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Wednesday, June 25, 2008

Your Medical Privacy Rights

What exactly are they anyway?
Information on how to protest these violations can be found here.

36 comments:

Joel Sherman said...

Here's a state by state breakdown of what your actual medical privacy rights are from Patient Privacy Rights org (see links).
We need a more general topic to discuss this.

Joel Sherman said...

It occurs to me that it might be helpful to see the formal rights listed by a hospital. The following is the rights statement of a local hospital. This information is available online, but as I haven't asked for express permission to publish it, I have deleted identifying information.
It should be representative of most hospitals.

PATIENTS’ RIGHTS AND RESPONSIBILITIES

… is committed to the following basic rights and responsibilities of patients:

PATIENTS’ RIGHTS
Access to Care
Patients have the right to medical treatment and accommodations regardless of race, creed, sex, national origin or sources of payment for care.
Respect and Dignity
Patients have the right to considerate, dignified and respectful care at all times and under all circumstances. ... Hospital respects psychosocial, spiritual, and cultural understanding of illness and death.

Exercise of Rights
Patients have the right to participate in the development and implementation of their plan of care, including the right to make informed decisions involving their health care. In particular, patients have the right to be informed of their health status, to be involved in care planning and treatment, and to request, accept or refuse treatment to the extent permitted by law.
To refuse to talk with or see anyone not officially connected with the hospital. This includes visitors, or persons officially connected with the hospital but not directly involved in a patient’s case.
To wear appropriate personal clothing and religious or other symbolic items, as long as they do not interfere with diagnostic procedures or treatment.
To be interviewed and examined in places that provide visual and hearing privacy. This includes the right to have a person of one’s own sex present during certain parts of a physical examination, treatment or procedure performed by a health professional of the opposite sex. Patients have the right not to remain disrobed any longer than is required for an examination, treatment or procedure. Patients also have the right to formulate advance directives and to have hospital staff and practitioners who provide care in the hospital comply with these directives. Upon admission to the hospital, a patient also has the right to have the following people notified of his or her admission:


(1) a family member or representative of his or her choice; and (2) his or her doctor. Privacy and Confidentiality

Patients have the right, within the law, to personal privacy, as indicated by the following rights:
. To expect that any discussion or consultation involving a case be discussed privately. Individuals not directly involved in a patient’s care will not be present without patient permission.
. To have a medical record read only by individuals directly involved in treatment or in the monitoring of its quality. Other individuals can read the medical record only with written patient or legally authorized representative permission.
. To have all communications and records pertaining to care be treated as confidential. This includes the source of payment, and all clinical records.
. To request a transfer to another room if another patient or a visitor in the room is a disturbance.
. To decline care by a student or other health care professional who delivers clinical care as part of training by notifying the nurse responsible for care.

PATIENT SAFETY
Patients have the right to receive care in a safe setting free from all forms of abuse and harassment.
Comfort
When patients experience pain, they have the right to be believed, to be assessed at regular intervals and to be treated by a variety of therapies, not limited to medication. Patients have the responsibility to report their pain and let their caregiver know what therapies are working.
Information
Patients have the right to know the identity and professional status of individuals providing services. They have the right to know which physician or other practitioner is primarily responsible for care. This includes the right to know of the existence of any professional relationship among individuals involved in care, as well as the relationship to any other health care or educational institutions. Participation by patients in clinical training programs or in the gathering of research data is voluntary. Patients have the right to obtain complete and current information from their practitioner concerning their diagnosis (to the degree known), treatment and any known prognosis. This information is communicated in terms the patient can understand. When it is not medically advisable to give such information to a patient, the information is made available to a legally authorized individual. Patients have the right to participate in the planning of personal care.
Additionally, patients have a right to access their medical records within a reasonable timeframe in accordance with ... Hospital’s policy.
Communication
Patients have the right to receive visitors and to exchange verbal and written communication. We ask that your visitors respect our visitor behavior expectations and responsibilities. When patients do not speak or understand the predominant language of the community, the hospital makes a reasonable effort to provide interpretation services. This is particularly true where language barriers are a continuing problem.
A confidential interpreter service is provided for patients desiring clarification of specialized or complicated terms or concepts of care. Interpreters provide meaning-for-meaning rather than word-for-word clarification. Interpreters are familiar with technical concepts and are able to accurately interpret explanations from the expert to the lay person. Patients should ask their nurse if they desire interpreter service.
Upon request, a qualified interpreter is provided to all deaf or hearing-impaired patients. Tele-communication Devices for the Deaf (TDD) and hearing-impaired handsets are also available.

