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Alert on surgery confidentiality breaches

A covert investigation by researchers has revealed patient confidentiality is frequently being breached in GP surgeries, writes Joanna Clarke-Jones.

Undercover observers posing as patients were sent into 13 waiting rooms as part of the study, published in June's British Journal of General Practice.The researchers, who spent a total of more than 24 hours monitoring the surgeries, uncovered dozens of cases where patient details could be overheard.Breaches ranged from revealing patients' addresses to medical information such as symptoms of illness, test results and diagnoses.Half of the lapses, which were defined for the purposes of the study as information revealing more than just a patient's name, were initiated by staff.And although the other half of the confidentiality breaches came from the patients themselves, many of these were prompted by questions from surgery staff.'Half of the occasions where patients themselves revealed confidential data were as a direct result of staff requesting information,' said the report.'It was evident in at least one instance that the receptionist did not pick up a cue that the patient was uncomfortable with their disclosures.'One of the study's authors, Professor Niro Siriwardena, professor of primary care at the University of Lincoln and a part-time GP, told Pulse: 'Patients are often uncomfortable about revealing details but they felt they had no option if they were asked by staff.' The report said risk of confidentiality breaches should be taken into account when surgeries were designed.And it suggested measures to draw the focus away from the reception area of a practice, including playing background music in surgery waiting rooms and screening off the reception telephone and fax machines.Researchers called on practices to conduct patient surveys on confidentiality to come up with other ways of improving the situation.Dr Claire Davison, a GP in Newham, east London, said her surgery had taken measures on confidentiality such as having at least a six-foot gap between the reception desk and patients' chairs, outside phone calls being diverted away from the front desk and having a sign by the reception area telling patients to ask if they would prefer to speak to someone in confidence.But she said in a busy surgery it was difficult to monitor the situation all the time and there had been 'incidents when staff have said more than they should have done'.'I would be interested in what would happen if the observers came and sat in our waiting room,' she said. 'It can be bedlam in the mornings.'But Dr Peter Swinyard, a former chair of the GPC premises subcommittee and a GP in Swindon, Wiltshire, said practice layout came down to a compromise between having a Berlin wall mentality and an open plan design that could help to reduce patients' anxiety.'It's never going to be 100% confidential unless you have soundproofed cells.'And if confidentiality was breached by patients, 'if they do not mind people knowing they have genital warts or piles, then so be it', he added.

• Confidentiality breaches, page 68

How confidences were breached

• Observers spent a total of 26 hours monitoring 13 surgeries• They discovered 44 cases of patient-identifiable information being able to be overhead• Of these incidents, 22 were initiated by staff and 22 by patients• Face-to-face conversations were responsible for most of the breaches

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