Q A practice has received a request from the UK Border Agency for the address and phone number of a patient who they intend to arrest. The practice manager is unsure about whether or not to release this information and calls MDDUS for advice.
AUnder certain circumstances, the disclosure of patient information is required by law and the patient’s consent is not necessary. This applies here. As with any disclosure made without consent, the minimum necessary information should be provided. In this instance, the practice is only required to provide the address of the patient and not the phone number. There is no need to inform the patient concerned as this would defeat the purpose of the disclosure. Make sure the reason for any decision made is fully documented in the patient record. In general, disclosure without consent may be justified in certain circumstances where the public interest in disclosing the information outweighs the patient’s interests in keeping it confidential. Normally, the patient should be made aware of any disclosure unless it is not practicable to do so (i.e. they can’t be contacted quickly enough) or if informing them would defeat the purpose of the disclosure (as in this case).
Q A patient has secretly recorded a conversation with her dentist, provided him with a transcript and demanded her dental record be changed to reflect the verbatim account. The practice manager is not happy about the recording and is unsure about changing the record.
A Patients are within their rights to covertly record consultations with their dentist (or doctor). It doesn’t breach the Data Protection Act because it is their own personal data being processed and it doesn’t breach the dentist’s rights because the discussion is about the patient’s own care. The dentist could only object if a discussion of his private life had been recorded. When changing the record, the old notes should not be obliterated. Simply score through with a single line and add a note confirming that a recording was taken and the new note reflects what was said.
Q A practice manager calls MDDUS and explains an elderly woman recently collapsed outside the practice. A passer-by came in and asked for help but the receptionist advised him that the doctors could not assist as the woman was not a patient. He told the passer-by to call 999. The manager has only just learned of this incident and is concerned it may lead to a complaint.
A Doctors are required by the General Medical Council to provide assistance in emergencies – wherever they arise and regardless of whether the person is a patient – provided they take account of their own safety, competence and the availability of other options for care. Practice staff should be made aware of this and a procedure for responding to emergencies should be drawn up. The adviser tells the manager to call back for further guidance if a complaint is made.
Q A dental practice manager has received a complaint from a patient over a disputed bill for orthodontic treatment that has been carried out. The dentist says a price of £3,000 was agreed but the patient says she believes the figure was £2,000. There is no record in the patient’s notes about the treatment cost. The manager asks MDDUS which party is in the right.
A The General Dental Council requires dentists to provide clear, written guidance to patients regarding the recommended treatment, the basis on which it is being provided and the likely costs. In the absence of such a treatment plan, the dentist might struggle to insist on the £3,000 bill being paid. The manager is advised to encourage the dentist to reach agreement with the patient on the matter.
TOO MUCH INFORMATION
Q A practice has called a number of patients to inform them of test results, but one is not answering. The receptionist is considering leaving a voicemail message but the manager is unsure if this is appropriate.
A Practices who wish to contact patients by email, text or phone should always have prior consent before doing so to ensure messages can be sent in a way that won’t compromise confidentiality. Voicemail messages pose a particular risk as these could easily be intercepted by other members of the household. Without the patient’s express consent, it may be advisable to find an alternative way of communicating the test results.
MISSING PRESCRIPTION FORM
Q A new batch of prescription forms have been delivered to a practice and the manager is concerned about securing them following a theft last year. She asks MDDUS for advice.
A When a new delivery arrives, medical and dental practice managers should ensure a process is in place to record how many pads are in stock and the relevant serial numbers. In using the forms, the prescriber should be recorded along with the date of issue, the number of prescriptions issued and to whom. This means missing forms can easily be accounted for, at which point the matter should be reported to the relevant person at the health board/CCG. Retain serial number records for at least three years along with an audit trail for prescription forms, including forms completed and subsequently not used together with forms not issued due to an error filling them out. Staff should also be encouraged to report any incidents of theft.