Dr Christine Gregson is an ST5 in Infectious Diseases and General Medicine. This year, she is working as a Scottish Clinical Leadership Fellow. She writes here about sharing patient information within the government and its implications for doctors.
I have completed ST5 in Infectious Diseases and General Medicine and for this year I am working as a Scottish Clinical Leadership Fellow. My post is split between working with the Chief Medical Officer (CMO) and her team at the Scottish Government and working with Healthcare Improvement Scotland.
As part of my work, I was asked by CMO, Dr Catherine Calderwood, to look at confidentiality in the Health and Social Care Directorate of the Scottish Government. Most of us think about confidentiality in relation to the conversation we are having with the patient in front of us, or whether or not information needs to be shared in the public interest.
But, there are other roles that raise questions about confidentiality that are not so clear cut. Within the Scottish Government 28 doctors, most seconded part-time, work as clinical advisors alongside civil servants.
Confidentiality is central to trust between doctors and patients. Without assurances about confidentiality, patients may be reluctant to seek medical attention or to give doctors the information they need in order to provide good care. But appropriate information sharing is essential to the efficient provision of safe, effective care, both for the individual patient and for the wider community of patients.
Confidentiality, General Medical Council, 2009.
Sharing information to shape policy
Data is critical to informing health policy and most patient information used for this purpose within the directorate is already anonymised.
Paragraph 82 of draft GMC confidentiality guideline states: ‘Without patient information the health and social care system would be unable to plan, develop, innovate, conduct research or be publicly accountable for the services it provides. But anonymised or de-identified information will often be sufficient for such purposes and must be used in preference to identifiable patient information wherever possible.’
Relying on implied consent to find answers
However, there are times when patient-identifiable and potentially confidential information is seen within the Scottish Government. This usually comes direct from the patients themselves, when they write to Ministers or Directors with questions about their care.
Answering these questions in full occasionally involves sharing information with different people, including civil servants and doctors. This sometimes raises ethical questions surrounding confidential information, as doctors can be privy to information about patients for whom they do not have a direct responsibility. For example, is it reasonable to assume that the patient would expect their information to be shared in this way, and can we rely on implied consent to do this?
Taking heed of confidentiality guidance
This information sharing must be done in line with the Caldicott principles, applying to the handling of patient-identifiable information:
- Justify the purpose(s) of every proposed use or transfer
- Don’t use it unless it is absolutely necessary
- Use the minimum necessary
- Access to it should be on a strict need-to-know basis
- Everyone with access to it should be aware of their responsibilities
- Understand and comply with the law
Of course, civil servants have clear guidelines for the handling of confidential information, enshrined in the Civil Service Code.
The GMC Confidentiality guidance is predominately directed at doctors who are in direct patient care. There are, however, implications for doctors who are privy to information about patients for whom they are not directly responsible. The new guidelines, currently out for consultation, divide into three sections: direct care uses, indirect care uses and non-care uses.
For complex situations the guidelines do not fully address the confidentiality issues raised and, as with all guidelines, require personal judgment to be applied. It is good to be reminded to return to confidentiality ‘first principles’ as the new draft guidance states in paragraph 40:
You should consider whether patients would be surprised to learn about how their personal information is being used, accessed or disclosed on the basis of implied consent. If you suspect that information is being used in ways that patients would not reasonably expect, you should ask for explicit consent.
Have your say on our new draft confidentiality guidance and make sure we get our advice for doctors right. The consultation is now open until 19 February 2016.
Dr Christine Gregson is an ST5 in Infectious Diseases and General Medicine. This year, she is working as a Scottish Clinical Leadership Fellow with the Scottish Government’s Chief Medical Officer and Healthcare Improvement Scotland.
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