Margaret McCartney: Disrespecting confidentiality isn’t the answer to FGM
BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5830 (Published 12 November 2015) Cite this as: BMJ 2015;351:h5830All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
In Helen Hartley's response above the phrase 'Should the person miss the opportunity to object' sticks out like a sore thumb. Surely the onus should be on the health and social services practitioners in discussion with a Caldicott Guardian, gaining the person's decision, certainly not on sending off the information in such haste as 'by the next evening' without gaining consent or even as the law allows, over-riding consent.
As to Having the record erased from the HSCIC data set after the event, if a person does find out and object, that is a pretty underhand way of treating her. How would she find out after the event by the way? Do health and social workers have an obligation to inform her? And does she have the right to be informed that she is able to remove her information from the data set... how otherwise would most people know information is collected and recorded at the Health and Social Services Information Centre. Would the person need to pay?
Re the HSCIS web site anybody can make a Subject Access Request in writing with documents to prove identity and a payment of between £10 and £50.
According to the HSCIC web site..... 'People can opt out of sharing information altogether, but there is work going on to counter objections', although this is not made specific to FGM.
The next event is planned for 1st December 2015: 'An Invitation to Attend a Research and Academic Community Event regarding Patient Objections (Type 2) and Data Access'.
Competing interests: No competing interests
It has come to our attention that there is some confusion among doctors regarding the difference between the new rules on mandatory recording and mandatory reporting of female genital mutilation (FGM). This confusion is echoed in the above article which incorrectly suggests that medical professionals are obliged to report cases of FGM inflicted before the patient turned 18, regardless of their age at the time of discovery.
All cases of FGM in patients under the age of 18 must be reported to the police – ideally by the close of the next working day but no later than a month after treating the patient. The FGM Mandatory Reporting Procedure clearly explains that a doctor’s duty to report FGM does not apply where a woman aged 18 or over at the time of the consultation discloses she had FGM when she was under 18. The Procedure also confirms that doctors who comply with the duty to report FGM will not breach any existing confidentiality requirement or other restriction on disclosure.
In regards to mandatory recording, the FGM Enhanced Information Standard instructs all practitioners to record every time a patient with FGM is identified, what type it is, if they have had treatment relating to the FGM, or if they give birth to a girl. This information should then be shared with the Health and Social Care Information Centre (HSCIC), however, the patient must be informed of this and has the right to object. If this is the case, the doctor must consider the risks of non-disclosure, use their own judgement as to whether or not the HSCIC should be contacted, and document their final decision in the patient’s record. Should a patient miss the opportunity to raise an objection before the data is submitted, she can apply directly to the HSCIC for removal of her information from the dataset.
Any doctor who remains uncertain about their obligations relating to disclosing cases of FGM should contact Medical Protection or their own medical defence organisation.
Competing interests: No competing interests
I could not agree more. Many young women who may have experienced FGM as a baby / infant / child, are here under difficult circumstances, possibly also with a precarious immigration status. They may not even know if they have been cut - they certainly will not now (as some have done) come to me to ask me to check.
I cannot understand why I am being told to breach confidentiality for an event that may have happened 17 years ago in another country - and may utterly destroy my patient's trust in health services as well as her relationship with her parents (which may be sound). Her parents may not even be in this country or they may have had no control over the FGM if it was done 'back home'.
What use is it routinely sending these young girls to the police - thus stigmatising them further? Social services, perhaps, particularly of course for children, but surely we can take a more nuanced and empathic approach to these young women?
I feel there should be mandatory reporting to social services of ALL child abuse. Why single out FGM survivors? And why directly to the police?
While our government and press cannot seem to understand that the 'reported cases' are mainly historical, and continue to imply that there is rampant FGM happening here and now, it seems the main aim here is for a prosecution to be secured under this government. Ending this dreadful practice needs to come from within communities. The money would be much better spent empowering the brave women and girls who speak out and educate their communities and their peers - including men.
Competing interests: No competing interests
Mind the glaring gap which denies the same rights of confidentiality to specifically targeted women and girls. Much of the research and proposals suggested for dealing with abuse against women has been well intentioned but misunderstanding of the consequences. Some are being replicated by well intentioned but ill informed groups in the case of FGM. As so often, Margaret McCartney makes explicit that it is inexcusable to dismiss the moral rights of those who are often in a minority, at a disadvantage in relation to others making regulations which affect them and, as definitely in this case, unlikely to be able to speak out against the proposal or complain if the breach of confidence is found out after any disclosure.
Where would an under 18 year old or older women go for safety even if they wished that, if the family was under scrutiny? There is a principle of informed consent which should be honoured with regard to children as well as adults. Any come back on the child due to having disclosed could lead to very serious consequences. They will not always be obvious and certainly after any breach of trust, be disclosed - Groups who practise FGM are being made aware that it will be illegal. The children should not be made the carriers of information which could rebound on their own lives in often violent and isolating ways.
Margaret McCartney makes it clear that there can be no real advantage to collecting this information. It is strange that an equal policy is not being directed at the circumcision of young boys....it can be construed as one group being accorded superior rights to privacy over others. The argument that the level of pain is minor in comparison does not trump the boys' right to consent, or not, at an appropriate age.
Competing interests: No competing interests
Re: Margaret McCartney: Disrespecting confidentiality isn’t the answer to FGM
Helen Hartley is quite right, I should have included the brackets, below
"any cases of female genital mutilation (FGM) in girls or women who appear to have had the procedure before age 18 (at the time of discovery" ie the law applies to under - 18s only.
The link to the disclosure guidance is here
https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil...
"For the purposes of the duty, the relevant age is the girl’s age at the time of the disclosure/identification of FGM (i.e. it does not apply where a woman aged 18 or over discloses
she had FGM when she was under 18)"
Apologies .
Competing interests: My error