MANAGING PATIENT'S RIGHTS PROBLEMS

Whether or not a health care provider chooses to institute a patients' rights information program, there must be an administrative mechanism to deal with patient's rights problems. These problems may be informational, or they may involve therapeutic problems, such as medication errors. Informational problems concern questions of diagnosis, therapy, and prognosis. These questions may indicate a failure of informed consent or a misunderstanding between the physician and patient. While such problems usually do not directly involve situations that expose patients to physical injury, they can lead to liability if the misunderstanding results in inappropriate therapy. Therapeutic problems are more serious, because they may directly lead to patient injuries. Therapeutic problems involve errors in carrying out proper orders, in carrying out improper orders, or in having no orders at all. Patient complaints of therapeutic problems must be taken seriously and be fully explored at once. This requires the cooperation of both the medical and the nursing staffs. The potential reduction in patient injuries from such cooperation is great.

As the preceding material suggests, a hospital should encourage patients with problems to discuss them with a member of the hospital staff. To encourage this, the hospital should provide each patient with a basic information package upon admission to the hospital. This may be as elaborate as a patient rights handbook, or as simple as a single sheet explaining the hospital policy on visiting hours, visits by children, and other basic information that a patient should have. Included in this information should be the name of one person (or more in large facilities) whom the patient may personally contact if there are problems. There should also be a 24-hour phone number to handle therapeutic problems and other matters that will not wait until morning.

In many cases, just giving the patient a sympathetic hearing will defuse a potentially dangerous situation. This type of informal conflict management is important both to reduce lawsuits and to improve the reputation of the facility in the general community. For a physician, either in solo or group practice, the time invested in handling patient complaints and misunderstandings will be amply repaid in reduced litigation claims.

The patient's personal relationship with the physician is a major determinant of whether the patient will sue the physician. Well-liked physicians are seldom sued, irrespective of their professional competence. In most cases, patients will sue physicians they like only if they suffer a major injury that is clearly due to negligent treatment. On the other hand, competent physicians with poor "bedside" manners may be sued over minor mishaps that a better-liked physician would not be sued for. While this may seem unreasonable, it must be remembered that few patients have the technical expertise to judge the quality of the medical care they receive. They judge their care on more subjective criteria, such as how they feel physically and how they were treated psychologically. As long as the patients feel physically better, the well-liked and the dislike physician are in the same position. When the patient does not physically improve, that patient's state of mind becomes much more important in determining whether or not to sue the physician.

This does not mean that the patient can win a suit that is not based on a strong case of negligence. However, the proper goal of a quality control strategy is not to win lawsuits but to prevent them. This is because relatively few negligent incidents ever result in claims, much less litigation. This is especially true in the hospital setting. Any large hospital will experience a certain level of negligent injuries, yet only in rare cases will the level of litigation reach the level of the occurrence of incidents. A successful public relations effort that reduces the likelihood of lawsuits being filed will reduce both founded and unfounded lawsuits.

The public relations component in a patient's decision to sue is very important because it an lead a health care provider to confuse a lack of lawsuits with a lack of negligence. Many large, prestigious hospitals have a good reputation and are well-liked by their communities. These hospitals will have few malpractice claims filed against them, independent of the level of negligent injuries that occur in the facility. This leads to a false sense of security and lax mechanisms for monitoring the quality of care. If some event, either internal or external to the hospital, changes the public perception of the hospital, there may be an avalanche of litigation. Such a hospital will be especially vulnerable to suits based on corporate liability theories because of its history of poor monitoring of medical care.

In addition to its impact on risk management, a patients' rights education program can have a beneficial impact on the public image of the hospital. In today's competitive health care market, it is important that a facility hold onto its patient base. This is particularly true of older hospitals that may be competing with modern new facilities. While patients may be attracted by the physical plant of the newer facility, there is a growing tendency for younger, more affluent patients also to be concerned with patients' rights issues. These patients are becoming increasingly concerned about the way the hospital treats them, and less concerned with the age of the hospital.

While traditionally hospitals have marketed only to physicians, the trend to walk-in care illustrates the importance of direct appeals to the community. A highly visible patients' rights education program can help to attract the younger, more sophisticated patients that older hospitals tend to lose to newer facilities. Through the good will it can generate, such a program can also help a facility in its fund-raising efforts.