This has come in effect with legal approval of Passive Euthanasia and Advance directives. Please refer the linked post for getting details of scope and conditions related with this right.Checkout the sample patient satisfaction feedback form
