Cyprus Mail
Cyprus Health

The ethics of withholding test results

By Andria Kades

THE HIPPOCRATIC Oath, which binds all doctors to uphold certain ethical standards, and real-life practices within the private health sector do not always sit easily together, as 37-year-old Stella Loizidou has found to her cost.

A few weeks after Stella Loizidou had her gall bladder removed in an emergency operation, she was unable to eat without feeling extreme discomfort. After seeing a gastroenterologist, she underwent a colonoscopy and endoscopy during which she had a polyp removed and a biopsy to test if she had colon cancer.

Days later Loizidou was shocked when the gastroenterologist refused to give her the results of the biopsy before she had paid the full €1080 cost of the tests.

Although her doctor was acting totally legally – the money was owed, after all – Loizidou felt it was also unethical.

Loizidou was upset not only because of the policy – the secretary told her these were the rules the doctor operated with – but also because she had not been warned beforehand.

“I was never ever made aware of such a policy. He never told me anything about it,” she told the Sunday Mail.

The procedure had been pre-planned, but it was not until she was being taken into the operating theatre that she was given the forms to sign.

“He had had a week to tell me,” she said.

Instead, she was handed the forms by a nurse just before she was going to be put under general anaesthetic.

“As I was being rushed into the operating theatre and was just about to be put under, the nurse handed me some papers and said, ‘Sign this’.

“I explained I had no idea what it was and that I needed to read it.”

“There’s no time just sign it,” the nurse told her.

The next day and after paying €500, she went to find out the results, and it was only then, according to Loizidou, that she realised the significance of what she had signed.

“I asked his secretary who had the report in front of her if I could get my results. She blankly refused.”

Feeling conned yet powerless to do anything, within three days she’d paid three quarters of the amount, certain she would now get the results telling her whether she had cancer or not.

But even after having paid €850 – of the €1080 – she was still not allowed to see her results. It took her two more days before she could get the funds together to pay the remaining amount and receive her full report and biopsy results.

Although relieved she did not have cancer, Loizidou felt strongly it was highly unethical for him to have withheld such important information from her.

“This isn’t the first time we’ve heard of this kind of case,” Vasos Ekonomou, the chairman of the Cyprus Medical Association ethics committee told the Sunday Mail in response to Loizidou’s objection.

He explained that a doctor operating legally can impose whatever pricing policy they want, but ethically if they know their patient’s life is under threat then they are obliged to give out the results of vital tests.

Although in Loizidou’s case this does not stand as she did not have cancer, Ekonomou pointed out the patient absolutely should have been aware of this policy and signed it in written form.

“These are horribly complex situations you never get out of. One party will say I didn’t know while the other will always say they informed the patient.”

Loizidou insists she was never verbally told and emphasised the chaotic circumstances in which she had signed the papers.

Although she makes it a rule to never sign anything she has not read, under the pressure and panic of the moment, she put pen to paper and signed, thus putting the doctor, who cannot be named for legal reasons, on the right side of the law.

She sought to draw a comparison with another doctor who had done her original gall bladder removal surgery.

“He answered calls day and night, was willing to take appointments at short notice for no payment – and spent hours going through my result report after the op and BEFORE I’d paid.”

Ironically, despite the gastroenterologist’s strict money policies, when it came to answering patients queries he was completely unavailable to answer some serious questions Loizidou had about what she could and couldn’t do following the procedure.

“I rang with a list of questions, what I could eat, whether I could exercise, could I smoke, should I take supplements or vitamins?”

The secretary repeatedly told Loizidou the doctor was unavailable to talk or for an appointment. She has since been to A&E twice.

“I get really bad stomach pains especially when I eat. I don’t know what I should be eating.”

Resorting to online searches – not a reliable source – she got the answers she was looking for from a British NHS website. These contradicted what the doctor’s secretary had told her, which was that Loizidou could eat anything she wanted.

“I’m worried for other people that might have serious conditions and be clueless about medical professionals that operate on a money first basis, essentially bullying vulnerable people,” she said.

If someone has a negative experience from the health sector they can contact the Cyprus Medical Association at 22 316874 or 22 316812.

Paying to complain
It costs a €100 in administration fees to file a complaint to the Cyprus Medical Association, although some can have the fee waived provided they meet certain criteria such as low income.

Outraged on the principle that someone has to pay to investigate possible medical malpractice and essentially only the rich could file a complaint, Loizidou said “essentially we have a public sector that can’t serve its people and a private sector that rapes its people.”

The state medical services said each hospital has a box where people could put in their complaints (for free) and a committee to advise people on what to do.

Private clinics also have a complaints box, the medical services said.



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