Trust us

Patients have no more right to critical information about their health care than they did under communism

By Martin Jan Stránský

May 17, 2006

Shortly after I opened my practice in Prague in the early ’90s, I asked a patient to bring me a recent X-ray taken of him at the hospital. “They refused to give it to me,” he said with a shrug when he next showed up. I was incredulous. Today, the situation is no better – unless I give my patient a signed letter asking the hospital to ferry his X-ray to me as part of his medical care, no X-ray.

Sixteen years after the so-called revolution, the only law on the books regarding patient access to information goes back to the 1960s, when, during the thawing of socialism, Bolsheviks finally got around to mentioning it in the first place. The law stated that patients can access information about their health from healthcare providers, but in typical fashion, it did not stipulate just how that right could be realized.

This leaves the decision of what information to convey, as well as how and when to convey it, entirely up to healthcare personnel. As a quintessential act of post-totalitarian subservience, patients still dutifully ferry their healthcare information back and forth in tightly sealed envelopes, waiting to be told what’s inside.

Though an amendment to the law has been drafted in Parliament, it has been unintentionally sabotaged by politicians tacking on other controversial amendments to unrelated laws. The vote on the amendment will be in late May, but the amendment is not expected to pass because of the extraneous baggage attached to it.

In the Czech Republic, what is not written down is not allowed, and that’s bad news. For example, since there’s no law of any kind stipulating the right of patients’ relatives to access information, even getting a death certificate is difficult. I know of “benevolent” colleagues who, upon being visited by the family of the deceased, outline the law to them and then end by saying “I’m going to go now, but I may just forget something on my desk,” at which point they leave the death certificate on the table and exit the room.

In another example, a physician colleague of mine went to the hospital where her mother had just died. She asked her mother’s physician, who was reading the open chart, if she could look at it with him. “What would you like to know?” he asked, as he closed up the chart, holding it tightly to his chest. Ironically, he could be held liable for giving out “privileged information,” which is a punishable crime.

In all European Union states, the trend is well under way of putting patients at the center of healthcare policy in terms of giving them both more responsibility and more rights. The Czech Republic is moving in the opposite direction. There are two reasons for this.

In the political and social landscape of all post-communist countries, the road to individual rights and democracy is a slow and uneven one. Many relics from the totalitarian past not only refuse to die, but are actually thriving. In the Czech Republic, relic No. 1 is the healthcare system. Though everyone is now aware that a problem exists, all sides remain mired in old and maladaptive traits.

On the part of 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. Then there are the state healthcare workers who prefer fixed pay and who are unwilling to relinquish their bureaucratic “authority” over their fellow citizens.

State doctors get paid the same amount regardless of medical outcomes or number of patients seen. Their patients are used to standing in line and milking the system from the other end: Because prescriptions cannot be automatically refilled and because the state gives its citizens generous sick pay while mandating that sick leave (and even their return to work) be approved by a doctor, Czechs hold the world record in patients seeing doctors â an average of 17 times per year.

The above mindset has been made worse by the current health minister, David Rath, who has pursued an aggressive campaign of centralization of power into his ministry without any measures that would actually increase healthcare quality and efficiency.

His tightening the reigns of state control over both physicians and hospitals â such as setting limits on the amount of medication physicians can prescribe, coupled with controversial and often poorly drafted laws, such as one to nationalize private hospitals back into state hands â has created an atmosphere of increasing polarization, with complacent state workers on one side, and just about everyone else on the other.

A second public protest is now planned for May 26 on Prague’s Old Town Square, in which organizations representing the majority of private physicians as well as most hospitals will again demand healthcare reform as well as Rath’s dismissal.

Yet, there is a light at the end of the tunnel. Sooner or later, a law regarding proper access to information will be passed. Rath is not expected to survive in office past the elections, and all the other parties agree that there must be a shift in health care back toward the patient and toward decentralization.

There are many physicians within the state system as well who are exemplary in their work and who see a need for reform from within. In the most recent elections, to the Czech Medical Chamber’s board, the majority of members elected were those who oppose the negative activities of the union’s president, who has blindly supported Rath.

Healthcare reform will begin, because it will have to. But until it does, as a private practicing physician in this country, I shall do everything in my power to keep my patients not just healthy, but out of the state’s hands.

– The author is a physician and director of Polyclinic at Národní.


The Prague Post17.5.2006

My priority is that patients recieve
and have access to the best care possible.