Your rights and obligations as a patient
Very recognizable: one doctor recommends a treatment or medicine, a second advises the opposite. And the patient is in between and doesn’t know what to do.
A man goes to the doctor for a cholesterol-lowering drug. The GP prescribes this according to the NHG standard; this is a protocol of the Dutch College of General Practitioners (NHG) that general practitioners follow with certain disorders. Later, this patient sees a cardiologist. He believes that with this ‘average means’ the target values for cholesterol cannot be met and prescribes a more expensive drug. The patient then goes to his GP for a repeat prescription. He refuses, because according to his protocol he is not allowed to prescribe these expensive drugs first.
Unfortunately, this kind of situation is quite common. In a recent study by the Dutch Patients Consumer Federation (NPCF) a quarter of the more than 2,000 respondents reported receiving conflicting advice from health care providers. Then the says physiotherapist that considerable practice is required, while the orthopedist believes that the foot should have absolute rest. Or a specialist gives a patient a pain reliever after a hip surgery, while he is not allowed to have that at all due to a stomach disorder.
‘I don’t accept this’
Conflicting advice can have three causes:
1. There may be a competency battle between two treating physicians.
2. Doctors may simply disagree.
3. Much more often, however, there is a lack of consultation due to a lack of communication.
“The GP can’t get the specialist on the phone – which happens more often than you might think – and in the end he just does what he thinks is best,” says Lode Wiersma of the Royal Netherlands Society for the Promotion of Medicine (KNMG). “The patients who can do the worst with the conflicting advice are the people who don’t dare to protest. Who do not dare to say: ‘I do not accept this, you should find this out together.’”
The more caregivers, the greater the risk of poor communication and therefore of misunderstanding. Chronic patients, often the elderly, are most affected by this. The general practitioner after all, follows the NHG standard, the specialist has his own guidelines. And they sometimes deviate.
The Court of Audit issued a critical report in November 2010 on the care of chronic patients and the poor coordination between the various practitioners. Mutual communication must improve quickly, according to the Court of Auditors, especially since the group of chronic patients – already 4.5 million! – will grow significantly in fifteen years. One solution is to develop joint guidelines, says Marjolein de Booys of the NPCF patient federation. The general practitioner, specialist and specialized nurses then no longer follow their own protocol, but make agreements with each other in these joint guidelines, including about the medicines that may be prescribed. In many chronic conditions, such as diabetes, heart and vascular disease and COPD, those joint guidelines already exist.
The control of the GP?
Such a guideline works well when you are dealing with one chronic illness. But for the growing group of people with more chronic conditions, problems can also arise with these guidelines. The number of care providers is increasing: for one ailment there are easily four, for two disorders you quickly have seven or even eight care providers. This increases the risk of miscommunication. In addition, drugs prescribed for one condition may be bad for the second condition.
In these complex situations, a care plan will have to be drawn up. In it, the disorders are named and described, it is indicated what kind of care is required, what the patient can do himself, where the treatment methods can clash and how this can be prevented, and who is in charge of the treatment. Such a care plan can be drawn up by the GP or the practice nurse, but also by a nurse specialized in, for example, diabetes or heart failure. As a rule, the general practitioner is in charge, because he can oversee the patient’s entire situation.
All’s well that ends well? Unfortunately. Communication errors will always remain. Whether he likes it or not, the patient must claim a greater role for himself. He will have to act assertively, making full use of the expertise he has often already built up about his own illness. Especially when it comes to a rare condition.
The articulate patient
The rights of patients and the duties of doctors are laid down in various legal regulations. A new law will soon replace these schemes: the Healthcare Client Rights Act (WCZ). The bill is pending before the House of Representatives and should enter into force in 2011 if all goes well. The bill states, among other things, that every patient has the right to good care and a good care plan. But also that he is entitled to have his care providers (such as doctors and nurses) coordinate their activities properly. They are obliged to consult with each other and to transfer the correct information about the patient to each other in a timely manner.
The previous Minister of Health, Ab Klink, prepared the bill and literally wrote in his explanation: “The patient should never be sent from pillar to post when it comes to proper coordination.” Klink also argued for doctors to make agreements with their patients about who is in charge.
Of course, the patient in turn also has duties. For example, he must properly and completely inform his doctors, follow the medical advice and cooperate optimally in the treatment, for example by observing the rules of life.
The WCZ proposal states that the patient decides on examinations and treatments based on the information he receives from his doctors. The patient must always give consent and must not be overruled by a doctor. So the answer to the question ‘Who is in charge: your GP, your specialist or you?’ is ultimately: ‘You.’
One doctor says this, another that. What now?
Demand clarity
Remember that you are the one who makes the final decision. You are the boss. You have the right to good information before treatment is started and you do not have to undergo treatment that you are in doubt about. If you receive a duplicate message, you can demand that your care providers consult with each other in order to arrive at a unanimous advice.
Check the guideline
Patient versions of NHG guidelines have been drawn up for a number of disorders. This contains the professional guidelines and standards in layman’s terms. In these patient versions you can read, for example, which medicines are used for a specific ailment and how the medical process should proceed. With the patient guideline in hand, you can better check whether you are really getting the care you are entitled to and whether the practitioners are actually doing what they are supposed to do. See also www.plusonline.nl/guideline
Get a second opinion
You are always free to ask for a second opinion. Please first consult the conditions of your health insurer. Also keep in mind that the specialist from whom you ask for that second opinion may not take over the treatment. The consulted specialist may agree with the proposal of his colleague specialist. Then the decision is relatively simple for you. However, if another advice comes out, you should weigh all the pros and cons and ask yourself which treatment is best for you.
Increase your knowledge
It is always advisable to seek advice from a patient association. There is a lot of expertise there!
Sources):
- Plus Magazine
