Doctor Patient Relationship

These days with so much worry about mesh, women are wondering if their doctor is liable if he/she uses mesh without your consent or removes part of your body without you know about it. It took a while until I found a good article that really explained what your rights are. It is very long, so I took some paragraphs as a guide and will give you the link.

One of the things women are concerned about is patient confidentiality. There are doctors who threaten women if they dare state the things that went wrong during their surgery and you should know that confidentiality is on the doctor’s side, not yours. If you want to tell what happened to you, you have every right to do it but finding the right place to do it is the problem.

Support groups are not the place because you open yourself up to criticism by those who’ve decided that your doctor is so wonderful and can’t do any wrong, so my advice is to put your complaint in writing in the proper places. You may wonder where and I will give you a link to a blog I wrote in the past that will explain what you can do.

So first up what does consent mean? The article gives examples of cases that have gone to court. The problem is, taking a doctor to court is very expensive so if you find something has happened during your surgery, once again go to the link I provide and complain to the proper organization that will take up your issue for you.

Consent

Consent, particularly informed consent, is the cornerstone of patients’ rights. Consent is based on the inviolability of one’s person. It means that doctors do not have the right to touch or treat a patient without that patient’s approval because the patient is the one who must live with the consequences and deal with any dis-comfort caused by treatment. A doctor can be held liable for committing a battery if the doctor touches the patient without first obtaining the patient’s consent.

The shift in doctor-patient relationships seems inevitable in hindsight. In one early consent case, a doctor told a woman he would only be repairing some cervical and rectal tears; instead he performed a hysterectomy. In another case, a patient permitted her doctors to examine her under anesthesia but insisted that they not operate; the doctors removed a fibroid tumor during the procedure. In yet another case, a doctor assured a man that a proposed operation was simple and essentially without risk; the patient’s left hand was paralyzed as a result of the surgery.

Consent must be voluntary, competent, and informed. Voluntary means that, when the patient gives consent, he or she is free from extreme duress and is not intoxicated or under the influence of medication and that the doctor has not coerced the patient into giving consent.

Informed Consent

Simply consenting to treatment is not enough. A patient must give informed consent. In essence, informed consent means that before a doctor can treat or touch a patient, the patient must be given some basic information about what the doctor proposes to do. Informed consent has been called the most important legal doctrine in patients’ rights.

State laws and court decisions vary regarding informed consent, but the trend is clearly toward more disclosure rather than less. Informed consent is required not only in life-or-death situations but also in clinic and outpatient settings as well. A healthcare provider must first present information regarding risks, alternatives, and success rates. The information must be presented in language the patient can understand and typically should include the following:

  • A description of the recommended treatment or procedure;
  • A description of the risks and benefits—particularly exploring the risk of serious bodily disability or death;
  • A description of alternative treatments and the risks and benefits of alternatives;
  • The probable results if no treatment is undertaken;
  • The probability of success and a definition of what the doctor means by success;
  • Length and challenges of recuperation; and
  • Any other information generally provided to patients in this situation by other qualified physicians.

Only material risks must be disclosed. A material risk is one that might cause a reasonable patient to decide not to undergo a recommended treatment. The magnitude of the risk also factors into the definition of a material risk. For example, one would expect that a one in 10,000 risk of death would always be disclosed, but not a one in 10,000 risk of a two-hour headache.

Informed consent is rarely legally required to be in writing, but this does provide evidence that consent was in fact obtained. The more specific the consent, the less likely it will be construed against a doctor or a hospital in court. Conversely, blanket consent forms cover almost everything a doctor or hospital might do to a patient without mentioning anything specific and are easily construed against a doctor or hospital. However, blanket forms are frequently used upon admission to a hospital to provide proof of consent to noninvasive routine hospital procedures such as taking blood pressure. A consent form may not contain a clause waiving a patient’s right to sue, unless state law provides for binding arbitration upon mutual agreement. Moreover, consent can be predicated upon a certain surgeon doing a surgery. It can also be withdrawn at any time, subject to practical limitations.

I know women who have left the hospital when they feel something is very wrong and later have to go back to the Emergency room because they are hemorrhaging. If you feel there is too much blood leaving your body, stand your ground and ask to see your physician. Don’t get pushed out the door when you are having extreme pain or blood loss. Have someone you trust there at time of discharge who will stand up for you. Read the following.

