These cases are based on actual advice calls made to MDDUS advisers and are published in the magazine to highlight common challenges within practice management. Details have been changed to maintain confidentiality
AN ACADEMIC REQUEST
Q A primary school contacts the GP of a seven-year-old boy who has a poor attendance record. The boy’s mother has kept him off school several times in the past year and tells the school her son has been absent again because of a doctor’s appointment. The school asks the GP if they can confirm the mother’s story. The GP knows the boy has not attended any appointment and phones MDDUS to ask if he can give the school this information.
A The short answer to this query is “no”. Doctors cannot usually or normally disclose any patient information without first getting the patient’s consent, or in this case, consent from a parent. The school may argue the information relates to their concerns over the child’s welfare, but the GP is bound by strict confidentiality rules and cannot release any information without permission. Only in serious cases, where you believed the child is a victim of neglect or abuse and is unable to consent to disclosure, could you consider releasing this information without consent.
A FORGOTTEN VISIT
Q A GP makes a home visit to an elderly patient while he is on his way home at the end of a Thursday surgery. The patient had been receiving treatment for a heart attack two months earlier which had initially been misdiagnosed by one of the practice doctors. The GP is not due back in the practice until the following Tuesday and forgets to write up his notes on the consultation. The patient subsequently requests a copy of her notes and the GP discovers his mistake. He asks MDDUS for advice on how to proceed.
A An MDDUS adviser told the GP he should write up a note in the patient’s records for the visit now, but clearly sign and date the entry to indicate when it was written and include a brief explanation of why it was entered late. He was also advised to apologise to the patient and ensure the practice has a robust system in place to record home visits promptly. This is particularly relevant for any doctor who goes on a home visit directly before taking time off, or for locum GPs who may not be scheduled to return to the practice in the near future.
QA GP’s patient has been arrested by police on minor drugs possession charges. The patient denies any wrongdoing and claims his GP prescribed the pills. The police later contact the GP and ask her if she did indeed prescribe the drugs. She tells police she did not prescribe them but later contacts MDDUS concerned that she has made a mistake.
A The GP did not have the patient’s permission to disclose confidential medical information to the police and should not have done so. Doctors are entitled to disclose personal information about a patient to police only under certain circumstances, for example if it is in the public interest or if police are investigating a serious crime, such as assault or murder. In this particular case, the charges appear to be minor and would not give the GP the right to disclose without the patient’s consent. The GP is advised that if the patient in this case complains, an apology would be appropriate. Practices should always refer to GMC guidance on making disclosures to the police and call MDDUS for specific advice.
PARENTAL ACCESS TO RECORDS
Q A father contacts a surgery in England where his child is a patient. He and the child’s mother are unmarried and now separated, and he wants access to the child’s medical records. The mother also contacts the surgery to ask he not be allowed access. The practice manager calls MDDUS asking for advice how to proceed.
A It transpires that the father is recorded on the child’s birth certificate and the date of birth is in August 2005. This means that by law he does have a right to access his child’s medical records (note the location and DOB are important here as specific legislation varies among home countries). The mother is informed of this and insists that her own address not be disclosed in the records. MDDUS advises that this and any other potentially sensitive third-party information is redacted from the notes before being released to the father.
SCANNING PATIENT RECORDS
Q A practice contacts one of our dental advisers about a project to scan old patient records onto disk for uploading to the practice system. The plan is to contract the project out to a third party company specialising in this type of work. The company has reassured the practice that any work they do is fully compliant with the Data Protection Act (DPA) and that patient confidentiality will be strictly maintained. Can they contract the work?
AThe adviser explains that the onus will be on the practice to scrutinise any contract with the company in order to ensure that the work would be done in compliance with all relevant legislation – namely the DPA. Ultimately it is the responsibility of the practice to ensure patient confidentiality so it is important to be perfectly satisfied that any third-party contractors are completely trustworthy and professional.