Emerald Group Publishing Limited
Copyright © 2004, Emerald Group Publishing Limited
Protecting Patients’ Rights? is intended to provide a “flavour of the experience of patient advocacy and Patient Ombudsman systems in seven European countries”. The editors also present proposals to inform thinking around future reforms, which are unlikely (given that they deal with the need for impartiality, openness, standardised systems, monitoring and evaluation) to prove controversial. It is not clear, however, that they focus on areas which are of real interest to policy makers and health care professionals (the book's intended audience).
Since each of the chapters is rather short (only seven pages for Finland, for example) the book raises a number of questions, which are often explored only superficially or not at all. For example, the editors avoid discussing the extent to which patient rights, enshrined in law, should be part of an Ombudsman system. This may reflect the fact that, in the preceding chapters, the balance between description and evaluation of existing Ombudsman arrangements is heavily tipped towards the former, which makes drawing firm conclusions difficult. It is not clear, for example, from the brief accounts presented, what happens in practice when the “right to healthcare” enshrined in law in Finland and Hungary conflicts with the availability of resources in the system or whether the existence of such rights gives patients any greater degree of protection than in countries where formal statements of patients rights are absent.
The editors also suggest that “the messages in this book can offer ideas for promoting and sustaining beneficial relationships between patients and health professionals”, but they are silent on the important question of whether the systems established to protect patients rights should be aimed at resolution or retribution. The Greek system appears to favour the latter, judging by the examples provided of the identification and prosecution of “guilty” professionals. This contrasts with the avoidance of naming and shaming in the UK, although the author of the UK chapter speculates that reporting the names and locations of individuals might be a desirable approach.
The clear consensus from the literature on quality and clinical error is that the naming and shaming of individuals reduces the potential to learn from adverse events and is unlikely to contribute to a more open relationship between patients and professionals. Although the extent to which this consensus has the support of the general public or individual patients in the context of each of the systems described in the book is unclear. Indeed the tendency throughout the book to depict patients as passive agents in the context of processes and structures intended to help them exercise their rights sits uneasily with the editors' aims of encouraging more active patient participation. Involving patients in the design of Patient Ombudsman schemes and engaging them on issues such as explicit versus implicit rights, whether the system should aim for retribution or resolution (and anything else that they might see as relevant) is not discussed by the book's editors, but in the interests of active participation, it might be a good place to start!