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Treatment Participation, Access to Emergency Services and Choice of Plans All Part of Patient Rights

Susanna Sisson's picture
Doctor and Patient Care

You have the right to accurate and easily-understood information about your health plan, health care professionals, health care facilities and treatments. However the entire process can be daunting. If you speak another language, have a physical or mental disability, or just don’t understand something, help should be given to clarify, help you understand and make well informed health care decisions. So, what are your rights?


Choice of providers and plans

You have the right to choose health care providers who can give you high-quality health care when you need it and you should also be aware that cost can vary greatly between providers. The second annual study of health care costs in the 30 most populous cities in the US, released by Castlight Health, can help you ascertain if you are paying more than you should for health care services and tests. [1]

Access to emergency services

If you have severe pain, an injury, or sudden illness that makes you believe your health is in danger, you have the right to be screened and stabilized using emergency services. You should be able to use these services whenever and wherever you need them, even if they’re out of your network, without needing to wait for authorization and without any financial penalty.

Taking part in treatment decisions

You have the right to know your treatment options and take part in decisions about your care. You have the right to ask about the pros and cons of any treatment, including no treatment at all. You have the right to refuse any test or treatment, even if it means you might have a bad health outcome as a result. You can also legally choose who can speak for you if you cannot make your own decisions.

Respect and non-discrimination

You have a right to considerate, respectful care from your doctors, health plan representatives, and other health care providers without discrimination against you based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.

Confidentiality (privacy) of health information

You have the right to talk privately with health care providers and have your health care information protected. You also have the right to read and copy your own medical record. You have the right to ask that your doctor change your record if it’s not correct, relevant, or complete. HIPAA law mandates that your personal information be held private.

Complaints and appeals

You have the right to a fair, fast, and objective review of any complaint you have against your health plan, doctors, hospitals, or other health care personnel. This includes complaints about waiting times, the actions of health care personnel, and the adequacy of health care facilities.

Other bills of rights

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The above bill of rights focuses on health insurance plans, but there are many others with different focuses. There are special kinds, like

  1. Mental health bill of rights
  2. Hospice patient’s bill of rights
  3. Rights of people in hospitals

With regard to administration of medication you, the patient have the following rights when receiving drugs, and nurses are supposed to explain what medication and effects to expect.

• Right patient
• Right medication
• Right dose
• Right time
• Right route
• Right documentation

In addition every nurse has the right to refuse to administer a medication. I have had to exercise that right many times in my nursing career, especially working in teaching hospitals.

What are your responsibilities as a patient?

It is important to know your rights as a patient in order to make decisions regarding your care. I recommend you research side effects and benefits if being placed on any medication before you take the drug. Keep a notebook with questions you want to ask your physician during office visits because often we forget. If necessary ask a family member or friend to be your patient advocate. Know your rights and don’t be afraid to ask questions. If you feel you are being bullied by asking for clarification or alternatives or if you are threatened you should know that you have the right to file a complaint. Being proactive can and does eliminate issues with health care or treatments.

In a health care system that protects consumer or patients’ rights, patients should expect to take on some responsibilities. For instance, patients must tell their health care providers about any medicines they are taking, and about health conditions and medical or surgical problems in the past or present. Patients must ask questions or request further information from health care providers if they do not completely understand health information and instructions.

Also do not assume your doctor has does not make mistakes or knows all the side effects or drug interactions. They see hundreds of patients every week.

Donald Wright, a professor at the University of Medicine and Dentistry of New Jersey, School of Osteopathic Medicine and founding fellow of the Center for Bioethics at the University of Pennsylvania write, “Few know that systematic reviews of hospital charts found that even properly prescribed drugs (aside from mis-prescribing, overdosing, or self-prescribing) cause about 1.9 million hospitalizations a year. Another 840,000 hospitalized patients are given drugs that cause serious adverse reactions for a total of 2.74 million serious adverse drug reactions. About 128,000 people die from drugs prescribed to them.” [2] Wright co-authored with Norman Daniels and Ron Caplan, Benchmarks of Fairness for Health Care Reform (1996) and edited The Risks of Prescription Drugs (2010). [3]

Patients must also take responsibility for their lifestyles to help improve their own health (for instance, following a treatment plan, eating healthy, exercising, not using tobacco and using moderation in alcohol consumption. Patients are expected to do things like treat health care workers and other patients with respect, try to pay their medical bills, and follow the rules and benefits of their health plan coverage. Having patients involved in their care increases the chance of the best possible outcomes and helps support a high quality, cost-conscious health care system.

As a nurse, I have been asked why doctors are so averse to alternatives or adjuvants with regard to their patient’s health choices. There are multiple reasons. Most have a mind-set of illness, not wellness. Most only know what they learned in an already biased medical school. Most, do not take the time to do the research. Most fear criticism from peers or even being reprimanded by state boards if they do not follow protocols. But if you are interested in using an alternative then you do have that right.

Here is my advice as a health professional. Ask what they do. Doctors typically choose a different course of treatment for themselves than they do for patients! Sad, but true; and I have many friends who are doctors

I am a patient advocate, an educator, and believe in transparency with regard to cost as well as a provider’s capability. I believe people should have the right to a second opinion and even changing doctors but above all they have the right to informed consent and the right to choose. To not inform a patient of his or her rights is not only unethical, it is a criminal violation.

1. Castlighthealth.com
2. Harvard University
3. Harvard.edu