PATIENTS' RIGHTS AND RISK MANAGEMENT

Most health care providers, hospital administrators in particular, feel threatened by the patients' rights movement. While patients' demands for a larger role in determining their own medical care seem disruptive, they may in fact prove beneficial to the quality control program.

Indeed, a well-informed patient is the best line of defense against medical negligence. For example, the patient who knows what therapies and drugs have been ordered will be in a good position to cooperate with the nursing staff in preventing medication errors. If a patient refuses a blue pill because all the previous pills were green, the nurse should carefully check the medication orders before demanding that the patient take the blue pill. Questioning patients may be troublesome, but they reduce the risk of nursing mistakes.

It is the compliant patient, the one who follows orders without protest, who is the legal time bomb. When investigating a patient injured by a mistaken therapy, it is not unusual to find that the patient knew the nurse was mistaken but did not object. Most patients are very reticent about questioning their physician's decisions. They must be encouraged to ask questions and not to feel that the questioning will hurt their relationship with either the nurses or their physician. A well-informed patient will be able to determine if the nursing staff is providing the correct treatment without having to feel that this will be seen as questioning the physician's decisions.

From a quality control perspective, a patient's rights program should have two objectives: (1) informing the patients about their rights and duties in the health care system, and (2) providing an effective administrative mechanism to translate increased patient involvement into a more effective quality control program. The quality control manager should be prepared to work with the nursing and medical staffs to overcome any initial reluctance toward providing information on patient's rights. The quality control manager should keep in mind that most patient's rights are really legal duties of the health care provider that should be attended to whether the patients demand them or not. Violations of a patient's rights will often subject the health care providers to legal liability. Informing patients of their rights, on the other hand, can reduce the chance of liability by reducing inadvertent violations of the law.

Before discussing the administrative support needed to take advantage of patient input into the risk management program, it will be helpful to review the type of information that should be given to patients. In the following section, we present a sample patient rights handbook. The material in it is adapted from a handbook that the authors prepared for the Texas State Bar Association's Young Lawyers Division. The handbook has been published in booklet form by the Texas Bar Association and has been distributed free of charge to persons interested in their rights as patients. The booklet stresses both the patient's rights and the limits of those rights. In our opinion, the greatest benefit of patient rights information is in reducing unreasonable expectation by patients. To this end, health care providers may make use of already prepared booklets, such as that published by the Texas Bar Association, or they may adapt materials, such as the following sample, to their needs.