Dilemma: Cancer records request
The husband of one of your patients who has been receiving palliative care for breast cancer arrives at the surgery asking for her medical records as they intend to complain about the care being provided by the practice. The husband also asks that they receive a full copy of her records by the next day as they have an appointment with their solicitors to discuss the case. How should you deal with this request?
A full, open, honest and sensitive approach may diffuse the situation
This situation is not uncommon in practice, often precipitated by an unguarded comment by a hospital or community colleague, and tests a practice’s complaints and consent procedures.
If possible the GP should see the husband immediately, actively listen and explore the nature of the complaint. If the husband was present during GP and hospital consultations consent is not required to discuss details, but is required before complete records are released. Otherwise consent for an initial conversation could be gained by telephone.
If a GP is not available the receptionist should offer an early appointment and the husband encouraged to complete the practice’s complaints leaflet.
If appropriate offer to print off records pertinent to the breast cancer at the time of the initial conversation. Consider waiving any fee for this, but explain that a formal request would be needed for the full records, preferably from the solicitor, with written patient consent. If there are records kept only in hard copy you should advise of the unavoidable delay in copying them and any charges.
A full, open, honest and sensitive approach at the initial contact with appropriate sincere apologies may diffuse the situation, and avoid the stress caused by a formal complaint.
Dr Grant Ingrams is a GP in Coventry and has previously acted as the chairman of the GPC IT subcommittee.
Show compassion, no matter how unfair the complaint may appear
It’s an unpleasant shock when a complaint is made about patient care. The best response is to be co-operative and understanding, no matter how much you feel the complaint is unfounded. An invitation to discuss the care of his wife, with her consent, with the practice team involved may not have been considered by her husband and could be a conciliatory first step. In such a scenario the family may be under immense emotional as well as physical distress and should be treated sympathetically. A discussion at practice level could lead to a better understanding by both complainant and the practice where the difficulties lie and enable the formulation of a management plan that is acceptable to all parties.
But as GPs we are aware that not all individuals would be receptive to such a discussion. It must be explained access to the records of third parties needs their explicit consent, it could take time to prepare the records, the practice is under no obligation to provide them with such short notice and there could be a charge. Where there is a perceived grievance it is always best to show compassion, no matter how unfair the complaint may appear.
Dr Mary Church is a GP in Glasgow and chaired the LMCs conference in 2012. She was voted as one of the top 50 GPs in the same year.
Access to records must be given ‘promptly’
Under the Data Protection Act 1998, patients have a right of access to their medical records. In this case the request has come from a third party – the patient’s husband – and as such, you must first obtain the patient’s consent. Ideally this would be in written form but verbal consent could also be acceptable, particularly in cases where the deadline is tight.
The patient has requested her complete records but, if there is any information in the records about or provided by another individual (with the exception of healthcare workers involved in her care), then this third-party data should normally be removed. Likewise, if her record contains personal sensitive data which she is unaware of, and would be likely to cause her serious psychological or physical harm, this can also be removed as appropriate. The GMC provides specific guidance on this matter.
Access to records must be given ‘promptly’, ideally within 21 days, but the Act allows for a maximum 40 days from receipt of the request in writing and any payment due. In this case, therefore, you are under no obligation to supply the medical records to the husband by the following day. You may, however, decide to supply the records as soon as practicable to assist the patient with their complaint.
Alan Frame is a risk adviser at UK medical defence organisation, MDDUS.