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Rapid Responses: Rapid Responses published:
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Communications with PCTs: another challenge
- Anthony S David (21 April 2008)
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Confidentiality for all
- David A King (22 April 2008)
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Medical Confidence and Power
- Goda Venslauskaite (23 April 2008)
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Gmc and confidentiality
- David J Evans (29 April 2008)
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A bad example: John Paul II death and confidentiality
- Fernando Verdu, Ana Castello. Professor of Legal Medicine. University of Valencia (9 May 2008)
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Anthony S David, Professor Institute of Psychiatry, King's College London
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Sir - Bourke and Wessely are to be commended for their useful summary of medical confidentiality. However, there is a new challenge in this area: communication with PCTs and other organisations who control funding of clinical care. A secretary in my NHS trust was ordered to foward a clinic letter on a patient whom I had assessed in my neuropsychiatry clinic, by an administrator from a nearby PCT, so that they could decide whether a follow-up up appointment was to be "authorized". A threat was made such that failure to forward the letter would prevent the patient from being seen again. No account was taken of the sensitivity of information contained in the letter. There was no reference to obtaining the patient's consent. The PCT representative was not a clinician and was not writing on behalf of a clinician. Neither she nor the PCT formed part of the clinical team and the decision they were making was not necessarily in the patient's interest - it was purely about funding. It is ironic that in these times where legitimate access to patient information for research purposes is becoming ever more difficult, ostensibly to protect patient confidentiality, flagrant breaches are being made in the service of financial control. Competing interests: None declared |
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David A King, FY1 Doctor St James' Hospital, Leeds
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Bourke and Wessley's article on confidentiality was comprehensive in many respects but omitted a serious point, namely that medical staff only have the right to access medical records when they are directly involved in the patient's case. This was dramatically illustrated in the trust where I work when Richard Hammond, a well known television personality was admitted to Leeds General Infirmary after suffering a serious head injury during filming for his television show (1). It was estimated that around 300 medical staff accessed his medical records via the internal computer system in the 24 hours following his crash rather than the 20 or so, which would be expected for a patient in intensive care. Disciplinary action ensued for a minority and employees of the trust are now routinely reminded that they must only access medical records when this is strictly necessary. This example also serves as another reminder to medical staff: just because various personal details concerning a patient are in the public domain, does not mean their right to medical confidentiality is compromised. (1)http://news.bbc.co.uk/1/hi/england/north_yorkshire/5367616.stm Competing interests: None declared |
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Goda Venslauskaite, freelance philosopher Lyon, 69003
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Bourke and Wessely (1) summarise the rules concerning confidentiality in medical practice. However, the authors do not draw enough attention to the fragility of confidence in treatment of patients known for the health professionals or famous in their society. Indeed, what poses a difficulty or an ethical dilemma to doctors is not to hide the screen of computer, prevent overhearing, or ask if the disclosure is necessary. The real challenge is to manage the situation when the person’s health prognosis might alter political events, heritage, economic situation or prestige of other people, even this of the doctor himself (2, 3). The patient’s collegial liaison with his doctor pose difficulties to complain. Sometimes, famous personalities anticipate these events themselves providing information concerning health problems to society as they are afraid of its deformation (3). Disclosure of medical confidence may alter patient’s care quality, her professional or private life. Are all doctors really aware of this kind of power that sometimes they have to exercise? References 1. Bourke J, Wessely S. Confidentiality. BMJ. 2008;336:888-91. 2. [No authors listed]. President Mitterrand's doctor is sentenced for breach of secrecy. BMJ. 1996 ;313:70. 3. Lehman-Wilzig SN. Political ill-health coverage: professional- ethical questions regarding news reporting of leaders' ailments. J Health Commun. 2003 ;8:59-77. Competing interests: None declared |
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David J Evans, Emeritus Professor of histopathoogy,Imperial College Retired
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Sir,The GMC’s position on confidentiality is not entirely logical. The idea that confidentiality should continue after the patient’s death is incompatible with providing an honest opinion on the death certificate. To my certain knowledge AIDS was (and may still be) omitted from the death certificate. In these circumstances the Registrar General’s statistics may well have become valueless in certain areas without this being apparent to those who use them. Another important area is in the case of those individuals whose capability or judgement may be impaired by their disease but who will not admit this to their employers. I never met Mo Mowlem but given the information about her which is in the public domain would deduce that she had a long standing frontal lobe tumour which underwent a malignant transformation and that this seriously affected her judgement at a time when she held an important public office. Given the GMC’s ukase we shall never know, but if my supposition is true there is nothing to stop this type of problem happening again. Competing interests: None declared |
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Fernando Verdu, Professor of Legal Medicine University of Valencia, Ana Castello. Professor of Legal Medicine. University of Valencia
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On 2 April 2008 it was three years since Pope John Paul II's death. All this time there has been the possibility to discuss whether the medical care was the most suitable for the patient circumstances, or about the way the process was managed by the media. The main point to debate is whether the man's self-respect, one of the bioethics main value for Catholics (1), was offended through the long days preceding the Polish Pope death. There is no room at all for any kind of discussion about the fact that, immediately after John Paul II's death, took place one of the most flagrant offences that can be committed against a human being: the publication of his death certificate. In this document, that can still be seen publicly (2), the signatory doctor quite unnecessarily reveals the deceased person privacy, contravening one of the most elementary ethical duties of any professional in medicine: professional secrecy. The World Medical Association Declaration on the Rights of the Patient, adopted by the 34th World Medical Assembly in Lisbon, Portugal, on September/October 1981 and amended by the 47th WMA General Assembly in Bali, Indonesia, on September 1995 has been editorially revised at the 171st Council Session in Santiago, Chile, on October 2005. There can be read (3): Right to confidentiality: 1. All identifiable information about a patient's health status, medical condition, diagnosis, prognosis and treatment and all other information of a personal kind must be kept confidential, even after death. Exceptionally, descendants may have a right of access to information that would inform them of their health risks. It is specially obvious in this case that there was no need nor justification for publishing the aforementioned document. Since in 1896 The Lancet publishes the first reference to the professional secrecy, the problem of privacy as a right to be observed in medical practice has been tackled a lot of times. In other paper (5) it is defended, with clear and reasonable arguments that, under certain circumstances, it is admissible, and even necessary, that some specific personal details may be finally known by other people through a clinical investigation. There is no justification for the right to privacy of a person, as respectable as any other, has been flagrantly violated after his death A medicine doctor should never write such a document. Nobody should. (1) Markwell H. End-of-life: a Catholic view. The Lancet, vol 3666 pp1132-1135, September 24, 2005 (2) http://www.vatican.va/gpII/documents/denuncia-morte-jp- ii_20050402_it.html (accessed on 02.05.2008) (3) http://www.wma.net/e/policy/l4.htm (accessed on 02.05.2008) (4) The Lancet. Professional secrecy. The Lancet, Volume 148, Issue 3804, 25 July 1896, Page 254 (5) The Lancet. Striking the right balance between privacy and public good. The Lancet, Volume 367, Issue 9507, Page 275 Competing interests: None declared |
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