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Analysis: Restricting access is a reasonable compromise

There are risks to giving patients online access to their records, but only allowing prospective access should provide good protection, says Dr Brian Fisher

The RCGP’s decision to advocate prospective rather than retrospective access to medical records is a reasonable compromise. It’s wise, it’s safe and it reduces workload for practices.

There’s a concern over coercion - that an abusive partner, controlling parent or bullying parent might put pressure on a patient to share personal information - but we don’t know whether it’s likely to be a frequent issue. American research shows it doesn’t frequently occur, but then again we know coercion is dramatically underreported.

Another concern is that patients will be alarmed by things they read, or won’t understand what is in their record. This does happen, but it’s not very common. Patients understand about 75% of what they read, so understanding is not a big problem. We also know that the group of people most alarmed have psychiatric problems- but that’s counterbalanced by the number of people with psychiatric problems delighted by access to helpful information.

There are concerns over workload but the number of people who want record access is currently small, so practices won’t be inundated. There will be initial implementation and training costs, but for each piece of work, they’re likely to save time.

Probably most patients would understand why access is restricted. If they wanted to see something in the past they can still ask to see their paper records through a data subject request. There is no simple technological fix, so the best way to mitigate it is to inform people about it when they sign up, and make sure they know they can switch off access.

The GPC’s response to the report - that online access to records by 2015 should not be compulsory - is not a sensible position. The Government wants to fund this - the problem is that they are bullying the profession into taking the money.

The Government has irritated the profession because of the contract imposition and the record access has been bound into that. It’s taken on a bad odour as a result. I’m pleased the College have taken the position that patient access should go ahead.

It does have its risks, but it does make care safer.

Dr Brian Fisher is a GP in South East London and patient and public involvement network lead at NHS Alliance

Readers' comments (2)

  • It has its risks, in the form of doctor/patient disputes where patients don't understand what they've written or disagree with the diagnosis, but these disputes are just those which should and would already have been aired if communication was better. Any risks involved in improved communication are, almost by definition, worhwhile.

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  • Sorry, you are very far from the reality if you think a better communication will stop disagreement or disputes.

    I sometimes have patient disputing when they were last seen (no, doctor, I only saw you couple of months ago, not last year) - yet it's clearly in the computer records. I've even had a same person who complained about word "cancer" being used when discussing fast tract referral, yet absolutely denied word "cancer" was ever mentioned afterwords.

    What patient percieves and remembers is different from what a health professional percieves and records. As we are not a same person, and none of us have truely photographic memory, our recollection of the events will never be 100% accurate. And it is this discrepancy that causes dispute. Hence the medical record should just be that - health professional's aid-memoire.

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