Friday, April 08, 2011

PH Pharmacists 2: Patient Rights and Responsibilities

(Note: this is my article today in

Patients have the right to receive considerate, respectful and compassionate care regardless of age, gender, religion, nationality, sexual orientation or disabilities, from hospitals and other healthcare institutions they go to. But patients have the responsibility to provide complete and accurate information about their full name, address, health and medical history, present condition, past illnesses and related information when required.

These are among the topics that we discussed yesterday in Day 2 of the 3-days National Convention of the Philippine Pharmacists Association (PPhA) held at the Capitol Convention Center, Camsur Watersports Complex (CWC), Naga City, Camarines Sur.

The convention center was fully packed with possibly 1,500 people in the audience. I was one of three speakers yesterday morning. I talked on the “Patient Perspective” while Dr.. Eleonor Almoro, an OB-Gyne specialist andand faculty member of St. Lukes College of Medicine, talked on the “Physician Perspective.” Ms. Leonila Ocampo, current President of the Association talked about the PPhA Declaration of Patient Rights.

I thanked Leonie and Ma’am Mita Leyesa, past President of PPhA, for inviting me to this big Convention. I have known them for about two years now, they read my papers and articles including my book Health Choices and Responsibilities, that is why they invited me to be among the speakers in their event.

Patient rights and responsibilities refer to a set or bill of rights that a patient is expected to get from a hospital and its health professionals. Other patient rights include: (a) Right to receive care in a safe environment free from all forms of abuse, neglect, or mistreatment; (b) Right to be told the names of their doctors, nurses, and all health care team members providing healthcare; and (c) Right to have a family member or person of their choice and their own doctor notified promptly if admitted to the hospital, and so on.

The other patient responsibilities include: (a) To ask questions when patients do not understand information or instructions. Related to their treatment plan. If they do not follow the treatment plan, patients are responsible for the outcomes; and (b) Participate actively in their pain management plan, inform their doctors, nurses, pharmacists, other team members of the effectiveness of their treatment, and so on.

Each hospital and healthcare facility has, or is supposed to have, its own set of patient rights and responsibilities, This is important as it clearly delineates the distribution of responsibilities between the patients (and their guardians) and the hospital and health facilities management and health professionals. In a sense, there is a strong assignment of personal responsibility in healthcare and treatment of patients.

Talking about personal (and parental) responsibility of healthcare, the National Statistics Office (NSO) released the Death Statistics 2007 sometime middle of last month. It showed that the top 4 diseases were responsible for nearly 50 percent of all deaths in the country in 2007. These are: (1) Heart diseases: Coronary, cardiovascular, heart failure; (2) Cerebrovascular diseases: Brain dysfunction, hypertension, stroke; (3) Cancer: lung, liver, prostate, 200+ types; and (4) Pneumonia: Lung inflammation due to virus, bacteria, fungi, parasites. The 5th killer disease is Tuberculosis.

These are mostly lifestyle-related diseases. Gone are the days where the top killer diseases in the country are polio, malaria, dengue, flu and so on.

So, is “more government responsibility” in healthcare feasible?

Technically YES. All government spending is a political act. Whether the public debt is as high as Mt. Apo, if politicians will decide to increase spending on any particular sector, they can. But is it feasible without further long-term damage to fiscal situation and future spending on healthcare and other social services?

The answer is NO. Here are the outstanding debt of the national government: from P2.2 trillion in 2000, up to P3.4 trillion in 2003, up to P3.8 trillion in 2006, then P4.4 trillion in 2009, and P4.7 trillion as of end-2010.

The total budget in 2010 was about P1.7 trillion. Or our public debt is now more than 3x the total expenditures for the year. It’s a number that we cannot really be proud of.

Out of those trillions of pesos of public debt, how much are we paying each year?

From P227 B in 2000 to P470 B in 2003, P854 B in 2006, P622 B in 2009 and P670 B last year. There were lots of maturing debts that have to be paid middle of last decade. After that, debt payment somehow declined but still at a high level of close to P700 billion.

Interest payment constitutes about 40 percent of those annual debt payment. Almost P300 billion in interest payment alone in 2010, What does it mean?

It means that for every P5 of total government expenditure, P1 goes to interest payment alone. Principal amortization takes away more than P1 of that. So that ALL the sectors combined – healthcare, education, housing, agriculture, public works, social work, justice system, police, armed forces, the judiciary, congress, the various constitutional commissions like Comelec and COA – will have to fight it out with the remaining less than P3.

Increasing borrowings and bloating the public debt for whatever new programs, therefore, will be counter-productive as it will only mean less resources even for existing and continuing programs.

I added in my presentation, patient rights with respect to the pharmacists. This include the right to confidentiality of patient records, and the right to proper advice in rational use and non-abuse of medicines, especially if medicines are to be distributed free by government and other civic organizations.

On the issue of drug-switching in particular, some patients’ have the tendency to switch arbitrarily to the cheapest generic to get savings. Pharmacists should be able to explain to patients about the issue of bio-equivalence, pharma equivalence and related issues. Getting the cheapest generic drugs available is understandable, but if patients will experience some adverse effects later if the switched drug do not contain the necessary ingredients that a particular patient’s “bio-markers” will need, then other health problems will occur later.

Someday, pharmacists will be more integratedl within the health care system with more patient care skills, and not just selling and dispensing medicines.

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