Your Patient Rights: 10 Accommodations You Can Request Before and During a Medical Visit
How well a doctor can meet your needs goes beyond their medical training and experience. It also depends on how well they understand your identity and empathize with the values and concerns that are part of your background.
Enter culturally competent care. This principle describes an ideal of health care services that are "respectful of and responsive to the health beliefs, practices, and needs of diverse patients," according to the U.S. Department of Health and Human Services Office of Minority Health. It's seen as an important component of addressing racial and ethnic disparities in medicine, ultimately improving outcomes and making patients feel comfortable.
Culturally competent care might mean taking into account a person's religious beliefs when discussing family planning options, for example, or offering free language assistance to people with limited English language skills. It could be about respecting the right of a patient who has a history of eating disorders to not be weighed, or using the preferred pronouns of a person who is trans or nonbinary.
Ensuring a patient receives culturally competent care is a responsibility that falls squarely on the physician and health care organization—not the patient, Onelis Quirindongo-Cedeno, MD, an internist at Mayo Clinic who has done research on reducing health disparities in primary care, tells Health. But given that doctors might not know all the nuances of every cultural group or identity they serve, it can be helpful to understand your rights and feel empowered to assert them.
Finding culturally competent health care isn't always easy. While some services (like language interpretation in a hospital) are legally protected rights for patients, others are value-based and entirely dependent on a medical professional's training in cultural competence and willingness to apply these values to their practice. However, knowing the types of services and accommodations you can request can help you find comfortable, high-quality care. Here are 10 requests you can make before (and during) your medical appointment—from your annual check-up to an emergency visit.
The help of an interpreter
Under the Civil Rights Act of 1964, hospitals and other health-care facilities that receive federal funding (such as Medicare and Medicaid) are required to provide an interpreter or document translation to people who have trouble communicating in English. This can happen in person with a staff or volunteer interpreter, or it can be done through phone or video conference, depending on what's available at the hospital.
"Interpretation from a qualified interpreter isn't a cool service—it's an obligation," José Torradas, MD, emergency medicine physician and spokesperson of the American College of Emergency Physicians, tells Health.
If you're bilingual, it might be tempting to try to act as an interpreter for a parent or another relative or friend who needs care. However, it's better to leave this role up to the pros, says Dr. Quirindongo-Cedeno.
"A friend or neighbor can be a great patient advocate, but there are times where a clinician wants to explore sensitive issues and your connection with the patient may make them uncomfortable using you as an interpreter at that time," she says. "There's also literature that tells us that untrained interpreters often paraphrase, shorten information, or add in information that's not exactly what the patient is telling us, and that could be a problem."
Not to be weighed
Getting weighed can be an emotional trigger for many people, especially those with a history of eating disorders. The decision to have your weight read aloud—or taken at all—is entirely up to you, so it's important to advocate for your preferences at the get-go.
Likewise, you also have the right not to have your weight become the central focus of your appointment, Sean Phelan, PhD, a Mayo Clinic researcher who focuses on the implications of stereotyping, prejudice, and discrimination in health care, tells Health.
"A lot of patients who are heavier report that their concerns are dismissed, and treated like they wouldn't be such a problem if they lost weight. If people can't or don't want to lose weight, they still deserve care for things whether or not they're related to weight," he says.
He recommends using the following phrase at the doctor's office: "I totally understand this would get better if I lost some weight, but can we deal with the right here and now, so I can get relief from what I'm experiencing?" If the doctor continues to focus on your weight—even after you've asked them not to—you may be better off trusting someone else with your health.
Providers of a specific gender
If you have a strong preference for a doctor of a specific gender, your best bet is to make your request when you book the appointment. That way, the office can be staffed appropriately. "If it's culturally inappropriate for you to have a male provider, that's a very reasonable request to make, and I'm sure the medical team will do the best they can to accommodate that," says Dr. Quirindongo-Cedeno.
Getting a doctor of a preferred gender isn't a protected legal right, so it may not always be possible—especially if you need to see a specialist or it's an emergency. "The question becomes whether that request is possible or feasible in the moment," says Dr. Torradas. "There may only be one doctor working a whole shift for 12 hours, so if the situation is life and death, it may put the request in a different perspective."
Still, it's worth asserting your preferences. Generally, the staff will do their best to work with you and find a provider that makes you feel as comfortable as possible.
Keep your clothes on
Wearing a paper gown can be embarrassing and uncomfortable for many people, especially if their culture or religion values modesty. While certain types of care (like getting a pap test) might require stripping down, you can ask the staff to help you minimize the amount of time you spend without your clothes on.