Consent
Patients have the right to participate in decisions involving their health care. An understanding of the right is based on a clear, concise explanation of the existing condition and of all proposed medical procedures.
Explanations include possibilities of any risk of serious side effect or mortality, problems related to recuperation and probability of success.
Patients are not to be subjected to any procedure without voluntary consent or the consent of a legally authorized representative. Patients are informed of medically significant alternatives for care or treatment.
Patients have the right to know who is responsible for authorizing and performing procedures or treatment. Patients are informed if the hospital wishes to include them in research/education projects affecting care of treatment. Patients have the right to refuse to participate in any such activity.

Restraint and Seclusion
Patients have the right to be free from physical or mental abuse, and corporal punishment.
Patients have the right to be free from seclusion or restraints of any form that are not medically necessary or are used as a means of coercion, discipline, convenience, or retaliation by staff. Restraint or seclusion may only be imposed to ensure the immediate physical safety of the patient, a staff member, or others. Additionally, restraint or seclusion must be discontinued at the earliest possible time.
The term “restraint” includes either a physical restraint or a drug that is being used as a restraint. Specifically, a physical restraint is any manual method, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely. A drug used as a restraint is a medication used to control the patient’s behavior or to restrict the patient’s freedom of movement and is not a standard treatment or dosage for the patient’s medical or psychiatric condition. Seclusion is involuntary confinement of a patient alone in a room or an area where the patient is physically
prevented from leaving. Seclusion may only be used to manage violent or self-destructive behavior.
Restraint or seclusion may only be used when less restrictive interventions have been found to be ineffective to protect the patient, a staff member, or others from harm. Additionally, restraint and seclusion must be used in accordance with a written modification to the patient’s plan of care, must be implemented in accordance with safe and appropriate restraint and seclusion techniques, and must be implemented in the least restrictive manner possible. Restraint and seclusion may not be used simultaneously unless the patient is continually visually monitored in person by an assigned, trained staff member, or by trained staff using audio and video equipment in close proximity to the patient.
Restraint and seclusion must be ordered by a physician or licensed independent practitioner who is responsible for the care of the patient and who is authorized by state law and hospital policy to order restraint or seclusion. However, the patient’s attending physician must be consulted as soon as possible if the physician did not order the restraint or seclusion. Orders for the use of restraint or seclusion must never be written as a standing order or on an as-needed basis.
A physician, other licensed independent practitioner, or trained staff member will monitor the condition of a restrained or secluded patient. Additionally, when restraint or seclusion is used for the management of violent or selfdestructive behavior, a patient must be seen in person by a physician, other licensed independent practitioner, trained registered nurse, or trained physician assistant in order to evaluate: (1) the patient’s immediate situation; (2) the patient’s reaction to the intervention; (3) the patient’s medical and behavioral condition; and (4) the need to continue or terminate the restraint or seclusion.
Each order for restraint or seclusion used for the management of violent or self-destructive behavior may be renewed for up to 24 hours in accordance with the following age-based limits: (A) adults - 4 hours; (2) children ages 9 to 17 - 2 hours; and (3) children under age 9 - 1 hour. A physician or other licensed independent practitioner must see and reassess the patient before issuing a new order. Each order for restraint or seclusion used to ensure the physical safety of the non-violent or non-self-destructive patient may be renewed according to hospital policy. Patients have the right to safe implementation of restraint or seclusion by trained staff. All staff who have direct patient contact are required to have ongoing education and training in the proper and safe use of restraint application, implementation of seclusion, monitoring, assessment, and providing care for patients in restraint or seclusion. Additionally, staff are also trained on alternative methods for handling behavior, symptoms, and situations that have traditionally been treated through the use of restraints or seclusion. The individuals providing staff training are qualified by education, training, and experience in techniques used to address patients’ behaviors.
… Hospital must report to the Centers for Medicare and Medicaid Services any death that occurs: (1) while a patient is restrained or in seclusion; (2) within 24 hours after the patient has been removed from restraint or seclusion; or (3) where it is reasonable to assume that the patient’s death is a result of restraint or seclusion.

