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PCTs threaten GPs over computer system choice

If you let a pupil work in the practice, take care with confidentiality and consent, says Dr John Holden of the MDU

Places at medical school are hotly contested. Many school pupils will be contacting GPs to ask for work experience placements next summer.

Having work experience students in the surgery can provide valuable experience for students who are thinking of a career in health care. However, it also raises a number of significant medicolegal issues for GPs ­ most importantly for patient confidentiality.

When considering whether to accept students for work experience, you will need to decide on a case-by-case basis, as different students will show different levels of maturity.

Patients will need to know that their confidentiality will be respected and you will need to satisfy yourself that any work experience student you accept is mature enough to understand when you explain the duty of confidentiality.

In common with all other members of the practice team, the student will need to sign a confidentiality agreement.

If you accept a work experience student, you will then need to decide what elements of the practice's work are appropriate for the student to take part in.

For example, you will need to consider carefully whether and in what circumstances it is appropriate to ask your patients if a pupil may sit in on consultations.

One GP who rang the MDU's advisory helpline wished to help students, if she could, but was concerned that the presence of another person in the consulting room might inhibit some patients, particularly young patients and those near to the student's age.

Another was worried about whether someone of school age would appreciate the importance of patient confidentiality.

In the first instance, if it is your practice's policy to allow carefully selected students to be present during consultations for work experience from time to time, you will need to make this clear to all patients.

You could do this by placing a notice in the waiting room, explaining why you think it may be a valuable learning experience and making it clear that it will only be done with each patient's consent.

When seeking consent from individual patients, before the consultation begins, they should be told why you are asking their permission for a student to be present and exactly who the student is.

You may decide that it is not appropriate to ask everyone attending the surgery; for example, young patients may be embarrassed to be asked.

Patients need to know that they can withdraw their consent at any stage, even during the consultation, and that if they refuse permission for the student to be present this will not in any way affect the care they are given.

GPs need to consider that some patients may feel awkward about saying that they don't wish to have a work experience student present, and the effect that asking the question may have on the doctor/patient relationship.

If a student is present during the consultation, it is a good idea to record this in the clinical records, noting their name and status. If the patient makes a complaint or claim, it is possible that they may be called as a witness.

Case scenario

A 35-year-old woman attended her surgery for a routine review of her contraceptive pill. When the doctor called her in she was surprised to see a student sitting in the consulting room.

The patient was too embarrassed to say anything throughout the consultation, which went ahead, but complained afterwards to the practice manager that she had been very embarrassed and, if asked, would not have agreed.

The manager investigated the complaint and it turned out that the receptionist had asked a different patient for permission for the student to sit in but had made a note for the GP on the wrong records.

The GP wrote to the patient and apologised. He explained how the mistake had happened and said that the practice had changed its policy to ensure such misunderstandings did not happen in future.

They were going to put a notice in the waiting room alerting all patients when there was a work experience student in the practice and only the GPs would ask patients for permission for a student to attend, before the consultation took place.

The patient was happy with this explanation.

John Holden is an MDU medicolegal adviser

The cases mentioned are fictitious, but based on cases from MDU files ­ doctors with specific concerns are advised to contact their medical defence organisation for advice

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