Patient Rights - Top Ten List Of Most Violated

INTRODUCTION				about a patient in the next room. It was
Patient rights are under siege, as evidenced in a				embarrassing!"
recent survey conducted by the National Institute				CONFLICTS ABOUND
for Patient Rights (NIPR). NIPR staff compiled the				Conflict between "team" and patient/advocate
results based on responses from one-thousand				was the cause of #5 on The List. Patients and
randomly selected, former hospital patients who				their advocates have a right to know of realistic
took part in the study. The results of the survey				care alternatives when hospital care is no longer
show that, despite billions spent on advances in				appropriate. Some participants observed that no
medical technology, patients daily experience an				one ever approached them about realistic care
erosion of their rights "at the hospital bedside."				alternatives in the event that hospital care was no
Ironically, it may be a consequence of the				longer appropriate.
success of science in medicine.				Not only was there no discussion of alternative
Among those responding to essay questions, the				care options, but many respondents complained
following was a typical scenario. A hospital admits				about how they were made to feel when they
a loved one with "complications" (a medical				disagreed with providers about the continued
euphemism for "we really don't know all that's				appropriateness of hospital care. One respondent
going on here, but there are several organs				noted, "They made us feel like we were immoral
involved"). While the loved one rests stable in bed,				when we questioned their treatment
a line of doctors and nurses seems to form at				recommendations!"
the door. One after another, doctors enter the				Conflict was also the cause of violations #6 and
room, make a few comments, then turn around				#7, violations of a right to know hospital rules on
and exit. Primary care physicians refer patients to				charges and payment methods, and a right to
specialists who rely on subspecialists. It seems like				review the hospital bill, have information explained,
each separate organ has its own special doctor.				and get a copy of the bill. Said one respondent, "It
In the health care industry, this is commonly				was like pulling teeth to try to get an explanation
referred to as "component management," which				of certain charges. I still don't know why I was
results from a focus on the treatment of				charged for things I know we didn't use."
individual organ systems in isolation from others. It				Under violation #8, some participants complained
suffers from two shortcomings: (1) specialists and				about their inability to identify hospital personnel
subspecialists tend to segregate organ systems				who could help in resolving discrepancies over
at the expense of the whole patient; and (2) it is				billing issues or in disagreement over treatment
inefficient, because it inevitably leads to "episodic				between "team" and patient/advocate. Patients
intervention" where if something happens, you				and their advocates have a right to know of
see one specialist for a particular organ system; if				hospital resources, such as patient complaints and
something else happens, then you see another				grievance processes, patient representatives or
specialist or subspecialist, and so on.				ethics committees. It was common in the survey
Episodic intervention leads unavoidably to				results that respondents express the desire to
uncoordinated care that lacks continuity for the				have known about the hospital ethics committees
patient and for the patient's family. Many individual				and their members in the event of conflict over
decisions in patient treatment by numerous				treatment options.
specialists and subspecialists entail a fragmented				MEDICAL MISTAKES AND RECORD KEEPING
delivery system. According to the findings of the				Although listed at #9, the violation of a patient
NIPR study, this leads to the number one problem				advocate's right to know the identity and
in contemporary healthcare delivery: a failure to				professional status of those who care for the
communicate.				patient contained some of the most poignant
PIECING TOGETHER BITS OF INFORMATION				responses in our survey results. Some of the
The study suggests health care suffers from a				narrative statements were truly heartbreaking.
decided lack of coordination and cooperation				Many participants claimed to have suffered some
among diverse healthcare professionals.				harm as a result of medical error. Some even
Participants in the survey invariably stated that,				noted if they had had ready access to
with no one to treat the entire patient and				information about the identity and professional
coordinate care, patients and their families are left				status of their providers, they would have had
largely on their own to integrate their own care.				second thoughts about consenting to treatment.
According to one respondent, "We had to				Said one respondent, "I am permanently disabled
somehow piece together bits of information from				because of what a doctor did to me. I found out
different doctors to try to get a complete picture				only much later and through my lawyer the
of our mom's progress."				hospital knew the doctor caused similar problems
