The Patient’s Charter and some Questions

The National Human Rights Commission (NHRC) of India has developed a Patient’s Charter, which has also been released by the Ministry of Health and Family Welfare, Government of India, for comments by various stakeholders. The document enshrines 17 patient rights including the right to information regarding one’s medical condition, emergency care, informed consent, confidentiality, a second opinion, patient safety, and quality care. The charter also tries to establish a multi-layered grievance redressal mechanism involving a grievance redressal officer in the treating hospital, an external Patient Rights Tribunal or the necessary authority to be established under the Clinical Establishment Acts.

The Patient Charter actually puts together various patient rights, which were earlier scattered across multiple documents such as the MCI Guidelines, various court judgments, and extant laws. The charter allows patients to know about their rights in a single document, which in itself is commendable. This document once finalized needs to be vigorously publicised and patients educated about their rights.

While the Patient’s Rights Charter has laudable aims and is couched in lofty language, what is not clear is how will this be implemented. Healthcare in India is largely unorganized, unregulated and mostly in the hands of the private service providers. The majority of patients view their doctors as demi-Gods (yes, even in this age!!!) with miraculous powers to cure. The government institutions suffer from chronic overcrowding, creaking infrastructure, and perennial shortages. I am not sure as to how a harried doctor with hundreds of patients waiting to see him through the day will ever be able to provide complete ‘information’ to a patient about his condition, plan of treatment, likely prognosis etc. To make matters worse, even if the doctor was to attempt this, there would be a great fear in his mind of the patient not fully comprehending the problem or worse misunderstanding leading to completely unintended consequences.

It is nice to have the ‘right to confidentiality, human dignity, and privacy, however, how is one to reconcile this with the reality of many of our hospitals, where patients are often forced to share beds because of lack of adequate infrastructure.

Similarly, it is great to have a ‘right to a second opinion’, it is not clear how will this right be exercised. Should, the primary physician informs the patient to exercise his right to get a second opinion from another expert, should he facilitate this and what happens if the two opinions do not converge. Does the average Indian patient has the ability to fully evaluate the nuances of both the opinions and make up his mind about the treatment options on the table? I have seen even highly educated patients to struggle with this.

I find the ‘right to choose the source for obtaining medicines or tests’ particularly difficult to understand. The patients while in a hospital can choose to bring in medicines from any source of their choice and get tests done from any laboratory. In India, where we have over 30000 drug manufacturing units with many operating from people’s garages and sundry sheds, it is extremely hard to ensure quality clinical outcomes if patients were to get their own medicines. The same applies to unregulated labs thriving on almost every street in the country. While I can understand and appreciate the intent of this direction (to ensure private hospitals do not fleece patients by forcing them to buy expensive medicines and tests), how on earth will we have clinicians and hospitals take ownership of clinical outcomes under these circumstances?

The right to seek discharge from a hospital is indeed welcome. The hospital cannot detain a patient against her wish is simple enough to understand and agree with. However, what happens if a patient insists on leaving the hospital without settling her dues. This happens most often when the clinical outcome is adverse and the patient feels that she has not received adequate care in the hospital. Maybe defining a set of responsibilities for patients along with this Patient’s Charter will be a good idea.

The right to be referred to a higher clinical establishment or to a super-specialist without any commercial consideration is clearly the way it should be. The referring doctor/institution must only be guided by what is good for the patient and not by any other external considerations. This has been on the statute books for long. The million dollar question remains, how will this ever be implemented and monitored.

On the issue of grievance redressal, my view is that hospitals must have an ombudsman or a committee of external experts to be able to address patient grievances. The committee should consist of eminent individuals and experts who can evaluate the patient grievance without bias and address the patient concerns in a timely and just manner. The external appellate mechanism being sought to be established either through the CEA or an empowered quasi-judicial committee works just as well. However, patients must be educated on the nature of grievances that should be raised in these fora. Otherwise, they run the risk of being inundated by sundry patient complaints and fail in their primary duty of addressing genuine grievances.

The Patient’s Charter in itself is a great step forward. All the stakeholders, which includes medical establishments, government and patients must ensure that the charter in its final form is implemented both in letter and spirit.

An educated, well-informed and aware patient is after all in everyone’s interest.

The views expressed are personal.