Int. J. Pure Appl. Sci. Technol., 17(1) (2013), pp. 37-47
International Journal of Pure and Applied Sciences and Technology ISSN 2229 - 6107 Available online at www.ijopaasat.in Research Paper
Physicians’ Perception towards Patients’ Rights in Two Governmental Hospitals in Mecca, KSA Hager Ali Saleh1, * and Mohamed Mohamed Khereldeen1 1
Lecturer, College of Applied Medical Sciences, Umm Al-Qura University, KSA
* Corresponding author, e-mail: (
[email protected] ) (Received: 7-4-13; Accepted: 16-5-13)
Abstract: The Saudi society has its own unique values, morals, and ethics which are based on the religion of Islam. The social system in Saudi Arabia is very supportive of patients and their families, and in most hospitals patients have access to free healthcare services. However, there has been little discussion on how patients’ rights are practiced in such healthcare systems. In this research paper the perception of physicians concerning patients’ rights and their fulfillment in two governmental hospitals in Mecca, Saudi Arabia is compared, using a selfadministered questionnaire which examined the physicians’ knowledge, attitude and perception towards these rights.
Keywords: Patients’ rights, physicians’ attitude.
1. Introduction: Social, economic, cultural, ethical and political developments have given rise to movement towards the fuller elaboration and fulfillment of the rights of the patients [11]. Patients’ rights largely confine themselves to regulating the relation between the patient and the health care provider or institution. Successful implementation of them could lead to a better understanding between health care providers and the patients [7]. Probably the best way to look at this is to think of what we, ourselves expect when we get sick. The answer is simple. We expect to be informed truthfully about our illness and if the hospital is capable to treat our illness or not. We expect that our pain is relieved quickly and in an efficient manner. We expect that the care provided to us will be given in a compassionate and caring manner [8]. In Saudi Arabia, The Ministry of Health published a patients’ bill of rights in 2001, the patient bill of rights as a written document is available in most Saudi health care organizations, but many patients
Int. J. Pure Appl. Sci. Technol., 17(1) (2013), pp. 37-47
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and their families may not be aware of their rights that have been granted by the Saudi government through policies and regulations of the Ministry of Health [6]. Physicians’ perceptions towards patients’ rights have been described in a number of studies [1-5, 910] but in Saudi Arabia it was difficult to find a study that examine physicians’ attitude toward patients’ rights except one study by Al Bishi 2004 [1].
2. Materials and Methods: The study settings were two governmental hospitals in Mecca, KSA. The study design was a cross sectional analytic study. The target populations were physicians working in the two study hospitals. Inclusion criteria were physicians who attend morning shifts (8 am – 4 pm) and worked for more than 6 months starting before the study period (April 2012) in inpatients departments in the two study hospitals (246 physicians were included). Exclusion criteria were physicians who attend night shifts, who worked in hospital less than 6 months, and Radiologists, Pathologists and other non-direct patient care specialists. Data collected using a self-administered questionnaire which was designed after review of literatures [1-5, 9-10] the questionnaire included four sections. First: Demographic characteristics of physicians included gender, age, nationality, department, current position and years of work. Second: Physicians' awareness about 16 different right of patients. Third: physicians' opinions about the importance of patients' rights to patients. Fourth: physicians' opinions about the extent patients' rights are maintained in their hospitals.
Statistical Analysis: The raw data were coded, entered and analyzed using the SPSS (Statistical Package for Social Sciences) for windows, version 16. Data were described using frequency distribution tables and Z test was used for comparing two proportions.
Ethical Considerations: To assure the confidentiality, the questionnaire did not involve Physicians' personal data; only age and gender were included. Verbal permission was given by the physicians after necessary explanation about the nature and purpose of the study.
