More reords left lying arround

http://news.bbc.co.uk/1/hi/scotland/tayside_and_central/7414319.stm
It would seem that the NHS in Scotland are still not caring about looking after records. It is incidents like this that cause me to distrust health workers to look after my records. The hospital was in a 20 year shut down phase and the last thing they seemed to care about was patient confidentality.

It makes no difference if the records are on paper or on a computer if the person who is meant to be looking after it fails to do so. When patient confidentality is the last thing on your mind, you should not be allowed access to the records.

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.

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 3

A man is arrested for sexual abusing children, or ay other crime. The man is arrested and then questioned at which time he admits the crime. The only evidence the police have is the mans confession. The man is then charged and brought before the courts. At this point it is discovered that the man had not been read his rights after being arrested and had not been told he was under caution. He had also been lead to believe that what he had said before being arrested would ‘go no further’. Because his rights were breached, what he had said in the past could not be used as evidence, he then walks free.A patient. tells a doctor/nurse something under the impression that nobody else will know and unaware of the fact that the data would be used by others, such as for insurance or to determine if the idividual broke the law. The patient then finds out data latter date about this and the doctor then simply tells the patient this is the case and the patient can do nothing to stop it. If that means the patients would not have disclosed data or be examined, then that is tough luck, the patient has fewer rights than the criminal. If the patient happened to be a victim of the above crime and had sought help due to this, then that raises one big question. Why is it the patient has less rights? Their attacker walks free for not being told the truth, the patient simply has this back dated to allow data to be shared and accessed.I for one find that imoral, yet it gets done almost every day in 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.

Employer access to medical information

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

For example I have had questionnaires that ask (I am working on a way of getting a sample form online) 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.

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. 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.