Patients in treatment choice reduces risk
Involving patients in treatment choice reduces risk
By Robert Bycroft, Partner, Chapman Tripp
GPs carry an unenviable workload and degree of responsibility. Providing patients with information and involving them in decisions about their treatment can shift some of the burden to the person most affected by the decision – the patient. The Health and Disability Commissioner recently recommended that a neurosurgeon apologise in writing for failing to discuss all the relevant surgery options available to a patient. By failing to inform the patient of all the options the Commissioner was of the opinion that the neurosurgeon breached Right 6(1)(b) of the Code of Health and Disability Services Consumers’ Rights. That the alternative surgery was radical, only available privately in Australia, and not recommended by mainstream neurosurgical opinion in New Zealand, was not enough to absolve the neurosurgeon of the responsibility to provide the patient with full information.
The Commissioner confirmed that: “At a time when New Zealand patients are not infrequently referred to Australia for medical care (even in the publicly funded system), this [full information] includes information about treatment options available (albeit private) in Australia”.
With the growing gap between all the treatments available and those which are state funded, it is clear that in many cases a GP can no longer be confident that informing patients only of the publicly funded treatments amounts to giving patients full information. This is an ever increasing issue facing GPs and, as the gap widens, GPs cannot simply limit their advice to publicly funded treatment options.
According to a survey conducted last year by Research International, patients are more comfortable talking to their GPs about unfunded medications than GPs may realise, with 64% of people happy for their doctor to discuss unfunded treatment with them.
GPs can, and should feel good about, discussing all clinically appropriate treatment options with their patients.
Obligation to advise patients of available treatment options
The Code of Health and Disability Services Consumers’ Rights sets out patients’ rights to information. Specifically, right 6(1)(b) states that a patient is entitled to the information that a reasonable person in that patient’s circumstances would expect to receive about their condition and the available treatment options, including an assessment of the expected risks, side effects, benefits and costs of each option.
GPs’ obligations under the NZMA Code of Ethics mirror their patients’ right to receive information. The Code of Ethics obliges GPs to discuss with their patients (within the limits of a patients’ capacity to understand) the nature of their problems, the range of possible solutions, as well as the likely benefits, risks, and costs. GPs have an obligation to respect the patient’s autonomy and freedom of choice and are also required to assist patients in making informed choices. The New Zealand Medical Council’s 1995 Statement on Information and Consent affirms that failing to provide adequate information can constitute medical misconduct.
Costs not relevant to duty to advise patients of available options Naturally, the costs of a treatment need to be weighed in deciding the most appropriate treatment option. However, the cost of a medication is not an appropriate reason for failing to discuss with the patient the full range of treatment options open to that patient. Without information there is little choice. Although many people will accept what information they are given, the duty to volunteer information about treatment options is not dependant on the patient asking questions. If an option is clinically appropriate it should be discussed with the patient. Discussing treatment options with patients increases their awareness of the alternatives open to them. It reduces the risk that patients may feel that their only choices are to put up with any side effects from their current medication or to stop taking the medication altogether.
Comment GPs play a crucial role in providing patients with information about prescription medicines. A Colmar Brunton New Zealand Consumer Survey, prepared for and published earlier this year by the Christchurch School of Medicine, found that GPs are the most commonly used source of information on prescription medicines and are seen by the public as the most trustworthy and reliable source of this information.
Patients should be informed of, and given an opportunity to choose from, the full range of clinically appropriate treatment options. By assuming that cost is a prohibitive factor and protecting the patient from facing a choice, GPs are not only exposing themselves to legal risk, but are unnecessarily shouldering the responsibility for determining which treatment option to pursue. Clearly, many patients are capable of weighing the costs and benefits of treatment options to reach a valid decision.