3. Results: Total 246 physicians were surveyed; 112 physician for Hospital A and 134 for Hospital B. Table 1: shows distribution of the studied groups according to demographic characteristics. The greater proportion of physicians in both hospitals were males, Non-Saudi, resident and belong to Internal medicine department. Table 2: shows the distribution of the studied groups according to their agreement on patients' rights. In hospital A, it reveals that physicians agreed about all the 16 patients' rights; the percentage ranging from (100%) for knowing name of physician, care with respect, keep his secret, informed about treatment alternative to (85.7 %) for access to medical records. On the other hand, in Hospital B, it reveals that physicians also agreed about all the 16 patients' rights; the percentage ranging from (100%) for knowing name of physician, care with respect, privacy & confidentiality, informed about treatment alternative, written consent and informed about side effects to (73.1%) for access to medical record.
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Table 3: shows the distribution of physicians in the two hospitals according to their rating of patients' rights as (important and very important). Higher percentage of physicians (range between 79.9 % to 99.1%) in both Hospitals rated 13 rights as important and very important. while lower percentage of physicians (range between 47.8% and 72.3%) rated 3 patients’ rights as important and very important, namely, access to his medical record (56.3% and 47.8%), seek second opinion (64.3 % and 62.7%) and refuse the treatment (72.3% and 70.1 %). Table 4: shows the distribution of physicians in the two study hospitals according to their rating of patients' rights as neutral. In Hospital A, It reveals that access to medical record was rated as neutral by greatest percentage of physicians (29.5%) then seeks second opinion (28.6%) then refuses treatment (22.3%). While in Hospital B the greatest percentage of physicians rated as normal for Seeking second opinion by (26.9%) then refuses the treatment (25.4%) then access to his medical record (24.6%). Table 5: shows the distribution of physicians in the two study hospitals according to their rating of patients' rights as not important and absolutely not important. It reveals that in both Hospitals (14.3% and 27.6) of the physicians’ rate for having access to medical record then (7.1% and 10.4%) for seeking second opinion and then refuse treatment (5.4% and 4.5%, respectively). Table 6: shows the distributions of physicians in the two study hospitals according to their opinions about the extent patients’ rights are maintained. It reveals that the lowest percentage of physicians reported that 11 out of 16 rights were often maintained in Hospital A, the percentage ranging from (15.2%) for access to medical record to (1.80%) for informed about side effect, treatment alternative and examination of his complaints. While in Hospital B also low percentage of physicians reported that all rights were often maintained, the percentage ranging from (21.6%) for access to medical record to (0.7%) for physician introduce himself, respectable care , maintaining privacy and knowing treatment alternative. On the other hand for physicians who don’t know if rights were maintained or not, it reveals that in hospital A, percentage of physicians range from (87.5%) for written consent to (26.8%) for seeking second opinion, while in hospital B, percentage of physicians range from (87.3%) for keeping his secret and written consent and (29.9%) for seeking second opinion. Table 1: Distribution of the study population according to demographic characteristics
Demographic Characteristics Sex: Age: -
Male Females 0.05
3
2.2
0. 102
> 0.05
2.7
1
0.7
0.159
> 0.05
6
5.4
5
3.7
0.136
> 0.05
5. Informed about his Medical condition
6
5.4
7
5.2
0.016
> 0.05
6. Access to his Medical record
33
29.5
33
24.6
0.449
> 0.05
7. Knowing Treatment alternative
10
8.9
9
6.7
0.179
> 0.05
8. Written consent
2
1.8
2
1.5
0. 024
> 0.05
9. Informed about Side effects
4
3.6
5
3.7
0.008
> 0.05
10. informed about any intervention
10
8.9
14
10.4
0. 123
> 0.05
11. Refuse the treatment
25
22.3
34
25.4
0. 278
> 0.05
Patients' rights
Int. J. Pure Appl. Sci. Technol., 17(1) (2013), pp. 37-47
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12. Seek second opinion
32
28.6
36
26.9
0.156
> 0.05
13. Pain treated
12
10.7
15
11.2
0.041
> 0.05
14. Examination of his complaints
11
9.8
20
14.9
0.424
> 0.05
15. Informed about actions towards his complaint
18
16.1
21
15.7
0. 034
> 0.05
16. Not exposed to harassment
8
7.1
23
17.2
0.840
> 0.05
Table 5: Distribution of physicians in the study hospitals according to their rating of patients' rights as (Not important and absolutely not important)
Hospital A (n=112)
Hospital B (n=134)
No.
