Monday, December 27, 2010

2 A Reminder: Your Patients' Bill of Rights

If you're a patient, you may have seen this bill of rights hanging in your doctor's office.

I'm reprinting it here as a reminder to empower yourself. To ask questions. To learn about options. To ask about risks and benefits for a specific treatment. To refuse a treatment until you have researched it more, or refuse the treatment entirely from the moment it is suggested.

The Association of American Physicians and Surgeons adopted a list of Patient Freedoms in 1990 [3] which was modified and adopted as a Patients' Bill of Rights in 1995 [4]:

All patients should be guaranteed the following freedoms:
  • To seek consultation with the physician(s) of their choice;
  • To contract with their physician(s) on mutually agreeable terms;
  • To be treated confidentially, with access to their records limited to those involved in their care or designated by the patient;
  • To use their own resources to purchase the care of their choice;
  • To refuse medical treatment even if it is recommended by their physician(s);
  • To be informed about their medical condition, the risks and benefits of treatment and appropriate alternatives;
  • To refuse third-party interference in their medical care, and to be confident that their actions in seeking or declining medical care will not result in third-party-imposed penalties for patients or physicians;
  • To receive full disclosure of their insurance plan in plain language, including:
  1. CONTRACTS: A copy of the contract between the physician and health care plan, and between the patient or employer and the plan;
  2. INCENTIVES: Whether participating physicians are offered financial incentives to reduce treatment or ration care;
  3. COST: The full cost of the plan, including co-payments, coinsurance, and deductibles;
  4. COVERAGE: Benefits covered and excluded, including availability and location of 24-hour emergency care;
  5. QUALIFICATIONS: A roster and qualifications of participating physicians;
  6. APPROVAL PROCEDURES: Authorization procedures for services, whether doctors need approval of a committee or any other individual, and who decides what is medically necessary;
  7. REFERRALS: Procedures for consulting a specialist, and who must authorize the referral;
  8. APPEALS: Grievance procedures for claim or treatment denials;
  9. GAG RULE: Whether physicians are subject to a gag rule, preventing criticism of the plan.


  1. ****All patients should be guaranteed****

    But are NOT guaranteed. :(

    And too vigorous a 'questioning' can result in being 'dismissed' from that doctor's practice.

    What is 'right' isn't always what happens in the real world. How does a patient assure their 'rights' and what do you think about the egregious denial of those 'right' by some doctors?

  2. I think if I can't ask my doctor questions that are important to my treatment and well-being and get the answers I need to make an informed decision, that I'm going to look elsewhere. The doctor-patient relationship is so important to me that even though I know it takes more time, I'll look for someone new rather than continue with someone who is more convenient to see but less accessible in other ways.

    I think it's useful to get reviews and referrals from other patients who are friends whose opinions I trust - and even more so, if I have doctors who are friends, to ask, "If you had such-and-such condition, where would you go and where would you send *your* family?" Because I often find very good doctors that way, once I've found one doctor I have good rapport with. My own primary care physician helped me find a number of good specialists this way (though not so much Lyme-related).

    I am not sure how a patient can assure their own rights. Are the rights in this entire bill legally binding? I suspect some of them are and contractual, but the remainder of them fall into a gray area. If they're legally binding, a patient can choose to take action; if the patient does not want to, the patient can go elsewhere and tell his or her friends what they thought of their experience with that doctor. Either way, people will make their own judgments.

    The reason I posted this bill was as a reminder to myself (and to others who might need to see it) that as a patient I should be asking all my doctors (and not just LLMDs) if they are offering me treatment choices based on my insurance plan and what they could offer me instead if price were no object; to be able to ask them about the existence of a gag rule so I know it's there (yes, I know you can't talk about x or y, but can you *tell me* you can't talk about having a gag rule in general without the specifics?); to be able to ask them questions about my treatment and get answers - including ones I may not like but will respect because they are true.


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