A patient has the right to know why a test is needed; what the expected results are ; how much it costs; and how it can change her treatment options
Sample these reported cases reported in the media:
In October 1989, Zairunnisa Parekh got admitted for treatment of a tiny 1-cm stone in her kidney at Jaslok Hospital, Mumbai. She died 35 days later of peritonitis. Her husband Yusuf and son Mushtaq filed a case of negligence against the doctors, stating that the hospital denied them a copy of her medical records.
In another such case, Bhagwati Raheja died after a by-pass surgery at Mumbai’s Nanavati Hospital. The deceased’s husband maintained he was refused a copy of his wife’s medical records.
Medical Council of India Guidelines on Medical Records
The MCI Regulations 2002 state:
Indoor records need to be maintained in a standard Performa for three years from commencement of treatment (Section 1.3.1 and Appendix 3).
Request for medical records by patient or authorised attendant should be acknowledged and documents issued within 72 hours (Section 1.3.2).
In these, and several other such cases, patients or their families had to seek intervention from the Courts in order simply to access their medical records - documents that were legally their property. When complications occur, hospitals invariably deny wrong-doing and the onus shifts to the patient’s family to prove that what went wrong was a result of the doctor’s or the hospital’s negligence. Without concrete evidence in their possession, this can be almost impossible.
The Truth, the Whole Truth, and Nothing but Truth...
Sometimes, withholding the harsh truth from the patient is not a result of medical paternalism, but arises out of the doctor’s sincere desire to protect the patient from emotional distress.. It’s not always easy for a doctor to know how much truth the patient can tolerate and this can create a dilemma for the doctor, as the following story, “The doctor’s word” by R K Narayan illustrates:
The patient has already expressed his wish to write a will. The good doctor is in a fix. He resolves it by deciding to deceive the patient, and tells him that he can easily write the will the next morning, since there is no urgency. The patient is relieved, and survives
What is the moral of the story? The doctor needs to use his judgment as to whether or not to disclose information that has the potential to harm the patient.
Patient-advocates can help doctors to build a rapport with the patient, so that there can be a full and frank discussion of the risks and uncertainties which are inherent in any medical treatment.