Patient rights encompass legal and ethical issues in the provider-patient relationship, including a person's right to privacy, the right to quality medical care without prejudice, the right to make informed decisions about care and treatment options, and the right to refuse treatment.
The purpose of delineating patient rights is to ensure the ethical treatment of persons receiving medical or other professional health care services. Without exception, all persons in all settings are entitled to receive ethical treatment.
Many issues comprise the rights of patients in the medical system, including a person's ability to sue a health plan provider; access to emergency and specialty care, diagnostic testing, and prescription medication without prejudice; confidentiality and protection of patient medical information; and continuity of care.
Health care reform led to an emergence of health maintenance organizations (HMOs) and other managed health care plans. The rapid change in medical care moved health care decision making from medical professionals to business entities, a move many consider to be detrimental to the health care industry in general. Establishing a patient's bill of rights has been the response to this concern. The Bipartisan Patient Protection Act of 2001 has been debated and passed by the U.S. Senate and the U.S. House of Representatives and signed into law.
At issue, besides basic rights of care and privacy, is the education of patients concerning what to expect of their health care facility and its providers. These basic rights include the right to:
- participate in the development and implementation in the plan of care
- be treated with respect and dignity
- be informed about condition, treatment options, and the possible results and side effects of treatment
- refuse treatment in accordance with the law, and receive information about the consequences of refusal
- quality health care without discrimination because of race, creed, gender, religion, national origin, or source of payment
- privacy and confidentiality, which includes access to medical records upon request
- personal safety
- know the identity of the person treating the patient, as well as any relationship between professionals and agencies involved in the treatment
- informed consent for all procedures
- information, including the medical records by the patient or by the patient's legally authorized representative and hospital charges, except for Medicaid and general assistance
- consultation and communication
- complain or compliment without the fear of retaliation or compromise of access or quality of care
The patient is also expected to meet a fair share of responsibility by following the plan of care, providing complete and accurate health information, and communicating comprehension of instructions on procedures and treatment. The patient is further responsible for consequences of refusal of treatment, of not following the rules and regulations of a hospital, and of not being considerate of others' rights. The patient is also responsible for providing assurance that financial obligations of care are met.
The American Hospital Association provides an informal bill of rights for patients who are hospitalized, which informs patients that they have the right to refuse any procedure or medication that is prescribed, and that states that
Persons United Limiting Substandards and Errors in Health Care (PULSE), a non-profit organization concerned with patient education and improving communication within the health care system, encourages the partnership of health care professionals and patients. A patient who is educated about his or her own medical condition can work together with health care providers regarding treatment decisions.
New federal privacy rules, beyond the proposed patient bill of rights, give patients additional control over private medical information. Patients have the right to examine their own medical records and to amend them if necessary. In practice, medical personnel have often been reluctant to part with patient records, even when requested by the patients themselves. While health care providers and patients assume that medical records are private, the widespread use of computer transmissions opens the potential for seriously compromising patient confidentiality. Regulations recently imposed by the federal government are aimed at protecting patient records by creating limits on the methods in which medical information is shared. Direct authorization from a patient must be gained before information may be released. Criminal and civil penalties may be imposed for a privacy violation. Intentional disclosure of private information can bring a $50,000 fine and a one-year prison term. Penalties for selling medical information are higher. These rules became enforceable in February 2003.
Not all individuals or organizations agree with the new regulations. Some complain that they are too restrictive, while others maintain that they are not restrictive enough. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) cites complexity and cost factors as major problems, and that the full extent of the impact caused by the ruling was not adequately considered when it passed in 2003. Government estimates are that it will cost taxpayers $17.6 billion over 10 years to comply with the privacy regulations. Critics of the regulations imply that the cost will be more than triple the estimate, and that billable hours for attorneys specializing in the complexities of the regulations will skyrocket, thus resulting in even higher costs of patient care.
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American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (913) 906-6000. E-mail: <firstname.lastname@example.org>. <http://www.aafp.org>.
American College of Physicians. 190 N Independence Mall West, Philadelphia, PA 19106-1572. (800) 523-1546, x2600, or (215) 351-2600. <http://www.acponline.org>.
American Medical Association. 515 N. State Street, Chicago, IL 60610. (312) 464-5000. <http://www.ama-assn.org>.
National Patient Advocate Foundation. 753 Thimble Shoals Blvd, Suite A, Newport News, VA 23606. 800-532-5274. E-mail: <email@example.com>. <http://www.npaf.org>.
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U.S. House or Representatives, Democratic Staff or the Energy and Commerce Committee. [cited March 2, 2003. <http://www.house.gov/commerce_democrats/pbor/107pborsummary.htm>.
L. Fleming Fallon, Jr, MD, DrPH