Records Inappropriately accessed

It has been reported that the ECS of patients in Scotland has been accessed without patient consent. It is not kwon how many patients have been affected and when I was listening to the news last night it seems the NHS trust in question (Fife) do not know when the records were accessed or why they were accessed.

As usual, here are a couple of links about it.

http://news.bbc.co.uk/1/hi/scotland/edinburgh_and_east/7763349.stm

http://www.theherald.co.uk/news/news/display.var.2472801.0.rogue_doctor_accessed_files_for_unknown_reasons.php

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  

Termination rights

Having not said anything for a while, I thought it was about time I did and I thought I would go with something controversial.

 

There has been talk about a woman’s right to have a termination without having to get permission from 2 GPs and some people really hate that idea.

 

Being a bloke, I do not think I am in a position to say what is definitely right or wrong however I do think I can raise questions that people should be asking.

 

If a woman wants a termination and does not get approval from 2 GPs (20% GPs want terminations stopped and 25% refuse based on their own ethics), will she simply find anther way? For example she could force a miscarriage or go to a backstreet abortionist.

 

Should we not be doing more to avoid unwanted pregnancy in the 1^st place? This is where a lot of people seem rather 2 faced. Some people are completely against the idea of a termination but at the same time do not approve of contraception. In other words, they think you should only have sex if you are prepared to have children. If the result is you getting pregnant and giving your child away, then they would rather have that. Sorry to be blunt, but if that is your attitude, you really need to wake up and get in the real world with the rest of us.

 

There is also the issue of sexual assaults. There are people that think even if you get pregnant by rape you should be forced to have the child. Should someone that was raped be told what to do with her own body after having that right taken away from some sick pervert? What happens to those who get raped but do not want to rport it, ether because they do not want others to know or because they see reporting it a waste of time (the conviction rate for rape in the UK is embarassingly low)?

 

Then there is all those with access to the fact she had a termination. Accesse to such info is a large subject (see some of my previous notes), but would others knowing be yet another reason for a woman to go to the backstreets?

 

I do not think getting a termination is something any woman would find easy, but the way the current system works is not helping and is probably making things far worse. There is no reason why a woman can not book directly with a clinic where she can get advice, sources of help and some counselling before she makes up her mind.

 

http://news.bbc.co.uk/1/hi/health/7674361.stm

 

http://www.dailymail.co.uk/news/article-452318/One-GPs-wants-ban-abortion.html

 

http://www.pharmj.com/editorial/20000715/news/bpas_contraception.html

 

http://www.peopleandplanet.net/doc.php?id=1912

 

http://www.medic8.com/medicines/Morning-after-pill.html

 

http://www.prochoicemajority.org.uk/

 

http://prolife.org.uk/

Human Rights judgement: Major consequences for NHS database?

http://www.ardenhoe.demon.co.uk/privacy/Pres%20rel%20re%20ECHR.pdf

Although I am pleased there has been such a rulling I think it needs to ne looked at very carefully.

Paul Thormton mentions that it was about un-otherised access and about the nurse not having a role to play in the patients health care.

It should not be forgoten (and this is what makes this ruling less effective for those against the national database) the amount of aurthorised userers and ligitmimate access and use has been increasing over the years and doctors/nurses have refused to do anything about it (most have even been caausing the increase and have co-operated with those invading our privacy)). It is also up to GP practices (not individual GPs) who will have a legitimate need to access the data. This last ssue is also where the likes of TBOO and loads of doctors fall down and are shown to have double standards. If a nurse in an asthma clinic has a ‘need to know’ had an abortion, sexual problem, rape/abuse and everything ales in the patients record they can not then complain if a consultant at A&E were to access the same information especially where it is a matter of life or death.

It would also be hard to stand your ground and demand a receptionist at A&E should not have access to a patients record whilst at the same time allowing their own reception staff the same level of access.

I have been in practices where doctors can withhold medical treatment if the patient says no to data sharing, even if this causes harm or death to the patient or others. I think if GPs are allowed to do such things with the aproval/backing of the GMC, BMA, NHS, the ICO and Calldicott Gaurdians, it is hard, if not impossible, to say a consultant/nurse at the hospital can not do the same thing. If have been in practices where staff have accessed records without patient consent and as I found out from the ICO when complaining about Lancashier And South Cumbria Agencey in Preston, a patient has no right to stop access even where the person accessing the record has alterd an access request to gain access to the record.

You can jump for joy at this rulling if you want, but chances are you will hit the floor hard when reality sets in.

Other links about this story (soory they are so long):

http://www.helsinkitimes.fi/htimes/index.php?option=com_content&view=article&id=2156%3Aechr-finds-finland-in-breach-of-patient-confidentiality&catid=33%3Ageneral&Itemid=158

http://cmiskp.echr.coe.int/tkp197/view.asp?action=html&documentId=837925&portal=hbkm&source=externalbydocnumber&table=F69A27FD8FB86142BF01C1166DEA398649 (full rulling)

More access to health records?

It is not long since people like me warned about the increasing access to our medical records and now the NHS seems to be confirming our greates fears.

Bellow are links to stories about how there are plans to increase the amount of people with access to our records. It is bad enough a patient cant tell their GP something without having to let every doctor and nurse they see at the practice know about it despite there usually not being a ‘need to know’ basis, It is bad enough reception staff are getting access to our records and knowing our test results and what medications we have been issued, now they want to social care, voluntry orgs, private firms, researchers and never ending list.

