3


staff and other patients may know the patient you are dealing with. Be careful about conversations that can be overheard – for example, is the reception area open? If you take a telephone call there or chat with one of the receptionists, will the whole room hear the details? Patients may perceive


In the practice A


GP practice is closely involved with its local community. Practice


difficulties with confidentiality, even though they don’t exist. For example, a person well-known in the community being employed as reception staff may cause anxiety even though the staff member is highly professional. Reassure if there is any doubt. Remember that transient staff (eg, IT support) may be working at the reception desk and this could concern patients; again, reassure if you see patients becoming unduly worried. You will find that many


procedures in a practice balance the best interests of a patient with the need to maintain confidentiality. For example, many practices would allow a patient to pick up his wife’s prescription. Strictly speaking, this could be a breach of confidentiality without patient consent, but it would in many cases be reasonable to assume the patient’s implied consent. Your duty of confidentiality


relates also to demographic data about your patients and the dates and times of any appointments your patients may have made, or consultations they may have attended. The very fact that someone is a patient or has attended is a confidential matter.


Using manual records ■■ Make yourself familiar with


the procedure for booking out and returning records, and follow it. Return files as soon as possible after use.


■■ Do not leave files unattended – even for a short time – where they can be seen by members of the public.


Out and about ■■ When travelling or on visits,


do not leave information lying unattended in a car or easily accessible area. Keep laptop computers, USBs, records and files locked away.


■■ In a small community, where everyone knows everyone else, anonymising information can be difficult. Make it a policy not to gossip.


Security in the surgery ■■ Shut and lock doors and cabinets as required.


■■ Do not be afraid to query the status of strangers.


■■ Do not tell anyone how the security system works.


On the telephone ■■ Only identify yourself after


you have confirmed that you are speaking to the patient.


■■ There are circumstances in which letting a third party know that a doctor is calling them could be embarrassing and breach confidentiality.


■■ Take particular care when calling a patient’s place of work.


■■ Similarly, be aware of where you are making the call. Can you be overheard by anyone?


Mobile phones ■■ Many people talk more


loudly on a mobile phone, particularly if the signal is poor. Be aware of this, and the fact that you may be overheard in rooms that you would normally consider safe.


■■ Patients who sign up to a practice text message service, eg, to inform them of appointments or flu vaccinations, should be


advised of the importance of informing the surgery of a change of mobile number. If they choose to give their old phone to a friend or family member, there is obvious potential for breach of confidentiality.


Using a computer ■■ The Medical Council, in its


Guide to Professional Conduct and Ethics, states: “You are expected to be aware of your obligations under the Data Protection Act in relation to secure storage and eventual disposal of such records as well as relevant published Codes of Practice.”


■■ Always clear a previous patient’s details from the screen before the next patient arrives. Be aware that if you look at a different patient file during a consultation, eg, if a pharmacist rings with a script query, that the current patient may be able to view details of the file.


■■ Do not leave a computer logged in and unattended – always lock it, even if you are only leaving it briefly.


■■ Change your password regularly, making sure you do not use short or easily guessable passwords. Never share your password with anyone.


■■ Make sure your screen cannot be overlooked by others – eg, through a window. If it is helpful and you are comfortable doing so, you can show patients their records on the screen.


■■ Restrict access to relevant staff. Many GP software programmes limit access to confidential clinical information depending on password/PIN level


allowed. Consider using this facility to protect particularly sensitive information, or that of colleagues or high profile individuals.


■■ Regarding research or education, anonymise patient data as far as possible. Do not give unrestricted access to those undertaking internal audits or research, eg, medical students.


Confidentiality among


colleagues ■■ If a doctor is your patient you owe a duty of confidentiality, but it is similarly good practice to respect the confidence of fellow professionals. Any concern about the performance of colleagues should be raised with the proper authorities, and should not be a subject of gossip. It is useful to ask advice of a senior colleague regarding concerns or consult the ICGP ‘Health in Practice’ programme for information.


Faxes ■■ Consider developing a


“fax policy”, which should include the use of “fast dial” stored numbers used regularly (such as to a hospital safe haven) and the process to be followed if a confidential fax was to be sent to another location.


■■ On many occasions in the past, faxes have turned up in unintended places by the mere changing of one digit in the dialled number. The potential for breaches of confidentiality are substantial; such breaches are difficult to defend.


CONFIDENTIALITY


GP TRAINEE | VOLUME 5 | ISSUE 2 | 2012 | IRELAND www.medicalprotection.org


© PCD 2009


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