Patients' Rights in the Czech Republic
The government is still making the transition to democratic health care policies but progress is visible
The Czech government has dedicated the last decade to revamping its political system, economic policies and even its image to catch up at an almost frighteningly fast pace with its Western neighbors.
But along the road to modernization, there were a few things that stubbornly remained as they were during the bad old Communist days.
One of those things was the status of patient's rights. Until this summer, the law that governed patients' rights stood exactly as it had in 1966.
In fact the Czech Republic was the only country among the 27 European Union (EU) member states that had yet to guarantee patients direct access to medical records and the right to informed consent.
The two issues are linked, as restricted access to medical records inhibits patients' ability to understand enough about his or her condition to consent to treatment or a procedure.
On March 21st, the center-right Civic Democrats (ODS), who hold the majority of seats in both houses of parliament, passed an amendment through the lower house, the Chamber of Deputies, giving patients the right to view and copy their medical records. The next of kin of deceased and unconscious patients, according to the new amendment, will also have access to medical records.
President Václav Klaus signed the amendment into law and expanded the Health Care Act of 1966 to allow patients to view and make copies of their medical documents, according to Radio Prague. The amendment also permits family members of the deceased to view these records.
The new amendment is the first successful legislation that Health Minister Tomáš Julínek has proposed, and the new law went into effect June of this year.
The Czechs, who happen to visit the doctor an average 17 times per year -- more than any other Europeans -- finally have the same rights as their Western and Central European neighbors. But why did it take so long?
Lingering past leaves its mark
In December 2004, the issue of patients' rights was widely publicized following the sudden death of the Czech national ice hockey team's coach Ivan Hlinka. Hlinka was in a car accident in Karlovy Vary, and when the cause of death was unclear and questions regarding his treatment surfaced, Hlinka's wife demanded to see his medical chart.
Hlinka's wife was denied access to her late husband's medical chart because the health care law had no provision for this right. Publicity surrounding this case was such that the government set up a commission of experts to make sure the doctors were not at fault for Hlinka's death, according to a Radio Prague report on December 10th, 2004.
According to the Health Ministry's interpretation of the 1966 law, doctors should tell patients what information is contained within their records, but patients don't necessarily have the right to see and keep a copy of medical records.
David Záhumenský, a lawyer who works for the Liga lidských práv (League of Human Rights) and the Mental Disability Advocacy Center in the Czech Republic noted in The Prague Post last May that doctors' resistance to releasing charts to patients stems from the belief, endemic during the Communist era, that the patient doesn't have a say in matters of his or her own health.
Dr. Věra Zdeňková, a physician at the Plus medical center in Prague, represents this state of mind.
"It depends on the patient," she said when asked if she would allow her patients to see and copy their medical record. "First, I would look to see what information is there, and then I would decide if I would show the patient or not."
Zdeňková's comment typifies the attitude of doctors schooled under the Communist regime, according to patients' rights advocates. Knowledge was power, and people-power was nonexistent.
"Doctors are still regarded as the authority," said Jana Petrovka of the Koalice pro zdraví (Coalition for Health), a Czech organization that lobbies for patients' rights. Self-treatment and self-medicating are "frowned upon, and second opinions are not customary," she explained.
Finding the flaws
Dr. Sandeep Jauhar of the Long Island Medical Center refers to a patient's right to self-determination as, "the prevailing ethic in medicine today" in his April 3rd essay in the New York Times, A Patient's Demands Versus a Doctor's Convictions.
"The denial to medical records is an infringement of a patient's right to self-determination, not to mention bad medical practice," Dr. Jauhar writes of the ethical issues surrounding the healthcare policy the Czech Republic has now amended.
When it comes to patients' decisions, says Jauhar, "informed consent is one of the means by which patients can exercise autonomy. It guards against abuse and hard paternalism, which we, as a medical community, reject."
While insurance and funding for health care is typically the main concern in the United States, the Association of American Physicians and Surgeons adopted a formal Patients' Bill of Rights in 1995, guaranteeing patients the right to be informed about their medical condition, the risks and benefits of treatment, and appropriate alternatives.
"On the part of the patients, there is a lingering and omnipresent general complacency stemming from the habit of bowing to a state authority that they feel they can't influence," wrote Martin Stranský in his article published in The Prague Post on May 17th, 2006. Stranský is a Prague physician who has lived and practiced medicine in the United States.
This lingering "omnipresent general complacency" is derived from four decades of Communism that fell with the Berlin wall -- so what took the Czechs so long to recognize this and reform the policy?
"[Compared] with other European Union countries, the rights of patients are considerably neglected," said Vladimíra Bošková of the Občanské sdružení na ochranu pacientů (Civic Association for the Protection of Patients). Other post-Communist countries such as Slovenia and Slovakia have included patients' rights in their health care laws.
Dr. Jaromír Mašek, director of a psychiatric hospital in eastern Bohemia, was quoted in The Prague Post last year as saying that it isn't always in the patient's best interest to see his or her entire medical record.
"In psychiatry, it's important to give the patient information about his health condition in a sensitive manner, not by handing her a copy of her complete medical records."
In addition, the idea that patients would not understand their medical records is widely regarded as an argument against free access to them. Milan Kubek, president of the České lékařské komory (Czech Medical Chamber), was reported in the Prague Daily Monitor on March 23rd as saying, "some information might be harmful to the patient, especially if the diagnosis is bad."
While this might be true in the case of psychiatric patients, Dr. Jauhar says "[y]ou could make the argument that most patients would not understand the information in the medical record and may unnecessarily worry or suffer, but I think the benefits certainly outweigh these risks."
Waiting for Answers
Press Release: Legislators Secure Right of Patients to Access Medical Records (PDF)
Kristina Grbich is in her third year at New York University's College of Arts and Science, studying French and Politics. She is from Chicago, Illinois.
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