Medical Privacy?

My blog has links to other issues, including information about the proposed national database of medical records. these links will tell you stuff your doctor. nurse and MPs would rather you did not know. You can also post comments on my blog.

As far as I know the information is accurate. If any of this information is wrong, p;ease get in touch stating which part you think is wrong and why. (nonprivacy@hotmail.co.uk)

Other people with access

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As a patient you have the following rights (I have put sources next to most and willing to back the following information up). I will be posting more about this.

1) You can ask for a doctor of the same gender for intimate examinations – source, Strawberry Gardens Medical practice, Morecambe. Even hospitals will allow this but this might not always be possible as it depends on how many doctors they have and I think it would depend on who asked, for example a child’s need might come first, something I can understand. If that is not possible at your GP practice, go to another practice and tell them you are in need of immediate medical attention and due to the nature only willing to see a male/female GP (you do not need to tell them what it is for). In some cases some patients might prefer a doctor of the opposite gender, if that is the case, say so. You should also be asked if you want a chaperone to be present and they should be of the same gender as you. This individual should be specially trained.

2) You can refuse to have a trainee present. Might sound obvious, but this was not always followed in the past, especially by some teaching hospitals. In the words of a friend of mine "they viewed those patients as a piece of meat on a slab". When I pointed out to a practice I would not want trainees present in the future it was made clear that this request would be ignored even though that is a breach of GMC and NHS codes of coduct/practice.

3) You can refuse to allow data to be shared with admin staff and others. "You must respect the wishes of any patient who objects to particular information being shared with others providing care, except where this would put others at risk of death or serious harm." – Source, GMC. This is also seems to be backed up by the NHS code of practice 2003, the BMA and the Scottish Executive Health Department. It is also something the Clinical Governance Support Practitioner NHS Grampian (a Dr Fraser) said is a patients right (although he seems to have turned a blind eye to the fact that this right is being ignored and refused by practices in the Grampian area). You can also have clinical data withheld from other doctors/nurses unless it would put others at serious risk. For example if you have been raped/abused, you do not need to let every doctor you see know if that helps you cope.

4) You can refuse medical treatment. This can be overridden if you are not deemed to me mentally competent. This has been controversial in the past with patients being used for medical trials (This was thought to have been outlawed after WW2, but it seems to be still happening).

Tam Fry, the chairman of the Child Growth Foundation even seems to be planning on forcing children to give data and have medical exams for the ‘fat stats’ exercise the government wanted when he stated "The Social Care Act says that when there is an urgent need for medical information it can override an individual's right to refuse." (The Times, 21/12/06, p.24). In the future researchers will most likely get this info from their National Care Records without consent after SUS has carried out what is becoming known as 'data rape' of medical records by the state.

Top, Patient rights

Other staff with access

When you tell your doctor/consultant something, sometimes it is just between the 2 of you, but that is not always the case. It depends on what practice you go to and even between individual doctors./consultants.

For example some doctors make their own notes, while others simply tell one of the clerical staff so they can put it in your notes (I had one GP from West End Medical Practice in Morecambe which forms part of Coastal Medical Group, that hand wrote some notes to pass on to someone to put on a computer because he refused to put the notes on the computer directly). This means if you were to see 2 different doctors for something, the people that know will vary. This means in some cases only the GP will know about that UTI, thrush or sexual problem, in other cases, the info will be shared even where you say no even though this is a clear breach of your rights.

Even if they do not share it straight away, a lot of practice will allow admin staff full access to records in order to get information. For example if they wish to do a clinical audit (you can prevent this), then admin staff will be allowed access to the clinical data where the patient can be identified or where they can guess who it belongs to. They can also access it for other 'administritive' or 'contractural' purposes. Nobody, not ecven NHS Grampain seems to be able to say admin staff need to know you have been raped/abused, had sexual problems, emotional problems, chest infection or a bad case of thrush. They are also not capable of saying why a receptionist needs to have access to the Emergency Care Summary which can show you have had sexual problems.

In some cases they can use what is called anonymization service. This would involve sharing identifiable medical data with a third party so that they can remove your name, address ECT.

