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Warning on referral letters with ‘inappropriate’ history

18 Jan 2012

GPs are breaching patient confidentiality by routinely including ‘inappropriate' information in computer-generated referral letters, LMC leaders have warned.

Two members of Bromley LMC, Dr Hasib Rub and Dr Mark Essop, have taken action to adapt the GP systems used to compose the letters after reports that some had included detailed patient histories not relevant to referrals.

Bromley LMC newsletter warned GPs that including irrelevant information, such as ‘parasuicides or abortions from 30 years ago when referring a frozen shoulder', could breach confidentiality requirements.

Dr Essop, who has a background in IT, adapted the EMIS software to include an alert to users about the issue.

He told Pulse: ‘The concern was that you might inadvertently draw in the fact, say, that someone had a termination of pregnancy 20 years ago. If referring for hand surgery it's hardly relevant. Patients object.'

The warning follows discussion by GP leaders at Pulse's commissioning roundtable last month over whether some referral management procedures could breach confidentiality.

Dr Helena McKeown, a BMA and GPC council member and a GP in Salisbury, said: ‘Does your patient expect their referral to be discussed, not only across the practice, but across a large group of doctors, nurses and managers?'

READERS' COMMENTS

Vinci Ho, GP Partner,
18 Jan 2012
Something to do with the IT system for generating the letter to be attached onto Choose and Book . The actual space for describing the presenting complaint is limited and then the letter also includes a lot of so called past medical history . Rather inflexible .
I am trained in the old days where we would write proper letter to focus on the presenting history . You wonder whoever creating the IT system for these letters really understood what GP referrals are all about.
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Neil Bhatia, GP Partner,
18 Jan 2012
Not just Choose & Book - any letter generated (Word via EMIS) with the ~[ACTIVE PROBLEMS:AS~PS~FT] field will auto-insert significant PMHx.

GPs need to check the letter before it is printed/sent.
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Anonymous, Other healthcare professional,
18 Jan 2012
The example given in the article mentions abortions 30 years ago, surely this reflects that the summary or actice problems are NOT being kept upto date. Also, any letter whether typed by a secretary or composed by the computer should be checked BEFORE sending!!
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Anonymous, Other healthcare professional,
18 Jan 2012
Of course I should have checked my spelling before posting!!, have re-posted

The example given in the article mentions abortions 30 years ago, surely this reflects that the summary or ACTIVE problems are NOT being kept upto date. Also, any letter whether typed by a secretary or composed by the computer should be checked BEFORE sending!!
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Neil Bhatia, GP Partner,
18 Jan 2012
Many templates print off "active" AND "significant past" problems (some of which may well be relevant to a given referral). So the summaries may well be up to date, it just that everything (pertinent or otherwise) is being added to the referral letter.
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Anonymous, Other healthcare professional,
18 Jan 2012
This is a difficult one - I often wonder if I should be looking at someone's gynalogical history in a community diabetes role. But some things may be relevant for example a history of self harm when you are considering insulin. An operation 40 years ago may not seem relevant - and might be left off a referral - but the knowledge of a total gastectomy may explain why a patient struggles to gain weight
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James Bywater, GP Partner,
19 Jan 2012
This is difficult but I refer a person not a condition to other healthcare professionals who are bound by the same confidentiality duty as I am. If we believe we practise holistically we should not be selecting the information we send about them. If it is significant in primary care then it is significant for the patient and the recipient of the referral.
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Anonymous, PCT,
19 Jan 2012
NHS Wales are looking to include ALL information from GP records when sharing data across NHS bodies - strangely with the exception of smoking history and STIs. Some of the practices have objected because a patient would not expect their concerns over their spouse's affair to be made available to the OOHs service when they contact them with a sore throat. Unfortunately those practices are seen as being obstructive.
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Anonymous, Other healthcare professional,
19 Jan 2012
Smart action from two smart doctors who realize medical world is not composed just of very nice people,
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Neil Bhatia, GP Partner,
19 Jan 2012
The RCGP and GPC produced some joint guidance on "Good Medical Practice" in 2008.

"When you refer a patient, you should provide all relevant information about the patient, including their medical history and current condition."

"The exemplary accompanies referrals with the information needed by the specialist to make an appropriate and efficient evaluation of the patient's problem, and shares the content of the referral letter with the patient."

The key word is "relevant" - NOT the patient's entire medical history, but whatever is relevant. A termination is unlikely to be to a hand surgeon seeing someone about a trigger finger, but may well be to a gynaecologist.

And how many "share the content of the referral letter with the patient"? Because:

"You also need to be aware of sensitive information that the patient may not wish to be sent to other healthcare professionals. You should seek the patient's consent before giving sensitive information to another healthcare professional."

Sound advice.
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