Roberta B. Abrams on Patient's

[NRSKarenRN, BSN, RN]

A Nurse's Viewpoint

Patients' rights and responsibilities

By Roberta B. Abrams, RNC, MA, LCCE, for HealthLeaders.com, July 9, 2001

http://www.healthleaders.com/news/feature1.php?contentid=25712

The issue of patients' rights is attracting a lot of attention these days. Both state and federal legislators have spent a great deal of time trying to develop legislative guidelines to both protect and limit patients' rights from a variety of disparate perspectives. Hopefully, someday soon there will be some light to accompany all the heat that's been generated on the subject. In the meantime, let's look at the broader subject of patients' rights and responsibilities from A Nurse's Viewpoint.

In 1997, then-President Clinton announced the appointment of members of an Advisory Commission on Consumer Protection and Quality in the Health Care Industry. The Commission's work produced a series of documents that contained recommendations for demonstrable changes in the nature and shape of healthcare in the United States.

Unfortunately, several major issues (care for the uninsured, accountability for error, clinical trials) were removed from the commission's purview. Nonetheless, the commission's work provides inspiration for a discussion of patients' rights and responsibilities. What follows is this nurse's perspective on those rights and the attendant responsibilities.

Healthcare consumers have the right to receive accurate, easily comprehended information about their healthcare plans, the professionals who provide care, and the facilities in which they will be provided.

In other words, the healthcare consumer should be informed of his/her healthcare benefits. This description must include what is or is not covered under the policy, and the number, credentials, and qualifications of the providers. The Commission's Bill of Rights extended this to include the right to a "fair and efficient process for resolving differences."

I would suggest this implies that the consumer has the responsibility to become informed of the scope and nature of services provided and to avail herself of care - including health promoting services - at stipulated intervals. Equally important, healthcare consumers have the responsibility to practice optimal possible health habits.

Consumers have the right to education that promotes healthy lifestyles. They should be given knowledge and awareness of the sequelae of risky behaviors such as smoking, substance abuse, nutritional abuses and irresponsible sexual behaviors. They then have the responsibility to avoid known health risks. Patients should discuss with their providers individual risks occurring through family history, lifestyle choices, or job factors. They should receive counseling related to mitigating those risks.

The consumer has the right to a choice of provider and to sufficient availability of providers to ensure access to quality care in a reasonable time frame. One of the chief complaints heard today is that both the number and geographical distribution of providers fails to provide for timely access to care. Many pregnant women, especially those in rural areas, those covered by Medicaid, or the uninsured, are essentially denied appropriate care due to lack of access.

There is, of course, an implicit responsibility to seek care in a timely manner. The patient who arrives at midnight in the busy emergency room complaining of an upper respiratory problem of two weeks' duration has probably abrogated this responsibility. The pregnant woman who presents herself to the perinatal unit in advanced labor without having sought prenatal care has displayed a similar lack of responsibility.

Healthcare consumers have both the right and the responsibility to be fully knowledgeable participants in all decisions related to their care. Patients have the right to detailed explanations of the care to be provided. They need also to be made aware of alternatives and the probable sequelae of each. These explanations must be couched in terms commensurate with the patient's ability to comprehend. Caregivers need to elicit feedback that demonstrates that comprehension.

Healthcare recipients have the responsibility to adhere to the plan of care and to report results of care to the provider. They need to be comfortable in disclosing all relevant information and communicating their wants and needs with regard to the healthcare regimen.

Patients have the responsibility to ask questions until they have a full understanding of treatment options and ramifications. For patients who, for whatever reasons - age, physical or emotional status, speech or hearing impairments, language barriers - cannot understand usual explanations, family or community resource persons should be included in the explanation of treatment.

Patients who lack the competence to make decisions for themselves should have appointed guardians to protect their interests. All competent patients should be assisted in formulating advanced directives for healthcare. This helps to ensure that any and all interventions will be commensurate with the patients' own choices even when s/he is unable to speak for herself. The provider has the responsibility to adhere to the provisions included in the advanced directives. The patient has the responsibility to communicate these provisions to responsible family members.

Healthcare consumers have a responsibility to share with their providers all information that they have relevant to provision of care. This includes family and personal past history of both physical and emotional alterations in health status. It also includes information on dietary practices and drug use - whether prescribed or non-prescribed. Many clients today ingest herbal preparations, over-the-counter medications, and other substances that can and do affect health status. The healthcare provider needs all of this knowledge to appropriately participate in the plan of treatment.

Healthcare providers are responsible for providing their clients with a realistic appraisal of the risks and limits of the medical sciences, as well as the human fallibility of care providers. Both care providers and care recipients share the responsibility to report mistakes or errors in care. They also need to report cases of fraud or wrongdoing.

The commission's report also included "whistleblower" protections for healthcare providers. Their statement proclaims that "...healthcare providers, facilities, and plans should ... be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients."

Patients have the right to respectful, considerate care at all times and circumstances from healthcare providers. According to the commission's report: "Both in delivery of services and in insurance marketing and enrollment practices, consumers should be protected from discrimination based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment." Implicit in this statement is the need for providers to receive education requisite for communication and social skills that respect diversity of language, cultural practices, and disabilities.

Patients have the corollary responsibility to treat providers and other patients with similar respect and courtesy, regardless of any of the above-listed diversities. One of the factors frustrating to providers today is the increase in violence in the healthcare setting.

Healthcare consumers have the right to expect that communications with providers will be treated as confidential. Today's technological advances, coupled with needed exchanges of information involving providers, public health officials, and other disciplines within the system complicate privacy issues. But the greatest hazards to patient confidentiality still come from verbal exchanges among providers in elevators, cafeterias, and meetings.

Patients and members of their support system have the responsibility to protect patient confidentiality by refraining from discussions of private matters in public places. Many healthcare providers have dealt with complaints about breaches in confidentiality which, when investigated, have originated from inappropriate communications by the patient or his friends and family members.

The delineation of patients' rights and responsibilities is a dynamic process that changes as technology and other care provision factors change. The meat and substance of this or any other prescription for rights and responsibilities can be couched in a phrase attributed to the sage Hillel: "That which is hateful to you, do not do to any other individual."

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Roberta B. Abrams, a regular columnist for HealthLeaders.com, uses her education and experience to help further the evolution of healthcare delivery systems through her consulting group, RBA Consults, in Farmington Hills, Mich. She also is on the adjunct nursing faculty at Madonna University.

[Mijourney]

Hi NRSKaren. Can you tell me again? How can we hold the patient or family liable for breach of confidentiality?