Doctors and NHS managers also seem to ve saying the records can also be accessed for financial reasons. Example: At a meeting I had with a GP at Coastal Medical Group in Morecambe, the GP pointed out that for them to get paid for doing things like asthma clinics they must review a minimum amount of patients. To get paid they must also send clinical data such as peak-flow readings, blood pressure and some other things (he has no idea what the trust does with this). This data can be extracted by admin staff. In other words the GP can have the admin staff find out your medical info to make money to pay themselfe £100,000.00+ a year!

The same GP pointed out that admin staff at 3 other practices (there was 42 clerical/admin staff) and 48 others with full access would be allowed access to identifiable medical data even where the patient has said no (check out the ‘patient rights’ section about this). The GMC seems to want this to go away. I am not the only patient that has had this problem.

Other doctors who work at practices the Bucksburn area of Aberdeen (Gilbert Rd practice and another one) seem to share all data and does not allow patients to say no. For example if you see a nurse for your asthma review, the practice gives her the record so she can get the info. What’s wrong with this? What if that record shows you had sexual problems, emotional problems, STD/STI, been raped/abused or had drug/alcohol/gambling problems years ago? You might not care if that is shared, but what about those that do not want it shared? Should they be forced to allow it? As far as the practice is concerned the reply seems to be yes and they can/will refuse treatment if you say no even though you can prevent it (see your rights).  A GP can send you to see a consultant and not disclose that you have had things like an abortion as they should only be disclosing relevant medical data linked to your condition (but you can prevent this sharing according to the NHS and GMC), yet they are being allowed to share such information with a nurse. This refusal to allow restrictions has been approved by NHS Grampian managers. One practice manager even went as far as to say that admin staff would be allowed access to such data. What if this caused ‘harm’ to the patient? In her words "that is the way we do things". In other words if it causes ‘harm’ to the patient, that’s tough luck and the data will still be shared and accessed. Whats more if you have emotional problems and want help, they will not provide it unless you consent to every doctor/nurse and even admin staff knowing. If this leads you being clinicaly depressed to the point that it harms you and others, then it seems to be a case of tough luck. Same thing goes for all conditions. It would seem your discomfort is not relevant to how they make their profits so they can earn £100,000.00+ a year.

They seem to be saying that it is in the 'public interest' and it is safer for the patient and others to refuse access to health care for things like a chest infection, thrush, UTI, STD/STI, sexual problem, emotional problems, asthma reviews, medication for asthma and other life threatening chrobic conditions, report rape/abuse. if patients refuse to tell all doctors/nurses and a lot of admin staff why they seen their GP and it is better if the patient suffers or even dies.

Possible consequences (based on my experinces with NHS Grampian GPs and others):

A Patient wants to get access to counciling for emotional problems but does not want other doctors/nusres or any of the admin staff to know. The patient can not access health care by their GP because they are not allowed to tell the GP without telling the others. The patient ten decides there is nothing left for it, but to end things. The patient get a hose, connects it to the car exaust and sticks the other end in the car. This results in the avoidable death of the patient. The patients children (assuming they did not take them with them) discovers the body. The child/children are then not capable of accessing counciling without telling others in the future.

The doctors at Gilbert Road, another practice in the same area and managers in NHS Grampian and other NHS trust seem to think it is better the pattient kills themselfe.

A Girl wants to go on the pill, but does not want all the doctors/nurses to know and does not want the admin staff to know. She learns that this is not allowed. If this means she gets pregnant, the GPs seem to think that this is a better option to keeping the info private. The girl then ends up pregnant because she was not allowed the pill. She decides to have a termination but she must be willing to tell all the doctor/nurses she sees about it and let admin staff know. If she does not want this she will ether have to try and force a misscarage (and hide that), go to a backstreet abortionist or try keep the pregency private and then dump the baby at a hospital when it is born and then go without access to after birth health care.

On the other hand the GP might decide to lie to both of them to obtain the information/carry out examinations, which is a breach of trust and raises the question, can any doctor/nurse be trusted to tell te truth? Can GPs really mislead patients into having intimate examinations?

With records set to go national, you can wave good-by to what little privacy you had as these doctors/managers and others with the same attitude are the people that will be allowing access and deciding what they want to know about patients.

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