'No doctor can treat a patient without his permission'

Here are expert tips on how you can get the best out of your medical care.

An illness strikes suddenly and going to a doctor for treatment is usually the best thing to do. But often we forget that the kind of treatment we receive is entirely our prerogative. Here is an excerpt from Dr Aniruddha Malpani's book 'How to get the best medical care', that will tell you about the process of informed consent and how you can make sure you get exactly what you need, healthwise.

Informed consent: A Crucial Factor

No doctor can treat a patient without his permission, which is why a patient needs to give his consent to the doctor, before treatment starts. In the early part of the twentieth century, the law also recognized that the purpose of obtaining a patient's consent, was also to ensure that decisions about medical treatment were consistent with patients' wishes.

"Consent" became 'informed consent' as a result of a landmark case in 1957 in the USA. The verdict in this case declared that doctors have a duty to disclose "any facts which are necessary to form the basis of an intelligent consent by the patient to proposed treatment." These 'necessary' facts include information about risks and benefits of the proposed treatment, as well as existing alternatives. Only if the patient has had the opportunity to evaluate the available options and to weigh their attendant risks and benefits, the court held, can he make an informed and independent choice.

Informed consent is required before surgery, before many diagnostic and therapeutic treatments and before a patient participates in any clinical study or research. A signed consent form stands as evidence that a patient has been informed about, and has given permission for, the treatment described on the form. Consent forms protect the rights of the patient, not those of the doctors, as is often believed , since by signing a consent form a patient does not waive the right to sue a doctor hospital/clinic for malpractice. (Read: A layman's guide to getting the best during a hospital stay)

For a patient to give, and a doctor to receive, properly informed consent, several requirements must be met:

• The doctor must give the patient all relevant information about the nature and purpose of the procedure, along with its risks and benefits, and any alternatives (including the alternative of no treatment,) Although patients cannot expect to be told everything about the natural history of their disease (all the possible complications and remote risks involved in all alternative treatments), they are entitled to the disclosure of all "material" information. To define the term "material," courts so far have used a "reasonable patient" standard, instructing doctors to give such information as a 'reasonable person in the patient's position' would want to have. Such an option clearly leaves a great deal to the doctor's judgment. Of late, a new standard seems to be evolving in which 'material' information is defined as the information that a reasonable patient, in these circumstances, would want to know.
• The patient must understand the information, whether it is given orally or written on a consent form.
• The patient's consent must be given voluntarily, without coercion or undue influence from health care personnel or others.
• The patient must be mentally competent to give consent.
• As a patient, you need to make sure your doctor covers the following five areas when getting your informed consent.

Details of the medical treatment proposed.

• The benefits.
• The risks.
• The alternatives.
• The written documentation.

There are no guaranteed outcomes in medicine, but informed consent enables YOU to make a rational decision about your treatment and also promotes greater understanding between you and your doctor. It is your responsibility to read each and every word of the document, because, once you sign it, you acknowledge that you understand everything about the procedure(s) and the potential problems that may arise. (Read: Patients rights in India What you should know and ask for)

With informed consent:

You cannot demand services that are beyond what are considered 'acceptable' medical practice or that violate professional ethics.

You must recognize that you may be faced with some uncertainties or unpleasantness.

You should, if competent, be responsible for your choices. Don't have others make decisions for you.

A good doctor will guide you -- you should have enough trust in your doctor to be confident that he will not let you make a wrong decision. However, the final responsibility is always yours - make sure you are thoroughly and properly informed, before giving your consent!

The pertinent question in this context would be: What can you do to keep your medical expenses down? The sanest advise, of course, would be to keep yourself healthy, so that you never need to go to a doctor in the first place! Traditional Indian wisdom is replete with simple but extremely useful 'therapies' such as yoga, meditation and nature therapy, which can help you keep the doctor away far more efficiently than an apple a day can!

Nevertheless, if you do need medical care, there is quite a lot you can do to make sure your bills do not become astronomical -- following the guidelines in this book can help considerably! Some other useful tips are as follows:

Become an intelligent, informed patient and ask all the relevant questions to make sure that the medical procedures that you are required to undertake are really necessary.

Take out a medical insurance policy when you are healthy -- this precaution can be very helpful in case you do fall ill.

Do insist on receipts whenever you pay your medical bills. Insist on an itemized bill, so you know exactly what you are being charged for. Scrutinize the bill carefully, to ensure it is accurate.

Sometimes, hospital bills can be monumental, and they need to be carefully analyzed to spot the errors! Do not assume that just because the bill has been generated on a computer it is bound to be accurate. It is always worthwhile bearing in mind that billing errors are amazingly common, and you need to look out for them actively! Remember that it's your precious money and you cannot afford to waste it! You may need to shop around to get a realistic estimate of treatment costs. Medical charges vary widely, and don't automatically assume that the more expensive a doctor is, the better he is ! (Read: Patient advocacy why patients need to be given a voice)

It would be prudent on your part to discuss your financial concerns with your doctor! Many doctors can and do reduce their fees for patients who face problems with regard to payments. Also, remember that you will get exactly the same quality of medical care in a first class deluxe room in a private hospital, as you will in the general ward, but you will end up paying about ten times more in the former case! Don't forget that the government does provide highly subsidized medical care through its vast network of hospitals. While the queues are long and the wait can be interminable, the quality of medical care is usually very good, and, at that price, it's a fantastic bargain! (Read: Medical negligence How to file a complaint)

What has been your experience with doctors and other medical practitioners in India? Do you think awareness can improve the situation? Write to us at health@corp.india.com. We want to hear from you!

Dr Aniruddha Malpani is an IVF specialist who passed out from Bombay University, winning over 20 gold medals during his academic career. His clinic at www.drmalpani.com attracts patients from all over the world. He also runs the world's largest free patient education library, HELP , at www.healthlibrary.com. He has authored 4 books How to Get the Best Medical Care (www.thebestmedicalcare.com),Successful Medical Practise, How to Have a Baby and Using Information Therapy to Put Patients First. His passion is patient empowerment, and he believes that patients are the largest untapped healthcare resources, and we need to use patient power to heal our sick healthcare system. He has pioneered the use of innovative technology to educate infertile couples, using cartoon films, comic books and e-learning on his website- www.ivfindia.com. He is an angel investor in Plus91 ( www.plus91.in) , a company which provides websites for doctors, and PEAS ( www.peasonline.com) , India's market leader for creating digital media for patient education, and is on the Board of Inventurus Knowledge Solutions, a healthcare BPO which provides RCM solutions for the US market. He can be contacted at http://www.ivfindia.com

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