Much has been said about patients’ rights, but nobody talks about physicians’ rights. Dr. Rodel V. Capule, a law professor and medico-legal expert specializing in medical malpractice, physical injuries, and food torts, discusses that while patients come first, doctors have rights, too

Mylene C. Orillio from the article Doctors’ Rights

Some doctors are starting to feel that the public at large has unfairly painted them as “professionals without any rights”. We always hear about doctors’ duties and responsibilities, but when we enter the hospital, all you see are patient’s rights posted at the hospital lobbies.

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Patient’s rights are always put first before anything else. Yet, there are still lots of issues arising in the medical field concerned about the rights of patients. But, how about the people who put their utmost attention to them? Don’t you think we are overseeing their rights? Doctors have rights, too. Allow us to tell you more about it.

When a doctor is talked about, society refers to them as highly skilled professionals incapable of committing mistakes. And the absolute expectations come from patients to discharge his duty at the expense of his rights. As doctors, they should be able to balance the “expectations of patients” and the “exercise of their right” says Dr. Rodel V. Capule, a law professor and medico-legal expert specializing in medical malpractice, physical injuries, and food torts. What always happens was doctors were being shouted unreasonable by inconsiderate patients or their relatives.

Issues on doctor’s rights have been listed by M.C. Orillio below. These points are illustrations of how doctors were deprived of their so-called rights.

Patient as ‘captive consumer’

Perhaps, most will think of doctors as the “dictators” — telling patients what medicines to take, how to take it, until when patients consume it. This is one key factor why most would think of patients’ rights more than the doctors’ rights because they see them [doctors] being people in authority. But folks, all persons’ rights should be acknowledge.

“in a physician-patient relationship, the patient is a captive consumer. There is no other profession or business wherein one can “dictate to a consumer what brand [s]he must buy…how fast [s]he must consume it and how much [s]he must pay with the further condition to the consumer that any failure to fully comply must be at the risk of [her] own health.” [Magan Medical Clinic v. California State Board of Medical Examiners 57 Cal. Rptr. 256 (Ct. App. 1967)]

“Perhaps that’s the reason why nobody talks about your (doctors’) rights because this is the way the public at large sees it. You’re the boss, and everything you say is followed by the patient. But doctors’ have rights, too!” says Dr. Capule.

Usually, physicians refer to the Medical Act of 1959, Hippocratic Oath, Philippine College of Physicians and Philippine Medical Association Code of Ethics, but they don’t specifically indicate doctors’ rights. Most doctors have not even read the Medical Act of 1959, and while there’s a pending bill in the Senate and the Lower House trying to come up with a new medical act, unless it’s filed every year during the opening of the Congress’ session, it will only be overtaken by a lot of political issues and buried in the archives.

Medical Act of 1959

Physicians are also humans. They are not gods who can do anything and everything. Their rights are also subjected to the law.

The Medical Act of 1959 provides for and shall govern the standardization and regulation of medical education, the examination for registration of physician, and the supervision, control, and regulation of the practice of medicine in the Philippines. The Medical Act of 1959, Sec. 25 states the Rights of Respondents where the respondent physician shall be entitled to the following: 1) Entitled to be represented by counsel or be heard in person, 2) To have a speedy and public hearing, 3) To confront and to cross-examine witnesses against him or her, and 4) To all other rights guaranteed by the Constitution and provided for in the Rules of Court.

“Right of respondents, meaning you have a case [already]. But even without these, the Constitution will provide for your rights as a respondent. But it doesn’t indicate your right/s, but a regular course of your practice,” –  Dr. Capule.

In the PCP Code of Ethics, it only indicates that the parties may jointly waive their right to a formal hearing in writing by opting to submit their position papers in lieu of a hearing [2.5.3. Sanctions and Procedure]. The parties shall be accorded the right to have counsel present to assist them [2.5.3. Sanctions and Procedure]

The right to refuse patients

Do doctors have the right to refuse patients? Yes, they have the rights to do it. Just like how patients have the rights to refuse doctors for their medical concern, doctors are entitled to refuse, too.

In Dr. Capule’s practice, one of the most common issues or questions is, “As a doctor, do I have the right to refuse patients?” Under the PMA Code of Ethics Section 2, Article II, Duties of Physicians to their patients, it states there that “a physician should be free to choose patients.”

But if he’s a primary physician, who will be the first contact with the patient, he’s on deck or duty in the hospital, it might be a source of liability. He will be called anytime PhilHealth member, it can also be a source of liability if the doctor refuses him/her. But for company physicians, they have no choice but to accept the employee as their patient. They cannot refuse him/her as it is a breach of contract.

Dr. Rodel V. Capule, an attorney specializing in medical malpractice, physical injuries, and food torts and a law professor in Legal
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When can doctors refuse?