Consent of Autopsy
. Following the death of a patient, the person authorized to give consent for an autopsy has the right to request that it be performed or attended by a physician not affiliated with … Hospital.
. Likewise, the authorized person many request that the autopsy be done in an institution not affiliated with … Hospital.
. In both requests above, the authorized person shall be held responsible to arrange for the autopsy and any necessary associated services.
. The authorized person shall be totally responsible for payment of all costs related to use of a non … Hospital affiliated physician and/or institution.

Pastoral Care Services
Pastoral Care Services are available on a 24-hour basis. Patients have the right to request a pastoral visit from a member of their religious denomination.
Protective Services
Patients who desire services from any protective service agency (such as protective services for the elderly) are encouraged to ask their nurse to contact a hospital social worker.
Consultation
Patients have the right to consult with a specialist at their own request and expense.

Refusal of Treatment
Patients may refuse treatment to the extent permitted by law. The hospital’s relationship with a patient may be terminated upon reasonable notice when refusal of treatment by the patient or a legally authorized representative prevents appropriate professional care.

Transfer and Continuity of Care
Patients are not transferred to other facilities or organizations unless they receive a complete explanation of the need for the transfer. This includes the alternative to such a transfer and the understanding that the transfer is acceptable to the other facility or organization. Patients have the right to be informed of any continuing healthcare requirements following discharge from the hospital. This information is shared by the responsible practitioner or delegate.

Hospital Charges
Patients have the right to request and receive an itemized and detailed explanation of the total bill for services provided in the hospital. The Hospital encourages patients who are interested in the charges and costs of care to …. Patients have the right to timely notice prior to termination of eligibility for reimbursement by any third-party payer for the cost of health care.

Patient Communications and/or Complaints Patients are entitled to information about the hospital’s channel of communication for initiating, reviewing, and resolving a complaint. Patients may initiate a complaint by calling … Please be assured that your quality of care will not be compromised should you raise an ethical issue, a question of patient safety or make a complaint.

PATIENTS’ RESPONSIBILITIES
Provision of Information
Patients have the responsibility to provide accurate and complete information about a present illness, past illnesses, hospitalizations, medications, and other health matters. Patients are responsible for reporting unexpected changes in a condition to their physician or nurse. Patient are responsible for indicating whether they understand a treatment plan and if they understand what is expected of them.

Compliance with Instructions
Patients are responsible for following the treatment plan recommended by the practitioner responsible for their care. This may include following the instructions of nurses and other health personnel as they carry out the coordinated plan of care, implement the responsible practitioner’s orders and enforce the hospital rules and regulations.
Refusal of Treatment
Patients are responsible for their actions if they refuse treatment or do not follow the practitioner’s instructions.
Hospital Charges
Patients are responsible for ensuring that the financial obligations of their health care are fulfilled promptly.

Hospital Rules and Regulations
Patients are responsible for following hospital rules and regulations affecting care and conduct.
Respect and Consideration
Patients are responsible for being considerate of other patients’ rights. Likewise, they are responsible for consideration of the rights of hospital personnel. Patients are responsible for assisting in the control of noise and the number of visitors. Patients are expected to respect the no smoking policy of the hospital. Patients are responsible for respecting others’ personal property and the hospital’s property.

Anonymous said...

Joel,

When you read this, it makes you feel confortable and safe. I’ve read this many times but as we went over in the informed concent section, this just doesn’t happen as outlined. A few examples:

Patients have the right to participate in the development and implementation of their plan of care, including the right to make informed decisions involving their health care. In particular, patients have the right to be informed of their health status, to be involved in care planning and treatment, and to request, accept or refuse treatment to the extent permitted by law.

I know this doesn’t always happen, many times doctors do as they please without discussing it with the patient or getting their consent.

To wear appropriate personal clothing and religious or other symbolic items, as long as they do not interfere with diagnostic procedures or treatment.


Do I really need to discuss the above? Again, underclothes wouldn’t interfere with treatment at all but I can’t find a hospital in my area that allows you to wear them.

To be interviewed and examined in places that provide visual and hearing privacy.

Your kidding me,,,Right.


