Ethical framework for using medical records is needed

EDITOR—I support the idea of a social contract for the practice of medicine, as outlined by Gillon et al in their editorial.1 I write particularly from the perspective of surveillance of diseases.

Effective surveillance leaves no option for patients to opt out. That does not mean that patients have to be identified. Equally, no one can be forced to undergo a specific investigation procedure, but in the interests of public health we do need to identify the cause of epidemic diseases and patients are investigated quite specifically for protecting the health of the community rather than for individual patient management. By the system of legally required official notification there is a recognised mechanism for the notification of disease for which …