Doctor, please, what is wrong with me? Is it Malaria? Autie nurse, please, what medication are you about to give me?
What injection is this? What lab tests have you ordered, Doctor?
Most, if not all of us have asked a variation of these questions once or twice during our visits to health facilities, and though some Doctors and nurses/health workers have taken the time to answer us kindly, if we are to list the responses we have received, I can hazard a guess to say a majority of the responses we have received have been anything but pleasant.
Responses mostly range from being totally ignored as if they did not hear us (which to be fair, may spare us from embarrassment) to a look of disdain, being sharply shot down with a few words, to an outright rude response.
Most people are not new to responses such as “leave us to handle this,” “you are in safe hands,” “you wouldn’t understand it even if I explained it,” and “you are being too known!”
The normal human response to these may be an explosion of anger from the patient and family, and to be fair, this is, unfortunately, an expected response in such a situation.
Yes, ideally, there shouldn’t be yelling or fights in health care facilities, and we should be working to prevent them from happening, but the question is, why do some healthcare workers find it difficult to give polite responses to patients’ sincere questions?
Is it because they are overworked from understaffing?
Are they stressed and burned out and so can’t be bothered anymore?
Or frustrated from not having the supplies they need to work?
One or all the above reasons can be true at the same time, but I believe one other underlying reason for these behaviors and responses may be from the history of the paternalistic medical model of care where healthcare providers make treatment decisions for patients prioritizing the patient’s best interest over their autonomy.
In this system, it is assumed that the doctor knows best, which may sometimes lead to withholding information or enforcing compliance.
Over time, this has generally been replaced by patient-entered care, though paternalism remains in specific emergency situations.
Given differences in advancement of healthcare practices across the world, some healthcare systems are more patient-centered than others, and based on our experiences in this country, it is safe to say we are still practicing a higher degree of paternalism in medical care.
But why? Why can’t I know what you are about to do to my body? Why can’t I know what medication you are administering or asking me to take into my body?
What if I am allergic to something you are giving me? How can I trust you to do the best for me if you are rude to me? What if hearing me out will help you (healthcare provider) come up with the best plan of care for me?
Let’s allow these questions to simmer for a bit.
Fortunately, there are papers/documents that indicate that Ghana’s healthcare system practice patient-centered care as evidenced by the development of the patients charter in 2002, derived from Article 30 of the 1992 constitution of the republic of Ghana.
This has 14 rights and 9 responsibilities of the patient and was made to protect the rights of the patient.
Most significantly, it encompasses respect for the patient as an individual with a right of choice in the decision of his/her health care plans.
Below are excerpts from the patients’ charter that highlight the patients’ rights to ask our healthcare providers questions:
1. The patient is entitled to full information on the patient’s 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.
2. The patient is entitled to know of the alternative treatments and other health care providers within the Service if these may contribute to improved outcomes.
3. The patient has the right to know the identity of the caregivers and any other person who may handle the patient, including students, trainees, and ancillary workers
4. The patient is entitled to the relevant information regarding policies and regulations of the health facilities that the patient attends.
5. Procedures for complaints, disputes, and conflict resolution shall be explained to patients or their accredited representatives.
I will say that some facilities do have the complete patients’ charter posted in their facilities, but shouldn’t all health facilities have them?
Maybe they do, but how many of us have even seen them or paid attention to them?
For those who have seen/read them, have you felt confident enough to practice or express these rights?
My guess is that many may not feel that confident given anticipated unpleasant responses, as previously mentioned.
After 24 years of the existence of the patient’s charter, isn’t it overdue for us to see it in action?
We can all agree that if we as a nation are to see improved patient care, and our healthcare systems develop to match global trends, one aspect will be to take more practical steps to help teach and empower our people to practice/express their rights while ensuring that healthcare providers who deviate are held accountable.
How can we do this? Here are a few ideas:
The Ghana Health Service, in collaboration with the Information Services Department (ISD), can provide public service announcements and education sessions on the patients’ Charter to the public through various traditional and social media platforms.
These should be done in all the commonly spoken and written languages in the country.
After hearing about it, we now increase its visibility by translating the patients’ charter into all written Ghanian languages and posting them in all health facilities.
Utilizing these methods will help capture both those who can and can not read, and thus equally disseminate information to all.
While public education is ongoing, we must also ensure that the healthcare worker does his/her part by being willing and ready to answer the patients’ questions appropriately.
Yes, it is usually challenging to bring about change in any field, and our healthcare workers will be no different.
One sure way, however, to bring about change is to ensure compliance by holding people accountable for their actions (or inactions).
Healthcare facilities should provide patient/relation support units where issues of disrespect or patients’ rights abuse may be reported to.
I believe this is not a new concept as some health facilities do have some system of reporting abuse, but what happens after this?
Many clients/patients have been frustrated by bureaucratic bottlenecks after reporting and have eventually dropped the cases/issues.
This should, however, not end here; after reviewing a particular incident, the liable healthcare workers may be made to undergo mandatory refresher courses or study modules on patients’ rights if it’s an initial offence.
Subsequent or routine offenders may face more stringent actions, including fines and unpaid suspensions, depending on the severity of the case.
In all these, we should also remember that the charter also includes the patients’ responsibilities, which must also be met if we are to see a more seamless process.
I will also add that the above are only suggestions as each health institution may develop its own system of ensuring that both healthcare providers and their patients’ rights are appropriately respected.
From the foregoing, it is evident that one way of reducing antagonistic interactions and improving trust between the patient and the healthcare worker lies in the proper implementation of the patients’ charter, and if we are motivated to improve Ghana’s healthcare quality, this should be one of the areas to address.
Written by David and Angela Leo-Nkoah