To decline care by a student or other health care professional who delivers clinical care as part of training by notifying the nurse responsible for care.


I’ve never had this problem because I won’t go to the teaching hospital near me (Vanderbuilt). I’ve just read several post where this has happened without their consent.

Would you agree that a patients bill of rights is just a platitude (your word) to get people to come to their hospital in a sense. If all this is posted, how have they managed to get by this long without getting challenged? What’s your opinion on this?

Jimmy

Joel Sherman said...

Jimmy, I agree with you. These statements of rights are formal probably JCAHO required statements that are not necessarily taken seriously. It's similar to the privacy statements of Google and Microsoft health services; they sound good until you read the fine print.
I didn't post that statement to argue that patients always receive those rights. Rather these statements do have significance in that if your rights are violated, you can truthfully claim that the hospital broke their written pledge to you. It affords you a much better chance of effecting change if you complain.

Anonymous said...

Jimmy

I think Dr. Sherman's point is very valid. If you call the hospital and say my modesty was violated and i was uncomfortable they are less likely to take you serious than if you say my modesty was violated and this violates the written consent I gave and further is in violation of JACHO regulations...my guess is you will get a lot more attention and sincere dialouge, letting them know you are aware of the reglatory side of this will rattle them a little. While this is an after the fact issue at that point it will get their attention. Let the administrators know you not only know, you are willing to push it. The have more interest in avoiding dealing with JACHO and others than the floor people do. You are right, some of this is a joke, I went in for the suggested colonoscopy and our local hopsital uses the old fashion half curtains for prep area's. When it was over I wrote the admin and told them I thought they had violated Hippa regulations and proceeded to tell them the name of the patient, her medical history, and why she was there who was in the area beside me...I got a response from them detailing how they were going to address it. I wasn't satisfied, leaving a cubicle between patients just didn't cut it, told them so and told them from now on I was going out of town for care. I haven't been back but understand the installed walls instead of curtains...don't know that was a direct result, but it gives you amo to make them sit up and take notice.......JD

Anonymous said...

Joel and JD,

Thanks for the responses, I really wasn't trying to stir the mud or anything but I do feel that if your going to do as you want, those rights shouldn't be in writing. To be perfectly honest, if all facilities followed what they had on the wall, we wouldn't be having this conversation because as it is writen, describes the perfect care that anyone could ask for. It's upsetting when you've read this and realize that your rights were violated after the fact. I don't even know if advocates are the answer since most work for the hospital, I think the best person would be your spouse but that won't ever happen even though ganitors, and salesmen sometimes are allowed back in the OR area in view of surgeries taking place?

Jimmy

Anonymous said...

Jimmy

I think we fail to realize that there are sometimes different strata with different agenda's in hospitals. There was an interesting thread in allnurse where the nurses were complaining that the admin. had adpoted a customer service mind set that made thier jobs harder. They equated it to a happy patient meant more money. It was obvious their focus was different from the policy makers. I think the answer is to take it to the people who are signing checks and accountable for profits. They are most likely the folks that wrote the policy, the nurses/providers are the ones applying it....take it to the admin. I agree with you 100%, best intentions mean nothing if they are not backed up. At a minimum the policy gives you a talking point JD

Anonymous said...

Okay, so where is the fine print on this material? I've made a habit to read all consent forms in advance and have seen this posted at a few hospitals but have never seen where hospital rules take priority over patient rights. Could you point me in the right direction Joel.

Jimmy

Joel Sherman said...

Not sure what you're referring to Jimmy. My reference to fine print was referring to Google and Microsoft where I was referring to rights which were granted in general but then greatly restricted if you clicked further.
Every hospital does its own thing. Most do not use 'fine print' in their consent and general forms. But the statements are important. Federal and state laws generally do not grant very specific rights to patients so if you think that yours have been violated, you first have to check what each institution guarantees on its own. Hospitals generally are bound by JCAHO regulations, but these too are rarely specific and wouldn't help much in a court of law.

Anonymous said...

Joel

I'm not looking to file any complaints, just trying to determine where the breakdown is. I guess the question I have is if the providers choose just not to follow these rights or are we (patients) just not active in holding them to these standards? I'm leaning toward the latter but don't want to miss anything that could tell me otherwise. Hope that makes sense. Jimmy

Joel Sherman said...

