Patient’s Bill of Rights

L. Kay Garrison, PT, DPT

Let’s talk AUTONOMY

This principle is the basis for the PBoRThis principle is the basis for the PBoR

Autonomy = “to make one’s own choices”Autonomy = “to make one’s own choices”

As in our nation’s Declaration of Independence, As in our nation’s Declaration of Independence, patients have certain obligatory rights that we as patients have certain obligatory rights that we as health care providers should not violatehealth care providers should not violate

Each patient or their appropriate representative Each patient or their appropriate representative should have should have control over their own should have should have control over their own carecare

There are 7 Rights, but unlimited interpretations

We have to consider each patient’s individual We have to consider each patient’s individual circumstancecircumstance

Remember that each patient is entitled to Remember that each patient is entitled to EACH Right, at all timesEACH Right, at all times

If you are unsure of how the Right applies to a If you are unsure of how the Right applies to a patient, consult an experienced colleague, patient, consult an experienced colleague, supervisor, or ethical committee supervisor, or ethical committee

(These apply to you too!)So what are our Rights?

Number 1

People want the best health People want the best health care there iscare there is

A patient’s opinion can be A patient’s opinion can be swayed by the quality of swayed by the quality of your service or your attitude your service or your attitude

Patients can be our BEST or Patients can be our BEST or WORST referral sourceWORST referral source

““Treat others like you want Treat others like you want to be treated”to be treated”

Patients do not have to earn Patients do not have to earn respect, it is their rightrespect, it is their right

The patient has the right to considerate and respectful

care.

Number 2

The patient should know The patient should know what is going on at all timeswhat is going on at all times

““Because I’m the therapist Because I’m the therapist and I said so” DOES NOT and I said so” DOES NOT respect the right of your respect the right of your patientpatient

Patients should have access Patients should have access to their health records. They to their health records. They should know their own should know their own progress and expected progress and expected outcomes.outcomes.

If not the patient, then the If not the patient, then the appropriate entity should be appropriate entity should be properly informedproperly informed

The patient has the right to obtain, from their certified provider, complete current information regarding their diagnosis, treatment, and

prognosis in terms the patient can reasonably be expected to

understand. When it is not advisable to give such

information to the patient, the information should be made available to an appropriate

person on their behalf.

Number 3

INFORMED CONSENT = a INFORMED CONSENT = a must; the patient should must; the patient should know what to expect from know what to expect from any treatmentany treatment

They should be active They should be active participants in the creation participants in the creation of the plan of careof the plan of care

If the patient does not agree If the patient does not agree to one form of treatment, to one form of treatment, and alternative should be and alternative should be made available to them- made available to them- with all of the facts providedwith all of the facts provided

The patient has the right to receive from their certified

provider information to make informed consent prior to the

start of any procedure or treatment. This shall include

such information as the medically significant risks

involved with any procedure and probable duration of

incapacitation. Where medically appropriate, alternatives for or treatment should be explained

to the patient.

Number 4

You can not force any patient You can not force any patient to participate in physical to participate in physical therapy treatmenttherapy treatment

The patient has the right to The patient has the right to know the consequences of know the consequences of their refusaltheir refusal

If a patient does refuse, be If a patient does refuse, be sure to document sure to document EVERYTHINGEVERYTHING

The patient has the right to refuse any and all treatment to the extent permitted by the law

and to be informed of any of the medical consequences of

their action

Number 5

Expectation that any Expectation that any discussion or consultation discussion or consultation involving the case will be involving the case will be conducted discreetly and conducted discreetly and that all communications and that all communications and other records pertaining to other records pertaining to the care, including the the care, including the sources of payment for sources of payment for treatment, will be treated as treatment, will be treated as confidentialconfidential

Basically, you can not Basically, you can not discuss any part of specific discuss any part of specific patient care with anyone patient care with anyone that is not part of the team that is not part of the team working with that patientworking with that patient

The patient has the right to every consideration of privacy concerning their own medical care program limited only by

state statutes, rules, regulations, or imminent

danger to the individuals or others

Number 6 We are not allowed to use We are not allowed to use patients as subjects without patients as subjects without their knowledge and their knowledge and informed consent.informed consent.

Demographic information Demographic information that is not patient specific that is not patient specific can be usedcan be used

The patient has the right to be advised if the clinician,

hospital, clinic, or others propose to engage in or

perform human experimentation affecting their care or treatment. The patient

has the right to refuse to participate in such research

projects.

Number 7

If you are charging a patient If you are charging a patient for a service, you should be for a service, you should be able to justify why that able to justify why that service was necessary and service was necessary and show how it was beneficial.show how it was beneficial.

This is why documentation is This is why documentation is so important!so important!

A patient may not receive A patient may not receive their bill until well after you their bill until well after you have discharged them from have discharged them from therapy service therapy service

The patient has the privilege to examine and receive an explanation of the bill.

Case studies

How does this apply in

practice?

Case 1

You are a male PTA named Sydney working in a You are a male PTA named Sydney working in a subacute setting. Your 85 year old female subacute setting. Your 85 year old female patient has difficulty with toilet transfers. When patient has difficulty with toilet transfers. When you introduce yourself to her in her room, she you introduce yourself to her in her room, she refuses to work with a male provider in the refuses to work with a male provider in the bathroom and becomes aggressive. SCENE!!!!bathroom and becomes aggressive. SCENE!!!!

Case 2

You are a PTA treating Miss So N. Sew for the 3You are a PTA treating Miss So N. Sew for the 3rdrd time. She says she is going to the doctor next time. She says she is going to the doctor next week and wonders why someone else will be week and wonders why someone else will be seeing her on her next visit. “You’re my seeing her on her next visit. “You’re my therapist!! You’re the best!!!”, she boasts. “I therapist!! You’re the best!!!”, she boasts. “I thought you were my PT!??!”. SCENE!!!!thought you were my PT!??!”. SCENE!!!!

Case 3

Its your first day on the job in an outpatient Its your first day on the job in an outpatient clinic. Your PT supervisor, Martha Washington, clinic. Your PT supervisor, Martha Washington, tells you that her first patient is a referral from tells you that her first patient is a referral from her husband George’s orthopedic practice. her husband George’s orthopedic practice. SCENE!!!!SCENE!!!!

Case 4

You are a PT. You realize the patient you are You are a PT. You realize the patient you are evaluating has severely impaired cognition due evaluating has severely impaired cognition due to late stage Alzheimers. His wife dropped him to late stage Alzheimers. His wife dropped him off to go get her nails done. You understand that off to go get her nails done. You understand that it is important to put your patient first, but you it is important to put your patient first, but you realize that he can not agree to his plan of care. realize that he can not agree to his plan of care. SCENE!!!! SCENE!!!!