There has been a paradigm shift in the doctor-patient relationship. The balance is no more tilted in favor of the doctor as patients do not regard doctors as “parent figures” who took medical decisions on their behalf. They are equal partners in decision making today.
All patients have the right to know their health status and treatment. This right to information arises out of the principle of patient “autonomy”, which means that patients have the right to choose their doctor, the type of treatment. They even have the right to reject treatment.
Understanding this right of the patient builds a strong doctor-patient relationship, which is based on mutual trust and respect.
Patient autonomy is the legal and ethical basis for informed consent, which again gives the patient the right to make decisions about their health based on the information given. Failure to give all the facts to the patients that are necessary for them to take a decision regarding their treatment is a violation of their rights.
A valid consent has three components: Disclosure, Capacity and Voluntariness i.e. provision of relevant information by the doctor, capacity of the patient to understand the information given and take a decision based on the adequate information, without force or coercion. This is informed consent. Any permission given under any unfair or undue pressure makes the consent invalid.
Informed consent is not only an ethical obligation, but also a legal pre-requisite today. Not taking consent is gross negligence.
The National Human Rights Commission has drafted a charter of patient rights to be implemented by the Ministry of Health and Family Welfare.
The Right to Information is as follows:
“Every patient has a right to adequate relevant information about the nature, cause of illness, provisional / confirmed diagnosis, proposed investigations and management, and possible complications to be explained at their level of understanding in language known to them.
The treating physician has a duty to ensure that this information is provided in simple and intelligible language to the patient to be communicated either personally by the physician, or by means of his / her qualified assistants.
Every patient and his/her designated caretaker have the right to factual information regarding the expected cost of treatment based on evidence. The hospital management has a duty to communicate this information in writing to the patient and his/her designated caretaker.
They should also be informed about any additional cost to be incurred due to change in the physical condition of the patient or line of treatment in writing. On completion of treatment, the patient has the right to receive an itemized bill, to receive an explanation for the bill(s) regardless of the source of payment or the mode of payment, and receive payment receipt(s) for any payment made.
Patients and their caretakers also have a right to know the identity and professional status of various care providers who are providing service to him / her and to know which Doctor / Consultant is primarily responsible for his / her care.
The hospital management has a duty to provide this information routinely to all patients and their caregivers in writing with an acknowledgement.”
· Annexure 8 of standards for Hospital level 1 by National Clinical Establishments Council set up as per Clinical Establishment Act 2010
· MCI Code of Ethics
· Patients Charter by National Accreditation Board for Hospitals (NABH)
· The Consumer Protection Act, 1986
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA