Donít Trust Your Doctor To Keep Your Secrets

Dr Vernon Coleman MB ChB DSc FRSA

I believe that medical confidentiality is vital.

Over a third of a century ago I resigned as a GP when NHS bureaucrats tried to force me to write confidential information about my patients on sick notes.

I refused and was fined heavily for doing so. It seemed to me that this was a vital matter of principle.

Patients are entitled to believe that what they tell their doctors in confidence will remain confidential.

I felt that by putting diagnoses on sick notes (likely to be read by heaven knows how many people) I would be betraying that confidence.

And so I resigned from the NHS and became a full-time writer.

When I was a GP I found that I was constantly having to find ways to defend my patients from the bureaucrats.

Once, for example, a State bureaucrat arrived and announced that he was going to take away all the medical records I held for my 2,500 patients. He had a van parked outside my surgery, ready to take the records away with him. I pointed out that this would be a breach of confidentiality and would endanger the lives of my patients. The bureaucrat wouldn't budge. He had a form giving him the right to remove the records for routine checking. He asked me to take a medical record file from its drawer and to read what was written in red on the bottom of the file. I did so. It said: `The property of the Minister of Health'. Suddenly I remembered Shylock and the Merchant of Venice. `You can take the records,' I told him. `But you can't take the ink.' He stared at me, uncomprehendingly. `The paper belongs to the Minister of Health,' I conceded. `But the ink on the paper belongs to me. So you can take the records but you must leave the ink behind.'

He left.

Things today are rather different.

I received a letter from a reader in Scotland who advised me that he had been told by his doctor that before he could receive treatment he had to sign a `counter fraud declaration'.

He wanted to know what it was. (His GP didn't seem to know or care.) I discovered that patients registering at practices in Scotland are required to sign one of these documents (containing sensitive, personal ID information) before they can receive any treatment. The declaration entitles the doctor to share the patientís information with a variety of Government agencies including the UK Border Agency, the Department for Work and Pensions and HM Revenue and Customs. In other words: just about everyone over the age of 16.

Doctors in Scotland moaned a bit about the blatant breach of confidentiality, but did nothing. Since the Government is the body wanting the information, it's fair to assume that the GMC will have approved this outrageous abuse of patient confidentiality.

You might imagine that the General Medical Council (the body responsible for licensing doctors) would understand that medical confidentiality is of primary importance to the integrity of the doctor-patient relationship.

Any doctor who is guilty of a breach of medical confidentiality should be struck off the medical register. You can't be a little bit confidential any more than you can be a little bit pregnant.

Doctors should be instructed not to share confidential information with social workers, policemen, politicians, bureaucrats or anyone else who isn't directly concerned with the health of the patient concerned. Politicians and judges who attempt to overrule the principle of medical confidentiality should be advised that the GMC will not accept interference in this area.

However, instead of promoting the importance of confidentiality the GMC seems to have fallen over backwards to ensure that confidentiality becomes a thing of the past. In September 2009, the GMC told doctors that they should share a range of confidential information with the `authorities'. Alarmed by this I sent the following letter to the GMC:

`I was surprised to hear that you have decided that in future I should break my Hippocratic Oath and tell the police if I treat a victim of a gun or knife crime. I was equally startled by your assertion that I can tell relatives about diagnoses of genetic disease and should tell social services if patients harm themselves. These are appalling decisions which seem designed to destroy the very principle of confidentiality. Confidentiality is like pregnancy: it doesn't come in degrees. The doctor's primary responsibility must be to the patient he is treating and not to the public. When I qualified as a doctor I took the Hippocratic Oath. Who gave the GMC the right to decide that I should now break that solemn Oath?

These are appalling decisions (which seem to me to be politically motivated and contrary to Article 9 of the Human Rights Act) and no thinking doctor should obey them.

Although I am fully registered (and intend to remain registered and licensed) I will not obey your instruction to disobey the Hippocratic Oath and, indeed, I do not believe you have the moral right to demand that I do so.'

Over a month later, I received a reply from someone called Jane O'Brien, (described as Assistant Director, Standards and Fitness to Practise Directorate). She told me: `We agree that doctors' first concern should be the patients they treat, and that a relationship of confidentiality is a key part of forming a relationship of trust in which the patient can receive good care. However, we do not see the duty of confidentiality (as) an absolute'.

So, the GMC believes it is possible to be a little bit pregnant.

The bureaucrats at the GMC clearly don't realise that nothing a doctor tells the Government (or a State employee such as a policeman, tax inspector, local council employee, doctor, nurse or social worker) will be treated as confidential. The Government will either sell your information or lose it.

So, the bottom line is that you canít trust a doctor to keep your secrets.

Copyright Vernon Coleman

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