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Rapid Responses: Rapid Responses published:
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So Far - so pretty good
- susanne mccabe (14 March 2005)
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NHS culture, data protection and freedom of information
- Huw Llewelyn (18 April 2005)
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Re: NHS culture, data protection and freedom of formation
- susanne mccabe soostevens@hotmail.com (20 April 2005)
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Or you could just ask the patient
- John Hopkins (21 April 2005)
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susanne mccabe, retired cf24 3pf
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Seven GP Practices were contacted recently to ask for two pieces of information with reference to the Freedom of Information Act: - a copy of the Practice Leaflet; and information as to which, if any, voluntary agencies the practice has agreements/arrangements or contracts with. No sensitive information was requested. They were all given the same information ie that a small study was being undertaken to see how easy it would be to access information with reference to the FOI Act. One manager asserted he had no obligation to send a leaflet but later changed his mind on grounds that it would be churlish not to. This is an incorrect understanding of the Act, there is an obligation to comply. The DoH has actually published it's own guidelines which enjoin services to encourage a culture of helpfulnes and openess. The same manager stated he had no information about arrangements with voluntary agencies and would not know who did. This was surprising when it is the largest group practice in the area and is involved with the Integrated Heath Care Aapproach. Overall the approach in this area was so positive otherwise that the Lead for training around the FOI Act has decided to take further action on the basis of this one failure of compliance. Several others in the same areas had no hesitation about their willingness to send a leaflet. One asked the reason for a request for information about voluntary agencies. It is perfectly reasonable to ask the question but there is no obligation to state the reaason for a request with reference to FOI Act. With reference to the author's mention of copying letters to individuals, it is a shame that healthworkers in this area have decided not to comply with DoH guidelines ie they have decided not to copy letters. There is a mis-match here whereby much information about personal lives of citizens-users of services is being requested and recorded and it seems there will be sticking points where information is given grudgingly in the other direction. There is no reason why people should not know how funding is spent or how society is handling afairs. Reference: DoH website re FOI Act; Copying letters to patients. Competing interests: None declared |
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Huw Llewelyn, Consultant Physician Glantywi, Llanegwad, Dyfed, SA32 7NL.
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EDITOR-Doctors and other health professionals are committed through their codes of conduct to forming partnerships with each other and with patients based on respect, honesty and openness. We may fail to live up to this ideal because of the complexity and pressures of modern health care, and not just because of a cultural failing. Barbara Meredith also points out that the NHS is setting up a ‘HealthSpace’ to help promote openness [1]. Www.healthspace.nhs.uk already provides a space for patients to record their own medical history. Those with access to the internet and e-mail can see it for themselves. Patients have always had a responsibility of knowing their medical history and doctors and other health professionals have always had a responsibility for explaining it to them. However, there is a danger that patients and doctors will be overwhelmed with information when all records are also made available on HealthSpace; we are often overwhelmed by voluminous paper records, reports and letters now. The traditional way of dealing with this problem is to prepare a summarising structured Past Medical History (PMH) where each diagnosis is linked to its evidence and treatments, with dates. Such a PMH could be given to patients after each consultation (or attached to the latest letter). This PMH could be copied into the Health-Space to help patients to understand their complex records. However, the habit of creating an evidence-linked PMH appears to have been lost over the years. At least one attempt is now being made to restore it [2]. A PMH can also be produced using labour saving devices such as standard text based on local guidelines [3, 4]. They can also be based on NICE or other guidelines and be supported by published evidence. It would be a significant NHS reform if patients could expect to be given an updated PMH at the end of each consultation, which included the indication for treatments and the outline evidence for diagnoses. The previous typed version could be amended provisionally by hand and signed. (The late Dr Shipman might have resisted such a policy.) GP computer systems could be adapted to generate the evidence-linked PMH automatically and copy it into the HealthSpace record. All this would involve some effort initially but it would be less if the NHS supported it. In a pilot study, simply drafting such an evidence-linked PMH resulted in 38% more patients being sent home from hospital in 48 hours (P = 0.008) [4]. The GMC could remind doctors that they should be aware of the full PMH before changing a patient's treatment. The GMC might also recommend that the NHS should go an extra mile with ‘Copying letters to Patients’ by helping doctors to provide an up to date PMH so that any copied letter is put into proper context for the patient and the next doctor or other health professional. All this would be in keeping with Barbara Meredith’s spirit of “partnership and openness” [1] and the GMC’s role of “Maintaining standards and protecting patients”. References: 1. Meredith B. Data protection and freedom of information. BMJ 2005; 330; 490-1. 2. Llewelyn DEH, Ang HA, Lewis K, Al-Abdullah A. The Oxford Handbook of Clinical Diagnosis. Oxford University Press, 2005 in press. 3. Llewelyn D E H, Ewins D L, Horn Jackie, Evans T G R, and McGregor. A M. Computerised updating of clinical summaries: new opportunities for clinical practice and research? BMJ, 1988, 297, 1504-1506. 4. Llewelyn H, Chaudhry A, McGibbon V. Professional performance, transparency and the GMC. http://bmj.bmjjournals.com/cgi/eletters/330/7481/1#100104, 7th and 14th April 2005. Competing interests: None declared |
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susanne mccabe soostevens@hotmail.com, retired cf24
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Thank you very much - hopefully the use of a PMH with the support of the GMC will catch on all over Britain very soon. One problem for people in Wales though is that the web site for 'Healthspace' describes the project as intended for England only - and some of the information only applies to people using services in England. As you are based in Dyfed, Wales, could you say whether it has been adapted for use in parts of Wales - which now has it's own devolved Health Department with differing policies which confuses the picture even more. Competing interests: None declared |
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John Hopkins, GP DL5 4SE
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Dear Dr Godlee, Twenty years ago medical students were taught to ask patients about their past medical history and what drugs they are on. Patients are usually at least as well informed as their doctors about what illnesses and operations they have had. With the advent of computerised prescriptions sheets it is a pretty straightforward matter to work out what is going on with the patient. Diabetics tend to be on diabetic treatment, asthmatics use inhalers, most people using GTN spray have heart disease. There are exceptions to this of course. Vulnerable patients will be dependent on the quality of their records and hospital consultants need to know the detail of what other consultants have said and done. This means that we need investment in the quality of hospital record systems and effective transfer of information between hospitals and surgeries. However day to day general practice is mainly about looking the patient in the face, asking them what the matter is and then listening carefully to the answer. It would be a pity if this basic skill became lost in the rush to create, edit, verify and circulate ever more detailed computer print outs. Yours sincerely, Dr John Hopkins Competing interests: None declared |
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