Jimmy, I think most hospitals post what they need to for JCAHO and then don't worry about it much, doing whatever makes the most fiscal sense. Lawsuits on these issues are uncommon.

Joel Sherman said...

There are some limits to your privacy rights as well. If criminal activity is involved, the hospital may be mandated to report the incident to the police. Every state has its own regulations.
Here's a New York hospital that tried to protect a celebrity victim of a shooting and is now in hot water for it.

Joel Sherman said...

I think MER's comment on Bernstein that most men don't object to receiving opposite gender intimate care is correct.
But he didn't add the reverse, which is that many women also accept it. Yet it remains that women are generally offered a choice and men are not. It certainly should be equal. These blogs do establish that many more men care than are willing to complain. Women providers are generally well aware of this.

Joel Sherman said...

MER posted this to the 'male modesty thread'.

PT wrote in Dr. Bernstein's blog: " I assure you if you asked every nurse or physician in every hospital of
this country if they could recite
one phrase or one statement of that
facilities core values,they would be dumbfounded."

I agree with you. That's why we, as patients, need to go into the hospital culture armed with the knowledge of these specific core values attached to each specific hospital. If confronted with modesty problems, we then need to do ask them if what they are doing fits in with the core values of the institution. See if they know the core values. If they don't remind them. Keep in mind that it's easy to put words like "respect" and "dignity" into philosophical statements. Rarely do we try to define those words in the contexts of what we're talking about. We often just assume that everybody knows what they mean. It's not as easy as that. I've found articles out of UK trying to define these terms in medical contexts. I haven't found them in the US.

Just because doctors and/or nurses may not know know these core values, doesn't mean they don't exist, or that patients should not know them. We all have ideals. We all often don't meet our ideals. The fact that doctors and nurses are busy is a reason but not an excuse.

But remember, none of us likes being reminded that we don't live up to our ideals. So when we confront them with this, don't always expect a pleasant experience. At best, if they're decent people, you'll embarrass them. At worst, you make them angry.

Patients need to go into these encounters with their eyes wide open, knowing the potential responses and being prepared to meet them.

June 18, 2009 9:01 PM

Joel Sherman said...

I agree with both of you. I started this thread by listing a local hospital's patient bill of rights and responsibility. They are very important, but that doesn't mean anyone has them memorized. Not only couldn't the doctors and nurses recite any of it, I doubt that more than the 1 or 2 administrators who developed the rights statement could quote it either. Many of these statements are there because JCAHO requires them. They are published and forgotten. But that doesn't mean that they are unimportant. They are still binding on the institution. But there is usually little point in quoting these statements to the floor nurses or physicians who may not be hospital employees. But if you quote them to the hospital's patient advocate or upper administration, they will take you seriously.

MER said...

I don't know who originally mentioned this book -- My Angels Are Come by Art Stump -- but I just read it and everyone on this blog needs to read it.

It covers much of what we're talking about, from the personal experience of a man who went through prostate cancer treatment. What's important, I think, is that he is extremely observant and quite even-handed in his assessment of the hospital culture. He is able to separate the kind, caring nurses and techs who work with him from the cold, calculating administrative, financial, management of the hospital. As the title of the book suggests, he considers his nurses and techs to be angels.

A horrible experience happened to him, an invasion of privacy and dignity that is almost beyond belief. Excuse me if I use the word obtuse (meaning insensitive and stupid) to describe the people who did this to him. With his reaction, what you see is how traumatic these events can be -- I would call it post-traumatic-stress. His mind, body and spirit completely shut down while the event was happening, a survival strategy our we use to get through things like this. It reminded me of how women describe the shutting down, the out-of-body type experience they have while being raped. This man was emotional raped.

But he fought back. He complained. He wrote a letter. He didn't get a satisfactory letter from the hospital administration -- just a cliche-ridden, lip-service response. But then, he got the final word by writing his book.

I plan to post some quotes from it, but I strongly recommend that you, Joel, create a special thread for responses to this book. Let's see if we can actually get people to read it.

Frankly, I would not grant a license to any doctor or nurse or tech or cna or, especially, hospital CEO, who has not read this book. I exaggerate, of course. But that's how important this book is for the topic we're discussing.

Joel Sherman said...

