November 2013 TheChronicle; Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, optometry, dentistry, nursing, pharmacy, allied health, and other care providers. It refers to the work done in providing primary care, secondary care, and tertiary care, as well as in public health.
Primary care is the term for the health care services which play a role in the local community. It refers to the work of health care professionals who act as a first point of consultation for all patients within the health care system. A primary care practitioner must possess a wide breadth of knowledge in many areas.
Secondary care is the health care services provided by medical specialists and other health professionals, who generally, do not have first contact with patients, for example, cardiologists, urologists and dermatologists.
Tertiary care is specialised consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital. Examples of tertiary care services are cancer management, neurosurgery, cardiac surgery, plastic surgery, treatment for severe burns and so on
Rights of a patient
The Ghana Health Service has a Patient Charter that has the rights and responsibilities of a patient in its health facilities. These are the rights of patients on that Charter.
1. The patient has the right to quality basic health care, irrespective of his/her geographical location.
Basic health care comprises primary and secondary health care. The Ghana Health Service tries to provide a district hospital in every district to provide both primary and secondary healthcare services. In addition, there are several health centres in each district, with several CHPS zones, where mostly primary health care can be accessed. The quality of care depends on the availability of accessible and well equipped health facilities, manned by adequate numbers of well trained and highly motivated myriad of staff. Currently, there are populations in Ghana who cannot exercise this right.
2. The patient is entitled to full information on his/her condition and management, and the possible risks involved, except in emergency situations when the patient is unable to make a decision, and the need for treatment is urgent.
Care givers often cite the huge numbers of patients they have to take care of as an excuse to deny patients this right. They often say there is just not enough time to explain everything to the patient. For patients who really want to know what is wrong with them, should they ask the doctor, they are often thrown off, or given cheeky answers, or even abused by caregivers.
It is a scientific fact that patients who know what is wrong with them heal faster and are more cooperative in their compliance with medication. Even those with terminal illnesses (with incurable diseases that will soon lead to death) live better lives if their condition is made known to them. Thus, care givers must find the time to explain in simple language that the patient understands, the patient’s condition, what is being done, and the likely outcomes.
In these days of improved access to knowledge on the internet, most patients read widely about their conditions, and this must be encouraged to promote good health care of patients.
3. The patient is entitled to know of alternative treatment(s) and other health care providers within the Service, if these may contribute to improved outcomes.
This right is often abused in some private hospitals, where patients who need to be referred are not referred until their conditions, which could not be managed in the private facility, worsen or they die. These facilities do this for financial gains, and also for fear of losing the confidence of clients who may say, ‘as for this health facility they always refer you somewhere else, so why go there in the first place.’
Health facilities must know their limits in health care delivery and have protocols on when and how to refer patients. There must also be made available to all facilities, the kinds of services that are available in all other facilities in the district, region and country. The Ghana Health Service must have a catalogue of all facilities in the country, and what services they provide on their website, which should be updated weekly. This will improve the referral system in the Ghana Health Service.
On a few occasions, patients refuse to go to facilities they have been referred to, or they may go and come back with the same condition for which they were referred, with the reason that they were not satisfied with the services they received at the referral facility. This can be very difficult to manage, but adequate counselling and education on the condition may be helpful.
In health care, we do our best to improve patients’ conditions and not cause any harm, so undue delays must be avoided. We need to quickly decide on what we can do in our facilities for our patients, and quickly move them on if we cannot help them.
4. The patient has the right to know the identity of all his/her caregivers and other persons who may handle him/her, including students, trainees and ancillary workers.
Ideally, all health care workers must carry name tags or identity cards to identify them, as well as their rank and job designation in the health facility. This is very important to prevent impersonation and the operation of quacks or imposters, especially in huge health institutions.
Most people think a doctor is any person in white coat with a stethoscope around their neck, but it takes much more than that to be a doctor. It is the duty of the management of health facilities to ensure they have the right calibre of staff to provide quality health care.
Health care givers must always introduce themselves to the patients they are caring for, and must not abuse patients if they demand to know who their care givers are. Managements of health facilities must ensure that caregivers carry name tags whenever they come to work.