This can be very difficult to do in a hospital				in the past with other patients. Why didn't they
setting and extremely frustrating. Participants in				just tell me?!"
the study frequently stated that no one seemed				Coming in at a close #10 was the violation of a
willing to tell them exactly what was going on with				right to review medical records and receive an
the whole patient. Doctors were more than willing				accounting of disclosures regarding health
to share information about their specialty, about				information. Participants observed that they have
precisely what was happening with their particular				moved frequently during their life times.
organ system, but no one seemed especially				Consequently, they have received medical care
willing to say anything about how the entire				from various providers over time. Each provider
patient was doing.				keeps his or her records detailing visits and
THE TOP TEN MOST VIOLATED PATIENT				treatments. The same is true for hospitals, clinics,
RIGHTS				laboratories, pharmacies, and so on. One
This failure to communicate is responsible for the				participant noted, "Like most people, I've moved
#1 spot on the top ten list of most violated				around quite a bit. Over time, it's easy to forget
patient rights. A full 63% of participants felt that				when you were treated, by whom and even for
healthcare providers most often violated their				what!"
right to informed consent. When prompted to				Respondents noted such problems as the wide
explain, many complained about the inadequacy of				variation among providers in the amount of time
multiple diagnoses coming from multiple providers.				they retained records, paper records were
Without a single, complete diagnosis, respondents				misfiled or even destroyed, electronic records
felt unable to make an informed choice about				were lost, stolen, damaged or vulnerable to
appropriate treatment options.				unauthorized access, and physicians sold their
The #2 violation on the list is related to the same				practices. Stated a respondent, "I was made to
problem. Participants often complained about the				feel intimated in asking one of my doctors for a
way in which doctors presented them with				copy of my medical records. He acted like my
treatment options. The following is a				medical record was his property and his only."
representative statement, "I felt as if I was in				CONCLUSION
automobile show room and the salesman was				Despite billions spent on advanced medical
presenting me with a list of options for a new				technologies such as drugs and devices, patients
car."				daily experience an erosion of their most
The #2 most violated of patient rights was a lack				fundamental rights. The rights of patient
of respect for personal, spiritual, and religious				self-determination and informed consent suffer
values and beliefs. Participants observed that				the most.
many doctors do not seem to care about				Ironically, the widespread violation of patient rights
personal preferences. Consequently, they often				in hospital-based care may be a direct
failed to acknowledge the unique nature of				consequence of the success of medicine,
personal lifestyles in their presentation of				specifically of the application of science to
treatment options. To quote one respondent, "I				medicine. The scientific method lends itself to
would have liked my doctor to have				reductionism with researchers analyzing smaller
recommended a treatment option tailored to my				and smaller parts. Likewise in medicine, doctors
love of the outdoors. He never even asked."				become specialist who confine their focus to
A failure to communicate was also the cause of				individual organs; subspecialist focus even more
the #3 violation of patient rights, a lack of respect				narrowly on the parts of organs.
for advance directives. Participants complained				Component management leads to episodic
vociferously about the way in which advance				intervention and the fragmentation of care. The
directives are handled by most hospitals. Stated				lack of coordination causes anger and frustration
one respondent, "The only time any one every				among patients and their families by the
mentioned my living will was at admissions. No one				breakdown in communications. A failure to
ever asked me again about my personal wishes."				communicate may not just cause anger and
Miscommunication was the cause of violation #4.				frustration but also unnecessary conflict. Conflict is
Despite HIPAA, many participants observed that				costly! Miscommunications can also cause
providers often showed no regard for the privacy				significant harm when patients suffer underuse,
and confidentiality of their personal health				overuse or misuse as a result of medical error.
information. Cell phones were often cited as the				Until hospitals adjust to the success of science in
main culprit. Said one respondent, "A nurse bent				medicine, patients and their families are likely to
over me to straighten out a line with a cell phone				continue to experience one or more of the top
in her other hand, blurting out sensitive information				ten violations of patient rights.

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Patient Rights - Top Ten List Of Most Violated

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