MER, it makes no difference who was first though it may have been me. Go to the personal privacy violations thread of 12/2/08 to the start the discussion. Alan picked up on it because it's a local hospital for him and commented further.
But yes, the violation is nearly indescribable in its intensity and its effect on the author. I would love to be able to contact the author for further comments, but could not find a contact point, though I suppose if you wrote the publisher they would forward a letter.

MER said...

To PT -- We've occasionally disagreed on some issues, but I found an article that agrees with much of what you've been saying about ethics violations. You'll find it in the November 2009 issue of AARP Bulletin on page 8. It's titled Medical Ethics? --

"Some medical students are making a mockery of the Hippocra-ic oath. A study in the Sept. 23 Journal of the American Medical Association says 60 percent of medical school deans reported they were aware of 'unprofessional content' being posted by students on online social networking sites such as Twitter. The infractions include profanity, sexual suggestive material and breaches of doctor-patient confidentiality." (written by Mike Tucker)

Some of us have commented about some of the unprofessional material posted on allnurses.

I think this may be a generational behavior. I would suggest we may see similar behaviors among younger nursing, cna, med techs, etc. students. And, as PT has suggested, this behavior, practiced and gotten away with while in school, carries on into the profession itself and can be found in hospitals in clinics. I don't know how many medical professionals are guilty of this -- probably a small number. But any number is too much, especially if they are not reported by their fellow professionals.

Joel Sherman said...

I don't doubt the article MER, but I don't know if your conclusion is correct, at least about medical students. Crude behavior has always been around; it's just a little more public on social networking sites. In fact I suspect that overall it's getting better. The kind of crude talk that was tolerated in operating rooms in prior years from gruff military trained surgeons is no longer acceptable.
I don't know though about CNA's, MA's, et. al. Forty years ago that kind of talk would have been considered shocking from a woman. Nowadays it's commonplace in many circles.

MER said...

I don't know what's really going on today, either, Joel. You and Bernstein have a better idea. I'm just posting this article for comment. I do agree that people don't really change that much, the times do -- and the technology within the times. But I do believe that, unless efforts are made to prevent it, the technology can eventually change people's moral and ethical base. That's what may be happening. Human nature will always be a problem to be dealt with.

Joel Sherman said...

Just came across this statement online from an Illinois hospital called patient rights and responsibilities.
Here's the most pertinent section:

Respect and Dignity
You have the right to considerate, respectful care at all times and under all circumstances,
with recognition of your personal dignity. You have the right to have your cultural,
psychosocial, spiritual, and personal values, beliefs, and preferences respected. You have
the right to be free from mental, physical, sexual, and verbal abuse; neglect; and
exploitation.


Notice how carefully worded it is. You have the right to have your beliefs respected, but they don't say that they will grant them if they're against usual hospital procedure. I really don't know if you as a patient are better off with that statement or not. The statement though does list numbers to call on a state and federal level if you have complaints which I have not seen before.

Hexanchus said...

Joel,

Apparently Illinois has a patient's rights law that requires hospitals to provide patients a copy of their rights upon admission.

Url to another I found in Illinois"
http://www.rush.edu/rumc/page-1234554549200.html

Included in their list:
"A patient has a tight to persolan privacy."

Anonymous said...

To Hexanchus and Joel --

The statement you quote, Joel -- I disagree with your conclusion. If the hospital is unable to meet conditions of "respect" and "dignity," they could argue that -- but I don't think it would be successful. If you say you will respect individual values you have an obligation to make that work -- within reason. Now, if they won't go along with certain values for quantifiable medical reasons -- policies that are there for specific, objective, safety reasons -- I can see them refusing after a respectful explanation. But i read that statement as pretty clear. But...

Hexanchus -- I think we often hide behind abstract words that have a high positive connotative value -- words like "respect" and "dignity." Everyone wants to be treated this way and to treat others this way. But what do they actually mean? We could all sit around a table using those words and agree that this is what we want to do. But, once we get to the OR or the wards, or the exam room or the ER -- then we disagree with the actual carrying out process. When we talk about respecting patient values -- implicit is a personal definition of values. The "patient's" values, not the institution's take on how those values should be defined.
I'll see if I can find a few articles I've found trying to deconstruct the meanings of those words. We've got to discuss what we mean them. Their definitions must be embedded within policy statements like the ones quoted.
MER

askandanswer said...

