Patient Dignity 12: Does a Patient Have the Right to Choose the Level of Care He Wishes to Receive?

Does a Patient Have the Right to Choose the Level of Care He Wishes to Receive?

Why is it "All or Nothing" "My Way or the Highway?"

Medicine recognizes a Patient's Right to Self-Determination (and the right to choose the level of service they receive) in "Advanced Directives." But very often physicians ignore advanced directives (see: NY Times Article here). A study published in the Oncology Times (here) also supports this.

If as a patient I just want my heart, lungs, BP, cholesterol, and sugar checked, WHY DO I HAVE TO SUBMIT TO A PROSTATE EXAM?

If I refuse a prostate exam, I do expect you to talk to me about options: PSA test, ultrasounds, etc. I don't expect you to diagnose me if I get prostate cancer and refused ALL tests. Just because a patient refuses a procedure (DRE), does NOT mean that they refuse prostate health.

If I have lung cancer, I would expect that you catch that.

Resistance of the Patient as a Consumer

Providers resist the idea that patients are consumers. I agree (believe it or not). So why do patients fall back on this notion? Because the lack of respect for our self-determination. You can not deny that healthcare is subject to some of the forces that govern the economics of trade: supply and demand for instance.

If providers respected patients' rights to self-determination, to choose the level of car we wish to receive, each individual's definition of what our (individual) definition of dignity is, and accommodate it to the extent possible (NOT to the extent that it is convenient), then we would not see ourselves as consumers.

Inconsistency

The problem is inconsistency. Many patients can have a positive, caring, trusting relationship with their provider and never take their pants off.  We hear the phrase, "I can't give you the best care if you don't..."

Take the issue of having to remove your underwear for outpatient hand surgery. Consider the the standard procedure for prepping a patient for all surgery, including outpatient: naked wearing only a gown, wheeled into the OR on a gurney. Consider what LDS Hospital in Salt Lake City, Utah did as part of their overhaul of healthcare delivery in 1998:

SOME PATIENTS were especially bothered to spend half the day without underwear -- for shoulder surgery, say. Ms. Lelis was convinced this longstanding practice was meaningless as a guard against infection, persisting only as the legacy of a culture that deprived patients of control. "If you're practically naked on a stretcher on your back," she says, "you're pretty subservient." The nurses persuaded an infection-control committee to scrap the no-underwear policy unless the data exposed a problem; they have not. Source: The Wall Street Journal

So if LDS Hospital in Salt Lake City, Utah has been doing this since 1998, why are all hospitals NOT doing this? When providers give us ANY EXCUSE (NOT REASON), it boils down to "this is how we have always done it." As patients we know the real reason, we know that you are lying, and we don't trust you. 

Building Trust

It would be far better to allow us as patients to choose our level of healthcare that we are comfortable with. Then build our trust, work with us, and if you have earned that trust, we WILL TAKE A CHANCE ON YOU. 

--Banterings