Though doctors can refuse, there are still things to be prioritized and considered. Patient’s condition will always be the doctor’s priority.

If doctors fall under any of the above-mentioned categories, their playing field is very narrow. Doctors should have somebody to cover for them, especially if he/she is really not feeling well or tired. “It can be an internal arrangement. The important thing is there’s somebody to attend to the patient,” he says. Doctors also have the right to refuse participation in the treatment. Dr. Capule cites: “Conscientious objection implies the acted responsibly in making it clear in a courteous way to the patient what the limits of his/her medical practice are.

Right to be paid for services

All persons deserve to be paid for the service they provide, regardless of what profession they practice. But, doctors must not demand of a full payment first before giving certain treatments.

Obviously, when a physician treats a patient, it has an enforceable claim for full payment for his services, but that is if he’s willing to go to court to file a collection case.

The good thing about doctors is at the end of the day, most still practice medicine not because they’re solely after the money. “It’s our passion. But it’s your right. Once you render your services, you’re entitled to a fee, but to a ‘reasonable’ one,” he says.

Doctors can refuse a patient who has not yet paid their professional fee, but this is rarely done due to its repercussions. It will definitely leave a bad image of the physician for his/her patients and to the community once they’ve learned about it.

As to the case of deposits, Dr. Capule clarifies that it’s not wrong to demand for a deposit. What’s wrong is if one makes it as a precondition to render care or initiate treatment.

“That part is limited by the law (RA 8344 Demanding of Deposits). ‘Money down before I treat you’ is a violation. You cannot do that! We don’t do that. But asking for a deposit per se is not prohibited by the law.”

Right to withdraw

Doctors have the right to withdraw given that they give reasonable notice to the patient to provide them enough time to secure other medical attendance. But, this should not constitute to abandonment.

The physician has a definite right to withdraw from the case provided he gives the patient reasonable notice so as to enable him to secure other medical attention. Such a withdrawal does not constitute abandonment. Dr. Capule explains that a physician must continue to attend to a patient until the conditions for his rightful withdrawal are complied with. He cannot just abandon a patient. Some doctors withdraw because patient and family members become hostile, disagree with the treatment plan, or if they become disruptive or difficult to deal with. A physician may also find himself/herself unable to work with a medical colleague attending to the same patient.

“I’ve encountered cases where the doctor was being subjected to verbal abuse by the patient or family members. The question is, are you still comfortable being the attending physician?”

Dr. Capule shares one case he has handled wherein the doctor was recorded on video while doing his regular rounds. The video recording was surreptitiously done and used as basis for a complaint. “The problem is he [complainant] didn’t know that he was violating the Anti-Wire Tapping Act. It cannot be used as evidence against the respondent. Luckily I was able to have it dismissed.” Dr. Capule advises the doctors if they feel that the environment, society, hospital is already hostile, they should not subject themselves to that every day. He has the right to withdraw, but he has to follow certain procedures, so as not to be liable for professional abandonment. He must formally sign out. Doctors cannot be onion-skinned or hypersensitive. “You don’t have that right,” says Dr. Capule. “You cannot justify abandoning your patient just because nagtatampo kayo (you were touchy).”

Doctors as expert witnesses

Doctors should be expert witnesses and should not refuse to cooperate when it involves the administration of justice. Unfortunately, some doctors refuse to do so, especially when the incident involves their colleagues.

Dr. Capule notes that some doctors refuse in the administration of justice especially when their colleagues are involved. This issue continues to haunt the doctors as professionals on why they are not comfortable in helping the court decide on a particular case.

“That has been a nagging question ever since, especially if our colleague has committed malpractice. It is a challenge for us. When lawyers talk to us, everything is off the record.”

While doctors have the right to refuse to be an expert witness, they are challenged by the Duties of Physicians to the Community [Article III Section (2) Code of Ethics of PMA], “where a physician shall assist the government in the administration of justice in accordance with law. He/she may be accorded a fair and just remuneration when called upon as an expert witness.”

As a witness, doctors cannot refuse a subpoena. However, this law does not apply to a witness who resides more than 100 kilometers from his residence to the place where he is to testify. [Rule 21 Section 100 of the Rule of Civil Procedure]

“Doctors must advocate for themselves in ensuring that their rights are not violated, in the same manner that they try to respect and uphold their patients’ rights. “A conscious effort to understand these rights is the key to preempt conflicts that might arise in the course of a doctor-patient relationship,” says Dr. Capule in conclusion. Medico-Legal Issues: What are the Doctors’ Rights? by Dr. Rodel V. Capule, FPCP was one of the topics discussed during the Philippine College of Physician’s Annual Convention at the Marriott Hotel, Pasay City.

A healthy doctor-patient relationship cannot be fully obtained if only one party recognizes the other’s concerns. Patients and doctors should equally inform themselves about the rights of one another so they can understand each contexts when issues arise.

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