Practice dilemma - Medical record obtained through a receptionist

The Dilemma: The daughter of a receptionist at your practice wished to complain about the treatment of her baby, and consequently obtained the baby's medical record via the receptionist.

The member of staff has an exemplary employment history and it was unlikely that she initiated either the complaint or obtaining the record. You recognise that the patient has a right to see her and her baby's medical records but you feel that the request should have been made through formal channels and not through a relative who is not clinically trained and who did not ask anyone in the practice before taking the record. What should you do?

A GP's view
Dr Louise Jourdier is a part-time GP in London

The central focus in this case should be on the patient and her complaint. Given her approach thus far, she has not yet had the opportunity to discuss her concerns with the practice and this should be the first priority.

An important consideration here is why the patient did not follow the standard complaints procedure.

It may be that she did not know what this was, or perhaps she hoped that she could bypass the formality and gravity of an official complaint.

An alternative explanation is that she might have felt uneasy about confronting the staff involved. Bearing this in mind, it may be wise to offer her the chance to speak to someone who is not directly implicated in the case, such as the practice manager.

The patient does have a right to see her baby's notes, but she also has a right to have her complaint dealt with appropriately and sensitively, and it is not too late to offer her this.

In terms of approaching the receptionist, whilst she has not followed the most sensible course of action, you can understand her desire to support her daughter. She may have hoped that information from the notes would be enough to resolve her daughter's concerns without the need for a formal complaint, avoiding a potentially awkward situation.

Given her excellent employment history, it should suffice to sensitively point out the reasoning behind a standard protocol for handling complaints, along with reassurance that her daughter's concerns will be properly addressed.

A medico-legal opinion
Dr Bryony Hooper is a medico-legal adviser for the Medical Protection Society

This scenario may simply reflect a training issue, in a receptionist with a previously unblemished record. She may well be aware of a patient's right under the Data Protection Act 1998 to see their own and their children's records. However, she is clearly not aware of (or has chosen to ignore) the correct way in which to implement the Act.

A request for medical records, with view to raising a complaint, may be more appropriate going through the practice complaints procedure, so that the patient can be advised of how to make her complaint and how the practice will respond.

Even if the receptionist does not use that route, when responding to a request for medical records it is important that the notes are reviewed by a clinician to ensure that any third party information, or information likely to cause serious harm if disclosed, can be redacted before disclosure.

The practice should have a policy in place to clarify the appropriate route to use, for example through the practice manager. This scenario also highlights the potential pitfalls when families of members of the practice or their staff are registered with the practice.

It is unlikely your receptionist would have acted in this way if the request came from someone who was not a close relative.

GMC guidance states that doctors should avoid treating those close to them, so practices should try to ensure that families of GPs register with an alternative practice.

It is inevitable that some relatives of staff will be registered with the practice, so ensure all staff are aware of the additional caution needed in such situations. This will protect both the confidentiality of the patients and the position of your staff.

A patient's view
Antony Chuter is an expert patient

My first thought is that this is a trusted member of staff, who has perhaps been placed in a difficult situation. The receptionist could have followed the regular procedure, but chose not to.

It is a serious situation which cannot be ignored. I would hope that this staff member would be taken through the staff disciplinary procedure for breaching confidentiality protocols.

It may be necessary to ensure the receptionist has not allowed any other notes to be seen by her daughter.

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