%
No.
%
1. Knowing name of physician
1
0.9
1
0.7
0.015
> 0.05
2. Care with respect
0
0.0
0
0.0
0.0
> 0.05
3. Privacy & confidentiality
0
0.0
1
0.7
0.083
> 0.05
4. Keep his secrets
0
0.0
0
0.0
0.0
> 0.05
5. Informed about his Medical condition
0
0.0
1
0.7
0.083
> 0.05
6. Access to his Medical record
16
14.3
37
27.6
1.163
> 0.05
7. Knowing Treatment alternative
0
0.0
4
2.9
0.345
> 0.05
8. Written consent
0
0.0
2
1.5
0. 175
9. Informed about Side effects
0
0.0
0
0.0
0.0
> 0.05 > 0.05
10. informed about any intervention
1
0.9
1
0.7
0.015
> 0.05
11. Refuse the treatment
6
5.4
6
4.5
0.071
> 0.05
12. Seek second opinion
8
7.1
14
10.4
0.270
> 0.05
Patients' rights
z
p
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13. Pain treated
3
2.7
1
0.7
0.159
> 0.05
14. Examination of his complaints
3
2.7
2
1.5
0.094
> 0.05
15. Informed about actions towards his complaint 16. Not exposed to harassment
3
2.7
6
4.5
0.142
3
2.7
4
2.9
0.015
> 0.05 > 0.05
Table 6: Distribution of physicians in the study hospitals according to their opinions about the extent patients' rights are maintained Hospital A (n=112) Patients’ Rights
I don’t know No. %
%
I don’t know No. %
No.
%
No.
%
No.
No.
%
No.
%
No .
%
63
56.2
42
37.5
7
6.2
0
0
81
60.4
48
35.8
4
3.0
1
0.7
2. Patient take Respectable care
65
58.0
47
42.0
0
0
0
0
110
82.1
22
16.4
1
0.7
1
0.7
3. Patient privacy maintained
67
59.8
43
38.4
2
1.8
0
0
114
85.1
19
14.2
0
0
1
0.7
4. Keep his secrets
64
57.1
39
34.8
4
3.6
5
4.5
117
87.3
13
9.7
0
0
4
3.0
5. Patient access to his Medical record 6. Informed about his medical condition
58
51.8
23
20.5
14
12.5
17
15.2
50
37.3
26
19.4
29
21.6
29
21.6
70
62.5
42
37.5
0
0
0
0
106
79.1
23
17.2
2
1.5
3
2.2
7. Informed about treatment alternative 8. Written consent
51
45.5
54
48.2
7
6.2
0
0
97
72.4
32
23.9
4
3.0
1
0.7
98
87.5
10
8.9
1
0.9
3
2.7
117
87.3
6
4.5
1
0.7
10
7.5
9. Informed about Side effects
82
73.2
23
20.5
5
4.5
2
1.8
105
78.4
25
18.7
2
1.5
2
1.5
10. Informed about any intervention
46
41.1
53
47.3
11
9.8
2
1. 8
96
71.6
28
20.9
6
4.5
4
3.0
11. Refuse treatment
42
37.5
55
49.1
8
7.1
7
6.2
87
64.9
36
26.9
8
6.0
3
2.2
12. Seek second opinion 13. Pain treated
30
26.8
58
51.8
9
8.0
15
13.4
40
29.9
50
37.3
25
18.7
19
14.2
59
52.7
47
42.0
3
2.7
3
2.7
85
63.4
39
29.1
6
4.5
4
3.0
1. Doctor introduces himself
rarely
Hospital B (n=134)
Sometimes
Often
rarely
Sometimes
often
Int. J. Pure Appl. Sci. Technol., 17(1) (2013), pp. 37-47 14. Manageme nt examine his complaints 15. Informed about the actions toward his complaints 16. Not exposed to harassment
45
85
75.9
24
21.4
1
0.9
2
1.8
98
73.1
25
18.7
5
3.7
6
4.5
77
68.8
24
21.4
4
3.6
7
6.2
78
58.2
34
25.4
6
4.5
16
11.9
88
78.6
14
12.5
2
1.8
8
7.1
85
63.4
29
21.6
6
4.5
14
10.4
4. Discussion: The rights of the patients admitted to the hospital must be the prime concern of all health care providers. This research has been done to assess the awareness of physicians about patients’ rights and the degree of its implementation. Results of this study demonstrated the physicians’ opinion about patients’ rights. Regarding hospital (A), the agreement of physicians on investigated rights to be a patient right in their working hospital ranged from 85.7% up to 100% for 6 rights investigated. Regarding hospital (B), the agreement ranged from 73.1% up to 100% for 4 rights investigated. (Table 2). All physicians in both study hospitals indicated that the rights to know the name of attending physician, the right to be treated with caring and respect and the right to know treatment alternatives is considered an actual patient right. This could be attributed to the fact that these rights are basic human rights and not for debate. On the other hand, the lowest percentage of physicians agreed that patients have the right to access to their own medical records. Organizational culture and hospital rules and regulations may prohibit the patient