Czech doctors will soon be able to exclude patients from their rolls who they deem inconvenient, according to the Czech Medical Chamber (CMCH). According to their representatives, doctors should be able to refuse patients who file complaints against the doctors or have a different opinion on their treatment. The proposed change is not necessary, because doctors can, according to actual legislation, solve serious disagreements with patients even now. The argument that this change is needed so that physicians could choose their patients is secondary - there is another reason: to intimidate patients who have a different opinion, and, not least, the financial gain involved for the health care industry.
Do not punish, but offer treatment options instead
If a patient doesn't agree with the proposed medical procedure, his or her doctor should primarily try to offer an alternative treatment and explain its advantages and disadvantages. From a legal point of view, it is unsustainable to punish the patient for denying or withdrawing informed consent, which is also guaranteed by Article 5 of the Convention on Biomedicine.
It is already possible to stop cooperation with a patient, for example in the case in which the patient is repeatedly rude to the doctor or is harassing patients in the waiting room. It is also legally possible to exclude from care patients who willfully and persistently fail to comply to individually designed treatment, but only if the patient gave consent with this treatment before.
But it is not possible to exclude the files of patients who disagree with the recommended treatment, and patients also cannot be penalized for filing a complaint on the doctor. The doctor may not always be right and the complaint may return the treatment to the right path. But according to the CMCH, patients should be punished for complaining. The president of CMCH said that when the patient files the complaint against the doctor, the relationship of trust between doctor and patient vanishes and doctors should, in these cases, have a chance to say, "I will no longer take care of such a patient." Many patients would complain less and would not seek their own reviews on the treatment as a result of the proposed changes - but not because of the quality of health care and the human approach of the doctor. Instead, patients would act with the fear of rejection from their doctor and of a loss of access to health care.
Warning against the possible consequences of the proposed adjustments
There is a serious danger that doctors would abuse the new power and would get rid of uncomfortable patients and complicated cases with costly treatment. For example, a person with a rare disease can be a financial burden for physicians, because the cost of treatment often goes beyond the contractual limit of health insurers. In these cases, there is nothing easier for physicians than to refuse financially disadvantageous patients by citing a violation of trust between them. It would be easier for the physicians, for example, to exclude children whose parents prefer alternative medicine over the automatic prescribing of antibiotics and drugs. By rejecting the patient, the doctor may also impact the patient's right to available health services, because there may not be another doctor in the area.
Solution: an arrangement, rather than arbitrariness
The solution shouldn't be the empowerment of doctors, but a new arrangement between the physician and the patient. With this new set of regulations, what could occur is an absurd situation described by the following example: Imagine that you have filed a complaint against the conduct of firemen in your community. Due to your complaints, they could refuse to put out the fire engulfing your house and would tell you that you should look for help elsewhere, because the relationship of mutual trust has been disturbed.
There is no need to empower doctors in such a way; instead it is necessary to seek mutual understanding - to offer other methods of treatment or to resolve the situation by conversation.
This article is in response to this news from a Czech television station.
Kamila Holoubková, a lawyer from the League of Human Rights