5. The patient has the right to consent or decline to participate in a proposed research study involving him or her, after a full explanation has been given. The patient may withdraw at any stage of the research project.
Research is very important, as it is through research that we gain new knowledge. Some researches involve patients who may have to answer some questions, take some drugs, donate blood or some tissue sample, and so on. No patient should be forced to take part in any research if they don’t want to. If the patient chooses to participate in any research, she or he must understand what the research is all about, and they also can pull out of the research any time they want to.
6. A patient who declines to participate in or withdraws from a research project is entitled to the most effective care available.
No patient will be denied any form of service because they chose not to partake in a research project, or because they chose to opt out of an ongoing research.
7. The patient has the right to privacy during consultation, examination and treatment. In cases where it is necessary to use the patient or his/her case notes for teaching and conferences, the consent of the patient must be sought.
This right is very much abused in most health facilities. It is an uncommon site to meet four persons in the consulting room of a doctor. Health staff and their relatives are the worst culprits. Health staff often barge into consulting rooms with their relatives, and this disrupts consultation. Sometimes the consulting room needs to be locked to prevent these unsolicited interruptions.
Privacy is very important when dealing with all patients, as any information the patient gives is strictly confidential. Only the doctor and the nurse are entitled to be in the consulting room when seeing a patient. Any other person must be introduced to the patients, and their reason for being there explained, and permission of patient sought. If the patient is not comfortable with the presence of any other person in the consulting room that person must be sent out.
If the information of the patient is to be used for anything other than to treat the person, his or her consent must be sought before it is used.
8. The patient is entitled to confidentiality of information obtained about him or her, and such information shall not be disclosed to a third party without his/her consent or the person entitled to act on his/her behalf, except where such information is required by law, or is in the public interest.
This means a doctor cannot tell a husband that his wife has so and so illness, unless the wife has given him the go-ahead. A nurse cannot tell her daughter that the guy she is dating has erectile dysfunction or HIV. The condition of a patient cannot be discussed with anyone else without the permission of the patient. However, if a patient has typhoid fever and declines treatment and continues to cook and sell to the public, the health care giver is obliged to report to the appropriate authorities to stop such a person.
This also means health care facilities must ensure that the records of patients are well kept, and that no one who does not need that information to care for the patient gets access to such information. This includes laboratory, scan, and other reports that reveal the health information of the patient.
9. The patient is entitled to all relevant information regarding the policies and regulations of the health facilities that he/she attends.
If the health facility accepts the National Health Insurance Scheme (NHIS) or offers some free services, they must be made known to patients by notices, talks and so on. The dos and don’ts must be clearly made available to the patients. The rights and responsibilities of patients must be made readily known to all patients who visit the facility.
10. Procedures for complaints, disputes and conflict resolution shall be explained to patients or their accredited representatives.
All facilities must have a special desk to take the complaints and concerns of health care seekers. This helps the management of these health facilities to address their shortcomings and deliver better services. In some facilities, there are not even suggestion boxes, and where they are present, they are placed in some obscure corner out of the view of health care seekers. If there are no means in a facility to make complaints, you can write a letter to the administrator or the director of the facility to online your complaints.
11. Hospital charges, mode of payments, and all forms of anticipated expenditure shall be explained to the patient, prior to treatment.
This right must be ensured with tact, otherwise healthcare givers may appear to be demanding payment before rendering service. A health care seeker must be given an idea of how much it may cost them for a given service, so they can make informed choices.
12. Exemption facilities, if any, shall be made known to the patient.
Management must ensure that all exemption facilities are published boldly in places accessible to all patients, so patient can take advantage of them.
13. The patient is entitled to personal safety and reasonable security of property within the confines of the Institution.
It is the responsibility of the health facility to ensure the safety of all health care seekers who come into the facility. Patients must be discouraged from bringing unneeded items into the ward when on admission, but if they do, and these items get stolen or damaged by another patient, the owner may successfully take on the management of the health facility to replace the item
13. The patient has the right to a second medical opinion if he/she so desires.
If one doctor says you have fibroid, you don’t have to take it in hook, line and sinker. It is your right to see another doctor to see if the finding will be the same. You do not need to inform your doctor before seeking a second opinion.