accessibility to medical records. Also, physicians said that the patient will not understand medical reports and terminology. (Table 2) In consistent with results of this study, results of another study conducted in Lithuania, Finland [2] revealed that (50.2%) of physicians agreed with the statement that being informed about the diagnosis, medical treatment results and treatment methods was necessary, whereas, in this study, (98.2 %) and (98.5 %) of physicians in Hospital A and Hospital B, respectively, agreed on that patients would consider having information about their medical condition. (Table 2) Moreover, it was expected that physicians’ opinions about the importance of different patients’ rights to patients, would be consistent with the extent these rights were maintained in study hospitals, in Hospital A, respect was regarded by physicians as most important patient right to patients where (99.1 %) of physicians considered it as important, whereas it occupied lowest percent from rights that were maintained in the hospital (0%) for often and sometimes (Tables 3 and 6). However, consistent opinions were found in Hospital B as privacy was considered the most important right (98.5%) and lowest percent from rights that were maintained in the hospital with percentage (0.7 %) (Tables 3 and 6). Accordingly, physicians may not be providing care based on patients’ rights. Therefore, health care professionals’ knowledge of patients’ rights and their implementation of these rights, need to be evaluated regularly, and continuous education on the subject should be provided. Also there is a need to educate people about their rights and the current laws and legislation that honor and value these rights. As long as people do not know their rights, they will fail to ask for these rights and they will fail to seek legal protection.
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Limitations of the study: The study being conducted in two governmental hospitals and so many aspects are almost similar, as physicians’ attitude in both hospitals. On other hand, if physicians of private hospitals were included they may have different perceptions and views. Thus further research for examining patients’ rights in private hospitals is suggested. However one of the limitations of the study was that based only on physicians attitudes. They were not observed while interacting with patients, so results about their actual behavior cannot be concluded.
5. Conclusions and Recommendations: Based on the results of the present study, the following may be concluded: There is a similar discrepancy between physicians in both hospitals, most physicians are aware of patients’ rights and in particular of the basic human rights as respect, privacy and confidentiality and most of physicians agreed on the importance of the patients' rights in both hospitals while only few percentage of them reported that patients' rights were maintained in both hospitals. Based on study findings and conclusions the following recommendations can be suggested: Hospital’s policies and practices should address the rights of patients to treatment and care within its capability and mission and in compliance with law and regulation. Written policies on patients’ rights should be available, disseminated, or made visible to physicians.Specified list of procedures or treatments for which informed consent is required from the patients or other authorized person should be available. Patient consent forms should be available in all applicable locations at the hospital. Hospitals should provide regular training to all health care professionals on the subject of patients’ rights once or twice a year. Motivating physicians to accept an active patient role and to educate them about the beneficial effects of patient involvement on health outcome.
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