Federal and state laws require that patients give permission or be allowed to withhold consent for health information exchanges to use their individually identifiable health information (IIHI) for purposes other than direct patient care. Consequently, as health care providers start to adopt new care delivery models that necessitate clinical data exchange, patient consent is becoming a hot issue.
Despite the existing regulations -- or because of them, in some cases -- patient consent involves legal, technical and practical issues that are far from being resolved.
Which circumstances require patient consent, which parties can be allowed to access particular information and whether patients must opt in to health information exchange or should be allowed to opt out are all open questions.
I suggest patients who do not desire to be guinea pigs on health information security, privacy and confidentiality consider refusing use of EHR's to record and diffuse their confidential medical information.
There is no legal requirement that electronic records be used for rendering of medical care. There is also no legal requirement that live patients consent to be used as test subjects for hospitals and software companies in refining their IT systems ("beta testing") to make them secure.
If a physician or hospital refuses to honor the request, and/or refuses to provide care, litigation should be pursued.
Modern testing technology can extract a wealth of information from the merest speck of a person—a biospecimen—and information systems can transmit entire medical records at the click of a mouse. Given these capabilities, confidentiality—the notion that information patients share during medical treatment should not be disclosed to others without the patient’s authorization—is a fragile concept..
"My first question is how can a hospital conduct an investigation when the person who filed the complaint wasn't contacted about any details?
My former doctor eventually sent me a letter relinquishing my care. To add insult to injury she wrote that "the hospital would still provide care to me for 30 days in case of emergencies." I felt like I was being 'punked' this could not be happening to me!
I have written several letters and have not received any calls about why I think the actions of the doctor and staff were a violation of my rights."
Sadly, informed consent and shared decision-making, the twin pillars of patient-centered health care, aren't the rock-solid structures we would hope for. That's the lesson of a new study in the Journal of Intensive Care Medicine.
The point at which the physician-patient relationship forms is fundamental to all medicolegal liability.
It is the point at which the physician’s duties to treat the patient according to the standard of care, to obtain informed consent and to provide continuity of care all attach. It is therefore also the point at which liability for medical negligence, medical battery, and abandonment can also attach. “When is a patient my patient?” is therefore a critical question.
As our patients become older and less able to give informed consent we are going to have to address this issue in greater detail. Every disease has a treatment. We are used to analysing the ratio of discomfort to benefit for our patients, but the more I treat such ‘very’ elderly patients, the greater the weight I give to the present rather than future state of health with which we choose to justify pain.
A New York City woman is suing her doctor for informing her she tested positive for HIV. The 31-year-old woman says her doctor violated state law by testing her for HIV – the virus that causes AIDS – without her consent.
CONSENT is the most controversial term in the field of Medico-Legal Jurisprudence. Consent of the patient has an immense practical importance to the clinicians. Doctors may do nothing to or for a patient without valid consent. This principle is applicable not only to surgical operations but also to all forms of medical treatment and to diagnostic procedures that involve intentional interference with the person.
Autopsy Report Reveals Planned Parenthood’s Negligence Was Responsible for Tonya Reaves’ Death.
“As bungled as this abortion was, we believe Tonya Reaves could have survived her injuries if she had gotten immediate emergency care and if Planned Parenthood had shared medical information with the hospital related to her incomplete abortion and uterine perforation,” said Newman. “Instead, Planned Parenthood left the trauma team in the dark to solve the puzzle of Tonya’s injuries while her life ebbed away.”
Few principles are as often identified with bioethics as informed consent. In clinical practice, the doctrine of informed consent rose to dominance during the course of the 20th century. It replaced a medical ethos founded on trust in physicians' decisions—often on the assumption that “doctor knows best”—with an ethos that sought to put patients in charge of their own care. In medical research on human subjects, informed consent requirements gained prominence in reaction to abuses. One influential response to the cruelty of Nazi experiments was the Nuremberg Code of research ethics, which stipulated, “The voluntary consent of the human subject is absolutely essential” (Faden and Beauchamp 1986, 156). But why should we require informed consent when it comes at a cost to the individual's health? What is the content, the scope, and the status of that requirement? How does informed consent in bioethics, the focus of the present entry, relate to consent in sexual ethics, business ethics, and political philosophy?
Imagine if you or a loved one was diagnosed with cancer. Many of us are familiar with the panic and devastation that such a diagnosis causes. Now imagine that doctors knew that the cancer was there but didn't tell you for more than a year. Meanwhile, the cancer had time to grow and spread. What would you do?
For many people, this is not a "what if" but a reality. MSNBC recently reporting on the story of Peggy Kidwell, who's cancer continued to eat away at her body for a year, while her mammogram report sat idle on the desk of an orthopedic surgeon, where it was mistakenly misdirected. It wasn't until Kidwell showed up at her annual mammogram that the error was discovered.
When Kidwell has her routine exam that previous year and didn't hear from her doctor, she assumed that everything was okay. Her doctor assumed that she never got the exam in the first place; there was no test result present in her file. It was then that her doctor went back and was able to locate the old results, which revealed the presence of breast cancer.
If I can give you one piece of advice about being an advocate for yourself and you loved one, it is this: always confirm the results of any medical tests that you have, even if they are routine. I have some experience with this. Confirming the test results of a member of my family led to immediate treatment. If I hadn't called, there would have been a delay of three weeks, when someone in the medical facility got around to actually informing us (unaware that we had already received the results).
Most of the time, our doctors or lab facilities do inform us in a timely manner. I know that if results are normal, we will get a letter saying just that. But if no letter arrives and no phone call take place, it is important to be proactive and request the results directly.
How soon should you call? Find out how long it will take to get test results back, and depending on the tests needed (routine versus a possible serious condition) follow up accordingly. No news is not necessarily good news, unfortunately.
If you are facing a surgical procedure, you will have to sign an informed consent form. This is a form that spells out what the risks and expected outcome of the procedure may be. It is used to confirm that you are aware of everything that will happen in the operating room or office and area allowing the doctors, nurses and staff to perform the procedures. You may have several consent forms to sign, depending on the procedure. For example, you may have one informed consent form for anesthesia and another for the actual surgery. Parents or guardians will have to sign consents for minor children, and the immediate next of kin will have to sign for adults who are unable to sign for themselves.
Most of the time, the doctor, nurse or other staff person will come in and briefly explain the consent form. Usually this occurs right before the procedure, which means that you don't often have a chance to read the form. Because the person asking you to sign the form may be talking quickly and monotonously (they've probably have had multiples of these forms to get done before they have gotten to yours), you may not even be able to fully understand what they are saying to you. This is why it is so important to be proactive when it comes to your procedures and the signed consent form.
First of all, don't be intimidated into signing the form. Take all of the time you need to understand what you are signing. Ask questions. Remember that you are giving your permission, so you need all of the facts.
If you have any doubts about signing the form or feel pressured, and it isn't an emergency, ask if you can have a day to think about it. Ideally, whenever non-emergency surgery is suggested to you, you should leave your doctor's office with a good understanding of the risks and benefits, before you schedule the surgery. This way, you can take the extra time that you need to make a decision.
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