Patients’ Responsibilities Seem Half-Baked

You see them on hospital walls and hospital websites. Perhaps you even saw one in a patient admission packet if you or someone close to you had a hospital stay. I’m referring to the statements of patients’ rights and responsibilities issued by hospitals throughout the United States and beyond. The very notion of patients’ rights seems reassuring, and I’m glad that hospitals tell patients that they have a right to be treated with respect and to receive quality health care without being discriminated against, among other rights. However, some of the patients’ responsibilities statements reveal unrealistic expectations of patients, send mixed signals about patients’ autonomy, or include parts that seem downright silly.

For instance, The Johns Hopkins Hospital tells patients:

You are expected to provide complete and accurate information about your health and medical history, including present condition, past illnesses, hospital stays, medicines, vitamins, herbal products, and any other matters that pertain to your health, including perceived safety risks.

While patients may be the best, and at times, only handy source for much of this information, they may have trouble giving a full and accurate medical history. I write about medicine and health care, but I’d have trouble giving a full medical history—let’s see, what was the name and dosage of the medicine I took in 1997?

Some hospitals, such as Mayo Clinic‘s, add language like “to the best of your knowledge,” a welcome recognition that patients might lack perfect memory, particularly when they are sick, sedated, preoccupied, or comatose. Perhaps they should also add “to the best of your doctors’ attention span.” After all, doctors interrupt patients in 23 seconds on average, stopping them from giving anywhere near their full medical story.

Even worse, perhaps, some of the statements muddle up patient autonomy. What the rights statements seem to give, the responsibilities statements undo. For example, Massachusetts General Hospital weakly endorses patient autonomy in its patients’ rights and responsibilities statement. It tells patients: “You have the right to say yes to treatment. You also have the right to say no or refuse treatment.”

Oddly, the statement says nothing about collaborative decision-making. In fact, its responsibilities list could make patients doubt that hospital clinicians would welcome patients partnering with them to make decisions. It tells them to “follow the treatment plan recommended by the practitioner primarily responsible for your care.” It does not say, “The treatment plan developed by the patient and practitioner together.” Alas, the statements of other hospitals (e.g., University of Iowa Hospitals and Clinics, Presbyterian/St. Luke’s Medical Center) suggest similar ambivalence about patients having a say.

In addition, Massachusetts General urges patients to “make sure that you, the practitioner primarily responsible for your care and your surgeon all agree on exactly what will be done during the operation.” That seems a tall order for patients on the cusp of surgery. Few inpatients can correctly identify the doctor in charge of their care, and many can’t even state their diagnosis in lay or medical terms. Surely the two clinicians can work out the details directly without patients passing messages between them.

On the other hand, Geisinger Health System, among others, affirms patients’ rights to be “involved in care planning and treatment” and to receive “effective communication.” However, one item in its patient responsibilities list might not count as good communication: “Avoid drugs, alcoholic beverages or toxic substances, which have not been administered by your doctor.” Perhaps Geisinger patients sip doctor-provided martinis in their hospital beds, but I doubt it.

Lest rowdiness break out, New York/Presbyterian Hospital/Columbia University Medical Center advises patients to “be considerate of the rights of other patients and hospital personnel, especially with regard to minimizing noise, refraining from smoking, and assuring the appropriate conduct of your visitors.” Similarly, Beth Israel-Deaconess Medical Center instructs patients to “do what you can to help control noise, and ensure that your visitors are considerate as well.” Of course, few of us can control our family and friends even when we’re healthy.

On any day you might become hospitalized, don’t bring your bling. Like many hospitals, Johns Hopkins asks patients to “leave valuables at home and bring only necessary items.” Sorry, Hopkins, but I don’t think the ambulance driver will stop at my house on the way to the emergency room so that I can drop off my wallet. Like many patients, I’d be lost without a cell phone; does the hospital deem that valuable or necessary?

Health care has come a long way since 1973, when the American Hospital Association issued its first patient’s bill of rights, and Dr. Willard Gaylin likened it to “the thief lecturing his victim on self-protection.” After all these years, patients’ rights and responsibilities statements—what they say and what they leave out—show just how far hospitals still have to go to make patient-centered care the norm.

Photo copyright Cathy Yeulet/123rf.com stock photo

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Dear Readers,

Now that I’ve had my say, what do you think of what hospitals tell patients about their rights and responsibilities?

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