Practice Practice Pointer

“I need a note, doctor”: dealing with requests for medical reports about patients

BMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.b175 (Published 03 February 2009) Cite this as: BMJ 2009;338:b175
  1. Peter D Toon, head of postgraduate education
  1. 1Centre for Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT
  1. p.d.toon{at}qmul.ac.uk
  • Accepted 4 July 2008

Most doctors will have experienced the sinking feeling which denotes an impending ethical dilemma when faced with a request for a medical report or certificate.

Doctors are often asked for information about their patients by third parties (employers, government agencies, insurance companies, regulatory bodies, and many others). Any doctor may receive such requests, but in the United Kingdom they come most often to general practitioners (table 1) because general practices hold the most comprehensive patient records.

View this table:
Table 1

 Medical reports in British general practice

A form may need to be filled out, or the doctor needs to write a letter. The response may be a certificate, a statement, or a report; this makes no difference and I will call them all reports. Some are straightforward, but others pose difficulties: conflicts of interest between patients and third parties, uncertainty about the information the doctor possesses and how to present it, and problems about payment. Classifying them may help us understand the problems better.

Classes of medical reports

Legal reports that advance patient care

Recommendations under the Mental Health Acts,1 reports for child protection,2 and assessments of mental capacity3 are closely linked to normal treatment and are almost part of it. Ethically they resemble referrals and requests for investigation, except that legal procedures are involved and normal rules of consent do not apply.

The public good

All doctors have duties to the public. Notification of infectious diseases 4and adverse drug reactions5 are public health functions of personal doctors,6 although they are not always carried out conscientiously.7 Death certification provides epidemiological information and also partly serves public health but, like cremation certificates and reports to coroners, death certificates also serve the public good by detecting unlawful killing, deliberately or by neglect (not always successfully, as the Shipman case showed). Court reports on criminal injuries also advance the public good, though …

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