The influence of the law on patient's rights on the practice of the Flemish paediatricians anno 2010.

Background: The law on patients' rights in Belgium was issued in 2002. The new legal framework recommends the establishment of a true dialogue between physician and patient, and it assigns decisive priority to the adolescent rather than to the physician or his parents.

Purpose And Methods: The purpose of this study is to map the current interpretation of the paediatrician and the realisation of the law in practice. The answers of 117 Flemish paediatricians to an anonymous questionnaire were analyzed.

Results: Only 7.8% of the paediatricians state that they know the law well. 15.5% experience the law as a burden. 20.9% have adopted a different attitude when rendering care to adolescents under impulse of this law. 6.2% say they do not strictly follow the law. 27.8% think that the emancipating thought is too far-reaching. Most paediatricians apply protocols to interpret the traditional values that are stamped as being good medical practice: high quality care (81%), free patient's choice (70.7%), adequate pain control (77.4%). On the other hand paediatricans seldom dispose of procedures regarding the more emancipated amenities in the law such as obtaining informed consent (16.4%), access to the medical file (24.8%) and safe-guarding the privacy (13%). In practice most of the physicians offer the possibility of a free choice in 80% of the cases. All questioned physicians strive for a high quality care, for adequate pain control and for a careful maintained medical file. 79.1% of the physicians transfer to the parents all medical information regarding the adolescent. Proper experience and expertise (80.7%), case by case completed, are most often used as the basis for the judgment about the competence of the adolescent. From the patient's side, little advance is taken to exercise his own rights. Barely 1% of the adolescents consulting a paediatrician use their legal right to autonomously consent to a medical intervention. In barely 0.16% access is requested to the medical file. Practically no complaints are received regarding the law on patients' rights (0.1% in intramural setting, versus 0.001% extramural).

Conclusion: The law on patients' rights is, after 8 years of issuance, badly penetrated in the paediatric practice. On the one hand this is due to a poor knowledge of the law as well from the side of the physician as from the side of the adolescent and/or his parents. On the other hand 42.2% of the paediatricians experience difficulties with the practical interpretation of the law because of the lack of applicable guidelines. An important obstacle is the fact that more than a quarter of the paediatricians do not agree with the in the law foreseen autonomy of the adolescents. For that reason, paediatricians urgently need to be instructed in these matters. It is the moral duty of the Society of Paediatrics to organize workshops on these matters and develop clear guidelines concerning this law. Proper application of the legal context, the handling of the watertight procedures and the necessary communication in this respect is indispensable for the confidence and will lower the barrier for adolescents to use the healthcare system.