How does patient practice autonomy

Recently, other problems have appeared. Modern information technologies pose challenges to privacy and confidentiality [ 18 ]. Great effort has been undertaken to protect data personal health information , but this protection is not consistently applied on all levels. For example, to obtain coverage from the national insurance fund, patient-identifying data, such as their names and diagnoses, have to be sent to a central office.

There, even though the company and its employees have a duty to respect confidentiality, confidential medical information is still potentially accessible by unauthorized employees. According to hospital physicians, the electronic records of patients in hospital environments, as well as other written documents such as medical histories, are not adequately protected by privacy standards. All patient data is online. Private providers keep family medicine electronic records and some family physicians are worried that the commitment to confidentiality may thus be questionable.

Such inquiries are seen as problematic even though they are frequently tolerated. And I had great difficulties to keep that, just technically speaking… because in our community and mentality it is normal that the doorkeeper has the list of all the names and directs the visitors. It is often a custom that various medical certificates e.

This is not really an encryption because employers or other parties involved can readily look for the proper meaning of these diagnoses on the Internet. Family practitioners were especially concerned about this problem since they issue these certificates. Why should the employer have to know which particular disease his employee has? Sometimes purposefully omitting a diagnosis seemed ethically more appropriate. One family physician admitted:.

She requested documentation of all her past history in order to apply for a job. I found a record of psychiatric treatment from 10 years ago but after that she was fine. Regarding the qualitative content of the information, several viewpoints were raised. As one of the participants vividly described MP , truth in a medical environment is a very thin and malleable concept. Nevertheless, all could agree that in theory one has to be sincere and tell the truth.

For some participants, however, the truth can be packaged differently. Ethical norms should certainly be respected, but it is an art to know when something is possible to tell or not. You need a feeling for that. Some of them admit to having lied sometimes purposefully, or at least omitted the truth, justifying it by claiming that it had a positive effect on their patients.

I admit that, at the beginning of my medical career I have sometimes asked the pathologists to write their findings differently and I can tell you that these cases ended well. Even in cases with highly educated patients involved. Physicians, they said, have to be skilled, educated and aware of how to disclose the truth.

One participant from the patient group explained it vividly:. However, the disclosure of bad news can be an especially stressful experience for family practitioners because of their close connection with patients. This makes them prone to emotional decision-making and consequently also prone to paternalism. One emotionally understandable but ethically questionable approach was described as follows:. I think that it is very important, also from a practical point of view.

Family members have to be prepared for all. They will have to care for him. Regarding the quantitative extent of the information provided, two approaches were found as regards revealing the diagnosis to the patient.

The patient needs to know what to expect. As one of the experienced physician simply described it:. Do you have any questions for me? This paternalistic attitude was countered by some participants MP who promptly agreed with a participating cardiologist who stated that:.

Nevertheless, it is important to note here that the literature reveals preferences of patients to generally be informed [ 19 , 20 ]. Albeit information disclosure can have harmful effects on patients [ 21 , 22 ] it is now usually thought that benefits of disclosure greatly outweigh potential harms [ 18 ].

According to our findings the age of the patient and his cognitive abilities play an important role in the way and amount of information that can be given to him. Also, what is important is the terminology used. As one doctor explained:. For her tumor is ok even though she knows it is a serious illness.

Patients in our study felt the same and greatly appreciated that way of communicating. They frequently more readily accepted the term tumor rather than that of cancer. Medical students were particularly critical of the lack of communication in hospital settings.

On the other hand, students were startled, as were patients, when a difficult diagnosis was revealed too openly — that is, callously straightforward - which they perceived as being crude and thoughtless. I would frequently question myself why is it that they are so oblivious? The timing of the disclosure of a diagnosis and prognosis is very important.

Generally, all our participants could agree that it should be soon, although not before the patient is ready to hear it. Yet, it is not easy to judge when circumstances are right. Particular concerns over patients with psychiatric illness were expressed. The right timing here is very important. On the other hand, the patient group was concerned regarding the delayed diagnosis of a condition with a poor prognosis. I was lying there for days feeling really sick and miserable.

I was undergoing some diagnostic procedures but no one would tell me what they were suspecting. It has been generally acknowledged that the patient is the one who should be told first about his condition and it is his or her choice whom to tell later.

In practice, in Croatia, in the hospital setting as well as in family practice, there are frequent requests from family members not to reveal the diagnosis to the patient. This fact raises moral concerns for the doctors in charge. However, there are examples of appropriate ways of dealing with such situations. An experienced and sensitive clinician described his style and methods of dealing with such situations:. When their family comes I make them sit down and I go to ask the patient — can I speak to your family about your condition?

Written consent forms were introduced in Croatian hospitals only a decade ago. They have been primarily used to address legal concerns to protect the physician and the hospital and are still frequently administered to patients without first providing sufficient information. Even though great care has been taken in writing some consent forms, patients complain that they often do not understand the terminology. Some students observed that the forms are often administered by nurses or by students themselves who may not appreciate all that is involved in the procedure.

Thus, consent becomes a formulaic process and patients largely accept it. An experienced specialist stated:. What is the risk? And so forth… but the majority of my patients trust me and they just say — whatever you say, Mr. Not all of them say it in such an explicit way but they mean it. Our duty should be to ask them whether they have some more questions.

If everything is clear they can sign it. The perception is that there is a need to advance a larger social good -- for example, to protect the community from patients with communicable diseases or from psychiatric patients who are a danger to others.

One participant observed the negative side of this attitude. I think that now we have to slowly change that and give individual autonomy a higher [place in the] hierarchy of values than before.

The majority of participants the same was in MS1, MS6 and FM groups were more concerned about protecting the spouse or other close contacts.

By contrast, practitioners with more experience in treating such patients had different views - they were more concerned for the patient himself. It is worth mentioning that some medical students and residents learn at an early point in their education that deception can be an acceptable option.

Participants from groups consisting of medical students, family physicians and hospital clinicians complained that medical education, including residency programs, failed to instruct students and residents how to deal with the frequent ethical dilemmas that arise regarding patient autonomy.

The only ethical issues they remembered were debates on the right to abortion or euthanasia. Students MS1, MS6 admitted that they were greatly influenced by their teachers as role models. Guidelines and algorithms on how to behave ethically would be welcomed. Force feeding could be described as a paternalistic intervention designed to facilitate further treatment, with the intention of resurrecting the ability to make authentically autonomous decisions.

Home Advice and support Ethics Ethics toolkit for medical students. Previous topic Key principles of ethics for medical students. Next topic Medical students and the GMC. Ethics toolkit for medical students Autonomy or self-determination as a medical student Location: England Wales Northern Ireland. Audience: Medical students. Updated: Friday 1 May What do we mean by autonomy?

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