BACKGROUND: A 17-year-old girl provides her local general practice a sample for a pregnancy test. Five days later the receptionist receives a telephone call asking for the results of the test.
The receptionist asks for the caller to confirm her date of birth, address and the nature of the test. These details are all provided so the receptionist gives her the result which is positive. Something the caller then says makes the receptionist suspect that it might not be the patient on the telephone. She asks again if she is speaking to the patient and the caller then confesses that she is actually the patient’s mother but that her daughter had asked her to phone.
The receptionist reports this obvious breach of confidentiality to the practice manager who phones the patient. The girl is not upset and confirms that she had asked her Mum to phone as she could not face hearing the test result.
ANALYSIS/OUTCOME: The practice conducts a significant event analysis concerning the case. The practice manager phones MDDUS for advice on how such a breach might be prevented in future.
An MDDUS medical adviser points that it is very difficult to offer complete security when giving out test results over the phone. Results must be given in good faith if the patient can provide personal details along with the nature of the test. The problem is that friends and family members often know corroborating information that can be used to identify a patient.
The adviser suggests that with sensitive issues like this it might be best to have a detailed discussion with the patient about how she would prefer to be informed of the result. Are her parents aware of the situation and is confidentiality an issue? In this particular case it would appear the patient wanted her mother to know and this is something the practice might have been able to ascertain at the initial consultation when the pregnancy test was arranged.
Another possible way to ensure complete confidentiality would be to record something specific on the records, such as a test number, that the patient must quote when phoning in but this would be problematic to introduce in any systematic way.
- Discuss preferred means of disclosure when dealing with “sensitive” test results.
- Patients with a particular worry over confidential test results could be given a test number to quote.