Patient rights

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 Childs 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. You should also be asked if you want a chaperone to be present and they should be of the same gender as you.

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 hospital (http://news.bbc.co.uk/1/hi/health/2642861.stm). In the words of a friend of mine “they viewed those patients as a piece of meat on a slab”

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 and the BMA. It is also something the Clinical Governance Support Practitioner NHS Grampian (although he seems to have turned a blind eye to the fact that this is happening and 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 (http://news.bbc.co.uk/1/hi/health/6213546.stm).

Tam Fry, the chairman of the Child Growth Foundation seemed to be planning on forcing children to give data 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 they will most likely get this info from their National Care Records (http://www.thebigoptout.com/?page_id=30) without consent  

Employer access to medical information

So what can employers ask you? Quite a lot actually!

For example I have had questionnaires that ask  if you have ever had emotional problems, had diarrhoea, vomiting, dysentery, food poising and any other medical problems. In other words if you have seen a GP/nurse for something, you must declare it directly to the employer and anyone else that handles the form. You also have to supply ‘details’ for each thing. Even if the employer does not misuse the above info (we all know this happens) and does not tell anyone (again we all know this happens), I for one think asking those sorts of questions is bang out of order and the CO-OP should not be asking them. I have also had questionaires that go as far as asking if you have ever been sexually abused because the job involves working with children!

What happens after you start? Well think about it. If you had to declare this sort of info before starting, they will most likely want to know it after you start, so no way to get help with emotional problems or anything else without telling the boss. I for one think that is bang out of order. I am all for employers knowing if you are capable of doing the job, but that in no way should allow them to know our medical info. The Job? Stacking shelves and serving customers at a shop in Bucksburn area of Aberdeen.. Why would that thrush, UTI or bleeding from your rectum prevent you from doing the job?

Some employers can also ask you to have a complete medical examination, such a the ones BUPA offers for employee screening (http://wellness.bupa.co.uk/for-business/health-assessments). With that in mind, you might want to ask for doctor of the same gender if you are being asked to have a medical for an employer, just in case in involves anything more than very basic stuff (you are allowed a GP of the same gender for intimate examinations even if it is not for a job). If your not bothered then that is is up to you.

The UK health profession refuse to do anything to stop this sort of thing and last time I contacted the MSP for my area (an SNP guy in Aberdeen) he seemed far from interested in stopping it, he even seemed to think it was a good idea for employers to invade our privacy.  

ChildProtectionLine, good or bad?

I only heard about this via the media, so I contacted the Scottish goverment about it. To my suppsrise I got a prity full reply (not often that happens!).

From what I could make out from the reply, there are good and bad points about it (some of the questions/issues are still not sorted).

Good. This is a single phone number that people can call if they are not sure who to call. The people on the other side of the phone will be able to direct people to the relevant department/service. That means if the SS (social services) are the best people to contact, then they will be directed there, if it’s the police, then they will be directed there. This should save time in getting things sorted and it makes sure the right people are contacted. It should (if it works OK) mean that children can be saved/protected more than they are just now.

BAD?. There are few things in life that are all good, and this is no exception. In theory there will not be a creation of a national database of accused, but with the goverment looking to creat things like the childs index, then it means there is a database be default. It also means that that anyone with access to the child index (SS, police, schools, local authorities, fire service, health authorities etc) will be able to find out the family are being investigated. Some of them should know, but why would the fire service ‘need to know’? In theory those accused will be able to clear their names, but that is easier said than done (dont forget that forced adoptions have increased 3 fold in some areas after ‘targets’ for adoption were brought in and the SS are famous for miscarages of justice and operate under secrecy to the extent the concept of a ‘fair trial’ is not a garantee). There is also no way of knowing if their file will be deleted if they are found not guilty (remember even children never charged or cautioned have a ‘police record’ and have their DNA stored nationaly). It could (even if this is not the aim) mean that a national network of accused is set up due to the ‘joined up’ thing the goverment is keen on.

There is also the issue about people own perecption of what is right. There are people that think you should never drink when you have children, so could they report people that fail to meet their own personal standards? The theory is, they accused would be investigated but as I pointed out above, this has it’s own problems. There is also the issue of double reporting. That should be sorted out quickly, but the fact that some others have been brought in, such as the SS, could mean it appears on their childs record available via the child index. Having never done drugs, I dont know if people seeking help are always reported to the police or SS. This new scheme seems to garuntee they would be brought in.

There is also a question mark about how you check people are drinking too much or taking drugs. Would all accussed be forced to have a edical exam to test for drugs or conditions that could be caused by drinking? Would they be required to have a breath test for alcohol on a random basis? With goverment having a ‘nothing to hide, nothing to fear’ card for everything, would this be used against parents? Would children be asked about the acctivities their parents get up to? Would the accused be allowed to chalange claims made by others, such as neibours?

