Working in a deprived area of Sheffield I feel deeply concerned in the face of the implementation of record-sharing and so-called ‘improvements’ to record access.
As many GPs have argued, there are benefits to patients from improved record access, but I strongly believe that we must also defend the needs of the minority, for some of whom ‘better’ records access will seriously increase the risk of abuse.
Take for instance the patients in my care who live with a violent partner, carer or guardian. The GP is supposed to be one of the first places a patient can come to disclose abuse; recording these reports is a vital part of safe record keeping, but these patients are by definition at risk of coercion into giving record access to their abuser.
Once the perpetrator knows that all patients have a right to access their records he (and it usually is he) may well insist on access to the victim’s records – after all, it is just another way to exercise control. A record of disclosure would put such vulnerable patients at serious physical risk, it is not fanciful to anticipate that some may even pay with their lives.
There are also young patients at my practice who wish to keep their sex life private from parents, for instance – if parents were to have access to their records, then on some occasions they would face being thrown out of their home. We can hardly ask young people to act responsibly for their health when we ask them to risk their safety in doing so.
Confidentiality for some patients must even mean the need to keep appointments private from the people they live with.
Take, for instance, a woman seeking contraceptives against the wishes of her partner. Even if records don’t disclose details about diagnoses seeing the medication, as is now proposed can be enough to put them at risk.
You might argue that the minority affected negatively by improved online access to records is small compared to potential gains, but I would disagree. As one colleague put it to me recently ‘our job is to develop systems that protect all of our patients equally, including the most vulnerable, and not to pivot the perceived greater benefits against the fewer but real risks. We are not in the game of trading one off against the other or else we will lose sight of the vulnerable individual whose voice is already likely quieter’.
First do no harm
Others might argue that there are ways around this, and we have certainly considered some at my practice as we seek to reduce the harm that implementing wider records access will bring. But if online access is rolled out, and we seek to protect patients by stopping access, then abusers will want to know why the victim has been made a special case by the GP. This reinstates the original problem, putting the victim’s safety at risk and inhibiting the patient from seeking treatment.
There are still no failsafe solutions for helping vulnerable patients to access records safely, and there still seems no recognition from the BMA, RCGP or Government as to the potential severity of the unintended consequences of the plan. The maxim ‘First do no harm’ applies as much to the information we protect as it does to the medicines and procedures we prescribe.
In principle I am a strong advocate of patient access to their records and I would welcome a safe system. But unless we develop this system gradually – rolling it out in a controlled manner while addressing the risks to vulnerable patients – we risk the whole programme backfiring in a way that will not only cause serious harm to some vulnerable individuals, but also lose all the benefits a cautious and thoughtful development might bring.
Dr Geoff Schrecker is a GP in Sheffield and chair of the Watchdog Committee at EMIS National User Group.