"Sometimes women can keep a bra on until the breast exam is being done, and then they can put it back on right after," Sheryl Ross, MD, ob-gyn and women's health expert at Providence Saint John's Health Center in Santa Monica, California, tells Health. "If someone is very shy, they can also leave their underwear on until the pelvic exam.
Decide who will be in the room
The patient is in control of who is in the room during the exam. Pandemic-era social distancing guidelines have made this right a little murky at times, but in general, you can usually have a friend or relative accompany you. Likewise, it's your right to ask for another member of the staff to "chaperone" your appointment, especially at the gynecologist.
"All women should be asked if they want a chaperone to come in the room with them, even if it's a female doctor. If that's not offered, patients should be empowered to ask," says Dr. Ross.
In a hospital, you're also allowed to choose who visits you—regardless of whether they're blood relatives. "You can identify every person you want and don't want to be visiting you," says Dr. Torradas.
Sliding-scale fees for mental health
Therapy can be notoriously expensive. One session alone can easily run you $100 to $200, putting regular sessions out of reach for many people. In fact, cost or lack of insurance coverage is the most frequently cited reason adults with any mental illness never receive care.
If the services of a particular therapist are outside of your budget, ask for a sliding-scale fee, Geri-Lynn Utter, PsyD, a clinical psychologist who specializes in working with individuals diagnosed with both substance use disorders and severe mental illness, tells Health.
"Offering sliding-scale fees are part of our ethics code as psychologists," she says. "We're also encouraged to work with a couple of pro-bono patients per year."
There's no rule that a therapist must offer a discount to lower-income people, but "at minimum, they should offer a referral to a place that will honor a lower fee based on income."
Control over your body
Just because you seek care from a medical professional doesn't mean you hand over the rights to your body. Medical ethics codes offer a high degree of autonomy to patients, allowing you to decide what's acceptable for your body—whether that's a certain test, treatment, or nothing at all. You also usually have the right to leave the hospital, even if it's against medical advice.
"It's your body, your choice. As long as you can properly demonstrate capacity to make decisions, nothing can be forced," says Dr. Torradas.
As part of a growing effort to encourage more respect of autonomy, some gynecologists are even giving a patient the option to insert the speculum into their own vagina during a pelvic exam. This can be especially comforting for trauma survivors, but anyone has the right to ask for this accommodation.
"It's tricky to insert a speculum, but if it's another way to empower women, there's nothing wrong with doing it yourself," says Dr. Ross.
Spiritual support and guidance
Whether you're there for invasive surgery or because you're recovering from a serious illness, spending time in the hospital can be a scary and emotionally draining experience. To help, you may be able to receive emotional and spiritual support from a hospital chaplain. These individuals offer spiritual guidance and religious-based care to people of all faiths (as well as their families) when at a hospital.
"There's almost always a chaplain or faith representative in a traditional hospital setting," says Dr. Torradas. "Having faith-based representatives come to your room is acceptable and considered normal."
Meals and medication that fit your values
Animal products can sneak their way into all kinds of medications. One study discovered more than 1,000 medications with gelatin from pork or beef, which can make them unacceptable for people with certain religious beliefs or ethical concerns about meat consumption. You have the right to ask about what's in any medication a doctor is prescribing for you, and if there is an animal-free alternative available.
"If we don't have a feasible option, that should be a discussion between the provider and patient to see if that's something the patient is willing to make an exception for, or if the provider needs to think through a completely different plan to respect the patient's wishes," says Dr. Quirindongo-Cedeno.
Same goes for the meals you're provided during a hospital stay. Need a vegan option or a pork-free meal? Just ask, suggests Dr. Torradas. "Every hospital I've worked at has always given patients the option of having certain dietary preferences met," he says.
To be called by your preferred gender pronouns
Regardless of how you present, you have the right to be called by your preferred pronouns by your health care providers. Ideally, your doctor should ask you how you'd like to be identified. But given that many medical education programs haven't offered extensive training on caring for transgender and non-binary folks, you may need to assert your identity ahead of and during your appointment.
"The spectrum of providers who feel comfortable asking and using the correct gender pronouns varies, but the provider should do their best to avoid the wrong pronouns," says Dr. Quirindongo-Cedeno. If your doctor still can't get it right after a few gentle corrections (or fails to respect any other important part of your identity), it might be time to look for another provider who can offer the culturally competent care you deserve.