A doctor familiar with a patient’s condition determines when a patient is ready for discharge and signs a written order to that effect. If the patient disagrees with a decision to discharge, she or he has the right to demand a consultation with a different physician before the order is carried out. The decision to discharge must be based solely on the patient’s medical condition and not on nonpayment of medical bills.

If you feel your insurance company is refusing the care you need you can protest. I know many women who have insurance who say they can’t go out to UCLA because they are not in their network. Strong determined women fought hard and won. Some had to get Dr. Raz on board when they got out there and then their insurance decides they are not going to pay. I have had women call me crying and I told them to get in touch with him and he would help. They did and so did he. Don’t ever give up!

With the rise of managed care and Health Maintenance Organizations (HMOs), patients faced new issues involving the right to treatment. HMOs may deny authorization for expensive or experimental treatments, or for treatments provided outside the network of approved physicians. HMOs contend that they must control costs and make decisions that benefit the largest number of members. In response, state legislatures have enacted HMO regulations that seek to give patients a process for appealing the denial of benefits. The HMOs have opposed these measures and have vigorously defended their denial of benefits in court.

I think most of us have signed one of these when we go for surgery but we may not understand the laws and our rights.

Advance Medical Directives

Every state has enacted advance medical directive legislation, but the laws vary widely. Advance medical directives are documents that are made at a time when a person has full decision-making capabilities and are used to direct medical care in the future when this capacity is lost. Many statutes are narrowly drawn and specify that they apply only to illnesses when death is imminent rather than illnesses requiring long-term life support, such as in end-stage lung, heart, or kidney failure; multiple sclerosis; paraplegia; and persistent vegetative state.

Patients sometimes use living wills to direct future medical care. Most commonly, living wills specify steps a patient does not want taken in cases of life-threatening or debilitating illness, but they may also be used to specify that a patient wants aggressive resuscitation measures used. Studies have shown that living wills often are not honored, despite the fact that federal law requires all hospitals, nursing homes, and other Medicare and Medicaid providers to ask patients on admission whether they have executed an advance directive. Some of the reasons living wills are not honored are medical personnel’s fear of liability, the patient’s failure to communicate his or her wishes, or misunderstanding or mismanagement by hospital personnel.

Now about confidentiality. Note nothing says a patient cannot talk about what happened to them when they had a surgery. If there was, we would find nothing on the Internet about all the terrible things that have happened to women and no one would be allowed to say anything in public. Just remember this fact. You can talk, they can’t! Don’t let anyone bully you to stay quiet if you are injured badly.

Privacy and Confidentiality

Confidentiality between a doctor and patient means that a doctor has the express or implied duty not to disclose information received from the patient to anyone not directly involved with the patient’s care. Confidentiality is important so that healthcare providers have knowledge of all facts, regardless of how personal or embarrassing, that might have a bearing on a patient’s health. Patients must feel that it is safe to communicate such information freely. Although this theory drives doctor-patient confidentiality, the reality is that many people have routine and legitimate access to a patient’s records. A hospital patient might have several doctors, nurses, and support personnel on every shift, and a patient might also see a therapist, nutritionist, or pharmacologist, to name a few.

The law requires some confidential information to be reported to authorities. For example, birth and death certificates must be filed; child abuse cases must be reported; and infectious, contagious, or communicable diseases must be reported. In addition, confidential information may also be disclosed pursuant to a judicial proceeding or to notify a person to whom a patient may pose a danger.

In spite of the numerous exceptions to the contrary, patients legitimately demand and expect confidentiality in many areas of their treatment. Generally speaking, patients must be asked to consent before being photographed or having others unrelated to the case (including medical students) observe a medical procedure; they have the right to refuse to see anyone not connected to a hospital; they have the right to have a person of the patient’s own sex present during a physical examination conducted by a member of the opposite sex; they have the right to refuse to see persons connected with the hospital who are not directly involved in the patient’s care and treatment (including social workers and chaplains); and they have the right to be protected from having details of their condition made public.

A patient owns the information contained in medical records, but the owner of the paper on which they are written is usually considered the actual owner of the records. The patient’s legal interest in the records generally means that the patient has a right to see the records and is entitled to a complete copy of them. The patient’s rights are subject to reasonable limitations such as requiring inspection and copying to be done on the doctor’s premises during working hours.

This is the link to the full article

Don’t be afraid to report what has happened to you, just
report it in the right place.

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