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Definition

Patient rights encompass legal and ethical issues in the provider-patient relationship, including the patient'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.

Description

Many issues comprise the rights of patients in the medical system, including a patient'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 brought an emergence of Health Maintenance Organizations (HMOs) and other managed health care plans. The rapid change in medical care moved considerable health care decision making from medical professionals to business entities. Many feel that the change has been detrimental to the health care industry in general. Establishing a patient's bill of rights has been the response to this issue. As of mid 2001, the Bipartisan Patient Protection Act of 2001 was up for debate in the U.S. Senate. It is certain that patient rights are a growing concern for the public at large, a fact that cannot be ignored for long by legislators.

At issue, besides basic rights of care and privacy, is education of patients concerning what to expect of their health care facility and its providers. These rights include the right to participate in the development and implementation in the plan of care; the right to be treated with respect and dignity; the right to be informed about condition, treatment options, and the possible results and side effects of treatment; the right to refuse treatment in accordance with the law, and information about the consequences of refusal; the right to quality health care without discrimination because of race, creed, gender, religion, national origin, or source of payment; the right to privacy and confidentiality, which includes access to medical records upon request; the right to personal safety; the right to know the identity of the person treating the patient, as well as any relationship between professionals and agencies involved in the treatment; the right of informed consent for all procedures; the right to 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; the right to consultation and communication; the right to 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. The patient is to follow the plan of care, provide complete and accurate health information, and communicate comprehension of instructions on procedures and treatment. The patient is further responsible for consequences of refusal of treatment, following rules and regulations of a hospital, and to be 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. In it, the hospital informs patients that they have the right to refuse any procedure or medication that is prescribed, stating that full information should be provided by the attending physician if the patient has doubt or concerns.

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 to 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 one-year prison term. Penalties for selling medical information are higher. Following a two-year implementation period, the rules will become enforceable in February 2003.

Viewpoints

Not all 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 Health care 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. 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, and that billable hours for attorneys specializing in the complexities of the regulations will skyrocket, thus resulting in even higher costs of patient care.

Jacqueline N. Martin, M.S.