 

Will doctors defend the patient right to privacy? Dont bank on it!

http://www.ehiprimarycare.com/news/3915/access_to_nhs_care_records_may_be_widened

http://www.ehiprimarycare.com/news/3947/data_sharing_review_has_messages_for_the_nhs

Types of people who ‘protect’ data

When it comes to medical privacy there is often a lot of talk from those who want to share/access identifiable data about how data will be protected and they can control access. Unfortunatley these are often grouped into 3 different groups.

1. There are those who have a low standard of protection. An example of this would be most GPs. GPs often tell patients that what they learn in the course of their work will go no further and their records are protected, yet a lot will often start telling people about tye patient so the information can get into the patients records, as one of my ex GPs said “doctors do not do notes, that is someone elses job”. In other words, the min the patient leaves, the GOP will tell someone else. I have also found that most calldicott Gaurdians come under this group. As with GPs, their standard of aproprate sharing of data is often far lower than what patients think and when it comes to privacy, they rarely, if ever, will hear both sides of any complaint, usually deciding to side with their friends who also have a low standard. This is further complicated in that they are often paid by the people they are overseeing even though this creates a conflict of interest. Who have to ask whos interest they have at heart, their own or that of the patient? Unfortunatly I have found they have the interest of their own at heart and most would rather protect the reputation of health workers and the NHS than tell the truth. This group of people are the low of the low as far as I am concerned. they lie to patients to obtain data/carry out examinations and when patients do get told they ether attempt to make the patient think it is for their own good and those patients that see past this Bull are given 2 simple choices, ’share or die’. This group will also often share data so that it can be passed to others for targets or payments. In some cases it will be identifiable but even if it is not, the people accessing the records to get it will have access to the identity of the patient.
2. There are those who think they have a high standard by are not aware of what is being shared. An example of this are some Calldicott Gaurdians and some health workers (not all are scum, just most). Some will tell you that when it comes to the police and social services they will tell them to ‘get stuffed’. Whilst this seems good, they are often unaware of data sharing. for example data from the new Summary Care Record in the NHS in England will be copied in a way that police and social services have access. This means that when they tell the police or SS to ‘get stuffed’, the police and SS will simply access the data from somewhere else (such as SUS) or they will alreday have the information anyway. At the same time anti-privacy laws/legislation in the UK is being introduced faster, meaning any promise about privacy is no protection. Other groups of people that come under this are those who work in Sexual Health Clinics. These people are often unaware that identifiable data can be shared with researchers, but I have to say that some will know but simply not tell the patient
3. The last, and by far the smallest group, are those who do protect data. These people are far and few between. they will store data in a way that others can not access and they will stand up to those who demand it. Some will even not record data. An example of this are some therapist. If you wanted some therapy, you can often tell the person you are seeing that you do not want anyone else to know what you are there for. Whilst some will refuse to see you unless you ‘consent’ to notes being kept others will agree not to keep notes (the disadvatage of keeping notes is that they can be accessed under some UK laws by others. Although this does not happen often, it is staill a risk). Some of those that demand they make notes willl often make them very brief and a broad outline.

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

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 1

A girl becomes sexually active but does not want anyone other that her GP knowing. In most practices, that would not be allowed. The girl then become pregnant but wants a termination. She is now faced with 3 choices.
1) Tell the GP and allow her (or him if they chose not to see a female doctor) to share the data.
2) Try and force a miscarriage and not report it.
3) Go to a back street abortionist which may not be done safely and she runs the risk of being abused.
I for one think the latter 2 choices are dangerous and I find it appalling that the health profession seem to think these are 2 viable options.

Illegal abortions still take place in the UK. What has to be asked, yet the health profession refuse to ask, is, are illegal abortions taking place in the UK because the health profession refuse to allow access for legal abortions unless the woman agrees to inform others? If the answer is yes, then the health profession can/should be held responsible for illegal abortions. In other wards, the buck stops with the health profession. 

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.

Emergency Care Summary

This is something that has been adapted in Scotland, but it seems not all patients are aware of it or who will have access to the information. Just so that I can put my mind to rest, here are the facts about it.

1) All prescriptions are uploaded and although only accessible for 42 days, it is kept for good (nobody seems to want to say why they keep it). These prescriptions include Viagra, Ant-depressants and medications used in an abortion.

“) The record is not only available to doctors and nurses treating you. It is also available to the admin staff, such as the receptionist. This means that if you are not willing to tell the lass on reception you are on Viagra, you should not allow her to access the record.

3) When I contacted NHS Grampian about the dangers of not allowing the receptionist access to the record, they could not provide any evidence to support the claim that saying no would in anyway endanger your life.

4) When a GP practice contacted their patients about the upload, 19% of patients opted out of it. This is about 1,500 times the opt-out received from the letter drop that NHSScotland did. As far as I know, no other GP practice has bothered to write to their patients about it and GPs refuse to tell patients who are sitting in front of them, that their medical info is shared nationally even though it would only take seconds to do so. The NHS refuses to say why GPs refuse to actively inform patients about the data sharing even though evidence suggest patients are not aware of the sharing which means the GPs are in effect in breach of the GMC/NHS codes of practice.