Can you tell me if a pharmacist has the right to ask what condition a prescribed medication is for? Can they ask my doctor? If I have not signed a release will my doctor reveal my medical condition "as one professional to another"? I am in Arizona if that helps. Thanks!

Joel Sherman said...

Askandanswer, pharmacists are covered by state law and you'd have to look up the statutes in Arizona. In general, pharmacists are free to ask about anything, but you are not required to answer any of their questions. Usually what they tell you is informational only. What pharmacists cannot do most places is refuse to give out prescriptions unless they suspect fraud.

Joel Sherman said...

One of my local hospitals just posted this in areas where patients enter:

July

Standard of the Month


Confidentiality/Privacy

· We will protect the dignity and modesty of customers

----- Announcing ourselves and identifying our role when interacting with customers

----- Keeping customers appropriately covered

----- Closing curtains and doors during exams

· We will be sensitive to the customers around us by avoiding loud and/or inappropriate conversations

·We will not discuss customer information in public areas

·We will keep hospital documents secure and out of public view


I had nothing to do with this formulation by the way. I think it is quite good. Unlike what some others have said, hospitals can be willing to put statements about modesty in their protocols and regulations.

Anonymous said...

Joel:

Would you be willing to give the name of that hospital? I don't see why they wouldn't want people to know that they have this posted for patietnts to see. Could you take a photo of the sign and post it? I'd like to send this along to a few other hospitals and ask if they would post the same thing.
MER

Joel Sherman said...

MER,
I'll email you a picture.

Anonymous said...

In my local hospital's Patient Rights & Responsibilities statement they say we have the right "To be informed of your health status and participate in decisions about your healthcare, including informed consent" and "To participate in the development of your plan of care....."

But later they say that we have the responsibility "To cooperate with all persons providing your care and treatment." Is that last statement an "out" for them? If I request and then demand to know exactly what is going to happen to me, who's involved and who will see me exposed would I be considered a difficult patient who won't cooperate with everybody? If I want to be in the decision process of who exactly will be prepping me (I won't accept female CNAs) can they say that I'm not cooperating so they don't have to take responsibility to honor their promise of informed consent or letting me be a part of the decision process? I know you can't read the minds of my local hospital personell but what do you think?

Anonymous said...

Anonymous:
A number of hospitals also have within their patient rights list a statement that you have the right to be treated with respect relative to your values. This is where gender choice comes in. In my experience, most hospital caregivers will try to work with you if you make your needs known. Of course, some won't, and some may look for an "out" by considering you uncooperative. However, if you, as a male, are considered an uncooperative patient for requesting same gender care in some circumstances, then that would mean female patients would be considered uncooperative for asking the same -- which is most often not the case. If you run into trouble, remind them of this double standard. If blindly accepting the gender of one's caregivers regardless of one's comfort or values is what it means to cooperate -- then that applies to both male and female patients.
Doug/MER

Joel Sherman said...

Anon, no one can tell you how they'll respond; they probably don't know either. A large part of it will depend on who you ask and as MER says, how courteously you ask. And indeed, if they refuse you can pointedly ask if they would accommodate a woman. If you leave the request to the day of the procedure or test, anything is possible. They may not be able to accommodate you. But if you make your requests clear in advance with your doctor, there is a reasonable chance they will accommodate you if at all possible. If the procedure or test is urgent, you may well have no choice; women may have no choice either in such a situation.

Anonymous said...

My wife, a 65 year old housewife, needed her right hip replaced, and was scheduled for surgery at Sacred Heart (Providence) hospital in Spokane, WA on Jan. 17, 2011. She had had her left hip replaced in July 2010 at Sacred Heart.

She has had poor outcomes when students have been involved in her care in the past, and did not want students involved. In July, at the sign-in, she X'd out the paragraph giving consent to the use of students. It was no problem, the form was accepted, and the surgery was a success.