Would info get into the accused medical records? This is something the reply does not full answere. It is important that the choice about having the info stored in the medical record of the accused is only done with explicit consent, yet that is not a garuntee. Dont forget who will have access to this record. It is not just the GP, there are all the doctors/nurses and a large amount of admin staff at the practice (and future practices) who will have access. There are insurance comapines, employers can ask for it and with the goverment looking more and more at national records. I have managed to avoid some of these problems (cant do anything about insurance comapines or employers as the Scottish goverment could not care less about the level of access these scum have), but that was only after being treated like dirt by NHS Grampain and other PCTs, by me endgaering my health and by me not giving in to scum. I dont know of anyone else who has that protection/privacy, yet info could be getting put in their records without their explicit consent.

I fully support the idea of protecting children, but there is so much secrecy (this only protects doctors, SS, creates distrust, causes serious misscarages of justice and allows SS to do what ever it takes to get children. See links bellow).

There does seem to be better ways of helping drug users and people with other problems. The only problem is, this would need to be a truly confidential service and the goverment would ratehr spend money on paying locums £1000 a day or spend money on out of hour services to justify spending hundreds of millions (£20 billion in England) on national medical records that are less secure that the goverment claims. They could spend more money on having enough social workers, but again, they dont seem to fancy that idea. They seem to think it is better to set up a net work where neibour spies on neibour and thos who object to be spied on are simply told ‘nothing to hide. nothing to fear’. At the same time, they complain if they are monitoured talking to a suspected terrorist. I am not saying nothing should be done, but is a national phone number the best way to proect children or would it be better to help the people this number is targeting (suspected drug and alcohol abusers)?

Some links you might want to read:

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/07/15/nadopt115.xml

http://www.forced-adoption.com/introduction.asp

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/08/05/nadopt105.xml

Sample medical questionaire

medical questionaire

As far as the health profession and MSPs are concerned, this sort of questionaire is perfectly fine. Even the Information Commissoners Office seems to think this is fine.

If you notice option Q, it will be apparent that you must disclose all medical conditions/problems. That measn if you are not prepared to duisclose your thrush from 3 years ago or now, then you can not apply for the job. Thrush is unlikely to be relevant, but they are allowed to know it.

 This goes directly to the employer and can be read by anyone you give the form to or whoever the emjployer allows to handl it. The job is serving customers and stacking shelves.

Some examples

Below are just 5 examples of moral/ethical questions that need to be asked about medical privacy.

I decided to do this as a separate thing so that people who have an interest in such things, can see some basic questions that I have.

There are loads of examples, including the example of identifiable data being released from GUM clinics in England without patient consent that I could have put in, but I thought it best to start with the basics

It is because of these examples and the fact most patients are not aware of what is being shared (one patient pointed out that talking to a doctor was like talking to priest) that I get my back up. Informing patients does not take long. It can be as simple as printing off what the receptionist can see and showing that to the patient. Some patients might not be that bothered, but others would be. Some patients might not be that bothered about who sees their referral letter, test results for things like STDs/STIs (cervical smear test results are now held on one national database in Scotland without the informed consent of patients and despite the fact this database is not as secure as it should be) or who knows that they are on Viagra but others would be. It takes seconds to tell a patient that you dictate to a secretary who will know who you are and what is wrong with you, yet doctors and nurses seem to hate the idea of telling patients the truth. They give the impression that they keep info private, yet this is far from reality. Telling your doctor/nurse or any other health worker is far from ‘confidential’. 

Example 4

If I was to lead someone to believe that I was a doctor so that I could carry out an intimate examination on them, would it be an assault/ sexual assualt even if they agree to me touching them? I would say yes.If a patient was to allow a doctor to carry out an intimate examination because of they thought tht only the GP would know why they were there and what was wrong with them but the info was then known by others (ether from reading the info or from thr doctor dictating the info to them), would that be a assault/sexual assualt? Again I would say yes.A lie to touch is still alie no matter what your profession. This sort of assualt goes on almost everyday in the health profession, yet it goes un-punished

Example 5

If someone was to put a gun to someones head and demand sex, would that be rape? I think it would be even if the victim was to say yes, as saying no could result in their harm. If the gun was hidden away, but the patient knew it was there, would that still be rape? I would say yes. This is an implied threat by the attacker.Currently, in most practices, unless a patient agrees to data sharing (I have been in practices, such as Gilbert Road in Bucksburn, Aberdeen) where all doctors/nurses have full access to GP files, such as asthma clincs knowing if patients have ever been raped and in these pracices even admin staff are allowed to know which patient is on Viagra or been abused etc), the patient is not allowed access to health care even where this causes discomfort or even their death unless they ‘consent’ to data sharing. With the threat of discomfort or even death for saying no (said or implied), can the patient saying yes be of their own freewill? I for one say no as to be consentioanl you must be able to say no without it causing any side effects, and to me discomfort/death is a side effect. NHS Grampian and other NHS trust (even government ministers) seem to view the patients discomfort/death as a viable option for the patient.