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One in five GPs already self-censoring what they record in patients' notes because of concerns about online access

Exclusive One in five GPs have already changed the amount of information they routinely record in patients’ notes because of concerns about patients being given access to their full record online, a Pulse survey reveals.

A snapshot poll of 365 GPs also found 56% would not welcome online access to their own full patient record, despite the Department of Health’s plans to roll out online access for all patients by 2015.

A fifth (19%) of respondents said they had begun to change what information they enter into GP records over the past year due to concerns over online access. GPs reported excluding information about child safeguarding, possible diagnoses and information on end-of-life care in order to not distress patients or destabilise the doctor-patient relationship.

They also said they had begun to omit information about third parties, negative examination findings, information on mental health issues and concerns over fabrication of symptoms for similar reasons.

The Government is planning a DES to incentivise GPs to offer full online access to patient records next year, a policy the GPC has said should be scrapped due to concerns over workload, safety and confidentiality.

Dr Wendy Fletcher, a GP in Banwell, Somerset, said she was ‘not interested’ in routinely accessing her medical record as it would not benefit her, and said she was now routinely excluding information from patient records which she would have previously included.

She said: ‘People come in with vague symptoms that could be something or it could be nothing. Usually you’d note that down in the notes, but now it’s more difficult because you don’t want every patient with a tummy ache to be worrying they have cancer.’

‘I also jot things down to remind myself about things going on with family or work that might be impacting on the illness, but that’ll be difficult now.’

‘It’ll be the most anxious people who want to see their notes, and so they are the people you don’t want to upset the most.’

Dr John Etherton, a GP in East Haven, Sussex, said GPs would now be wary of writing certain details in records due to the risk of complaints.

He said: ‘GPs will be reluctant to write down their concerns as they could be misinterpreted and form the basis for complaints. It could lead to a vicious response. You want to avoid a bad atmosphere, a breakdown of the doctor-patient relationship.’

Dr John Hughes, chair of Manchester LMC, said the plans for access to online records would lead to worried patients.

He added: ‘GPs are going to have to be completely defensive when writing in them. Everything they write will be completely open to misinterpretation. I think it’ll lead to increased psychological pathology in patients, because they’ll be worrying about things in their record.’

A Government-funded report, published by the RCGP last month, raised similar concerns and ruled out retrospective online access to records as this would create too much work for GPs and risk disputes with patients.

A spokesperson for NHS England said it was taking the concerns raised in the RCGP report seriously.

He said: ‘We are pleased to see that the majority of GPs are developing their professional practice in order to prepare for the roll out of full patient access by 2015.

‘In line with the road map developed by the RCGP, they are taking seriously safeguarding, third party information and most importantly making patient records patient-friendly.’

‘All of these efforts will contribute to enabling patients to be in control of the information they need to improve their health and wellbeing.’

Pulse Live: 30 April - 1 May, Birmingham

Pulse Live

Dr Kartik Modha, a GP in London and founder of Tiko’s GP Group, will look at how technology and social media is changing GPs’ practice at Pulse Live, Pulse’s new two-day annual conference for GPs, practice managers and primary care managers.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.

Readers' comments (7)

  • Patients can access what is written anyway despite online access. We were taught at medical school to assume a judge is reading all our notes and that they need to be comprehensive. We do need to change how we document, but really this is best practice anyway.

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  • Being less than honest with patients in terms of the thoughts you have about a possible diagnosis might over-reassure - maybe not such a problem for the immediate relationship between you and your patient, as you will be following up, but the patient will take you at your word when buying their insurance policies! Failure to declare a condition, or a condition yet to be fully diagnosed or that is suspected, will invalidate their travel insurance policy. Now if they are in the USA and need medical care for something undeclared they may consequently find they are uninsured. This is serious and potentially bankrupting. In fact the whole of their medical insurance might become invalid, not just for the the one condition that they have not declared fully. Unsurprising that patients are anxious about symptoms if information is being witheld. Surely patients have the absolute right to all recorded information about themselves, including borderline/dodgy test results? IMaybe if you can't face the patient seeing their records then don't make the record in the first place.

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  • Anonymous | 16 April 2013 11:16am,

    You are wrong on several points.

    Patients are not held to account for a condition they are not diagnosed with - though they may be held accountable for not declaring the symptoms they had. You don't need a medical note for this.

    There is a difference between witholding diagnosis (which none of the doctor do, unless requested by the patient or their advesary), and making a list of differential diagnosis to remind ourselves on our thoughts. For example, I may write

    "Back pain, asking for extended sick note, seen to be mobilizing freely when entering the room. Waddell's sign all +ve, ?non organic cause. Refer physio, r/v if no better"

    This indicates, I've thought of "possibility" (and I emphasise this point) of the pain caused by non physical problem. It'll remind me to consider this next time. But Pt can read this, google what Waddell's sign means and become upset that I considered this possibility.

    I'm a doctor - my job is to try and consider objectively the possible causes of the illness and the treatment it involves. Unfortunately, many patients would not be so objective, especially when it comes to their own health. So this causes friction between a doctor who wants to help the patient by being objective, and the patient, who may be distrubed by the clinical (notice the word?) approach of the doctor.

    GPs often tread a thin line between becoming too clinical and becoming too unobjective. I fear this will tip the scale to the former.

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  • p.s. I forgot to say I don't mind patients seeing record of a borderline results or worrying differential diagnosis. But who will answer the questions patients may raise to ease their anxiety? If the government think GPs should be answering it, I suggest the government provide the resource to do so - a GP (or any health professional's) time wont suddenly become available just because the government has decided to increase the workload yet again!

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  • patients have right to see there record right now, so I dont see what the fuss is all about

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  • They don't have the right to see their record right now. Have a read of data protection act..........

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  • First to Anonymous at 11:45 you certainly put the points across clearly and I fully agree. To Anonymous at 11:16 we are not in the US and are not (yet) a fully privatised health system. However to repeat, patients are not denied healthcare insurance or other insurance based on a GPs hunches. We get companies asking for this and the date they have actually been diagnosed with certainity is the date required for insurance purposes. We as Gps often write letters in support of patients espeically when insurance companies try and confuse their 'symptoms' with the date they attended or were diagnosed. Another important point is that we Gps are human and sometimes need to record what may be irrelevant or seem unnecessary to the patient to help us retrieve a train of thought next time we see them. It helps to save time in our 10 minute consultation. Recording notes for the benefit of anxious patients is of no use to us when we re access the notes and certainly of no use to our colleagues who may be seeing the patient next time. But then we aren't masters of our own profession are we? I say open the surgeries to 'help yourself buffet diagnosis and treatement'. Set up a giant screen with google, have patients walk in or better access the screen from homes and rather than just access notes, do the rest of the job as well......

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