On January 17, 2011, when she checked into the hospital at 7:00 a.m., and was presented with the same forms, she again X'd out the same paragraph regarding giving consent to the use of students. The clerical worker stated . . . actually, three times . . . . that they "will not accept an altered form." That was the end of it, and we left and went home; there was no surgery. The hospital is mad, the surgeon is made . . . and we don't think what we requested is wrong. (By the way, this had all been cleared with the orthopedic surgeon, who said that he had no problem with it, and that although he sometimes had other orthopedic surgeons observe his surgeries, he never uses students in surgery, and does his own)

It's is very plain under Washington law that a patient may grant, or withhold, consent as to any individual, or group of providers. In discussion with the hospital since 1/17, all agree that the patient has the right to not have students provide care, and to withhold consent to that. Yet, as Sacred Heart operates, you must consent to student participation in your care, or you cannot get in the door . . . you aren't admitted to the hospital. The so-called Patients' Advocate reaffired that to us on Feb. 10, 2011.

An explanation given at on time by the American Association of Medical Schools regarding the "consent" issue was that the hospital admission form usually covers consent to student involvement in case, "AND THAT THE PATIENT WAS FREE TO DECLINE STUDENT PARTICIPATION."

Isn't consent under such circumstances an "adhesion contract", and therefore void?

Joel Sherman MD said...

Anon, you're asking a legal question and we're not lawyers. I had to lookup what an adhesion contract is which turns out to be a one sided contract. Well I guess it's one sided if you have to accept it. But it seems to me that 90% of contracts we're asked to sign are one sided. I've given up reading internet agreement contracts. So many of them contain absolutely outrageous clauses such as indemnification clauses that I've decided my legal position is better if I can claim ignorance. However medical consent forms are different in kind. One sided agreements are not per se illegal to my understanding unless they are disguised on the form.
I'm not sure what your intent is. If you want to sue them your case is not clearly winnable to me. To my mind, better than suing is what you have already done, protesting enough to the hospital that they have gotten the message. That's more likely to change their behavior in the future especially when your surgeon doesn't usually use students and this is not apparently a teaching service.
Hope that helps.

Anonymous said...

I hope this topic is still looked at. It's in most "rights" statements that a person has the right to have a 3rd person of the same gender in the exam room if the doc is of the opposite gender. Is it required though? I've seen in a few places that some hospitals require it to guard against the doc being accused of anything. I'm a pretty private person and can't stand the idea of anyone else being in the room during an exam. I go to ben taub in houston and when I met the first Fellow who treated me for his 2 years, he decided that I needed a physical (without telling me ahead of time). Before getting to the genital exam, he called his attending in. He then had me lay on the table, he undid my pants (is that normal??) and exposed me. Never told me what he was going to do and the attending was busying trying to engage me in distracting small talk so I didn't feel I had much chance to object. Freaked me out but didn't feel like I could say anything...it had already happened and what could be done about it now? I'm sure they forgot about it before they left the room. I had a bad dreams about it for a week. At least neither was female. (I think I'm one of those guys in the minority who is profoundly uncomfortable with even talking about male specific concerns with a female doc or nurse. It's nothing to do with their abilities but with some unpleasant experiences as a child). As this is a teaching hospital, I understand the need to have one's teacher review their work (I'm a teacher myself) but can't an exception be made for this sort of thing? Is there really a legal requirement to have a third person in the room?

Joel Sherman MD said...

Anon, every state has different regulations but I'm aware of no state that requires chaperones to be present for adult exams. Delaware may require them for pediatric exams.
Many states and/or medical societies recommend that chaperones be present for intimate exams. But these only rarely rise to the status of legal requirements.
In short, yes, you could have refused to have a chaperone of any gender present, though it is possible that they would have refused to proceed with the exam.

Anonymous said...

My wife had a hernia repair a few weeks ago. She chose her surgeon based on her PCM's recommendation that this surgeon had a good bedside manner and was a good surgeon. The partner in the group her PCM said was a good surgeon with no bedside manner. Unforuately my wife got to see this first hand during Saturday moening rounds. He walked in, introduced himself, ask if she had any complaints, she told him her stomach was very very sore. He said it was to be expected. He grabbed the sheet an her gown and went in opposite directions leaving her naked on the bed. I was standing at the foot of the bed, he never ask if I was the husband, if she minded me being in the room, did she want a nurse in there. I could of been a friend, pastor, brother anyone. He said it looked good and said have a good day and walked out. No more concern for her privacy than the man in the mood. Only had to deal with him once, thankfully the PCM gave her a heads up on this persone demeanor.

Gene

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