Many problems in general practice can have seemingly innocuous origins.
From repeat prescriptions to home visits, activities that GPs may have done many times can result in an adverse incident precisely because they are so familiar.
Take something as apparently mundane as the telephone, for example. Most busy GPs would struggle to cope without some form of telephone consulting, and how else could they keep in touch with the practice while making home visits?
However, there are obvious pitfalls when it comes to confidentiality: how do you avoid others overhearing confidential patient information; how can you be sure you are speaking to the right person; and is it ever appropriate to leave an answer phone message?
The following scenarios illustrate the problems that can arise and provide advice on how to deal with than.
On the move
A GP was buying a sandwich at his local cafe when he received a call from his practice receptionist confirming the details of an additional home visit that afternoon. The receptionist read out the address and explained the nature of the patient's problem.
The cafe was very busy and it was difficult to hear so to be certain he had the correct details, the GP repeated them back to the receptionist.
Unfortunately, one of the patient's friends happened to be in the cafe at the same time and overheard the conversation. She told the patient who later made a complaint to the practice about the breach of confidentiality.
Discussing a patient's condition over the telephone in a public place with another member of the healthcare team can cause a breach of confidentiality.
It may be advisable to call your colleague back when you are somewhere more private.
Alternatively, if it is a simple message such as the cancellation of an appointment, the practice could communicate this by other means such as text message or email.
Check who's talking
A patient telephoned the surgery and asked for the result of his blood cholesterol test. The receptionist retrieved the details from her filing system, which showed a very high cholesterol level and, in accordance with a note on the file, suggested that the patient make an appointment with his GP as soon as possible to discuss the result.
However, when the patient saw his GP, he was surprised to find that his cholesterol result was within the normal range and was irritated that he had had to take the morning off for an appointment that was unnecessary, as well as the worry of thinking that there was something seriously wrong.
When the complaint was investigated, it emerged that a patient with a similar name had had a cholestoral test at about the same time and it was these results that had been mistakenly retrieved by the receptionist who then hadn't confirmed the patient's details first.
The practice apologised to both patients for the error and explained that it had reviewed its procedures to prevent the problem happening again.
It is important to be sure that you are talking to the right person before confidential medical information is released, even if the person on the other end of the line seems to have the correct name.
When talking to patients on the telephone, many surgeries now ask patients to give another identifying detail, such as their date of birth or address, to prevent confusion.
When dialling out, it can be hard to be certain that you are talking to the correct person. If it is a business number, it is usual for the recipient of the call to answer and state their name, but with home or mobile phones this is not the case.
A GP received a message from a practice receptionist asking her to telephone a male patient at home regarding a private referral that she had arranged.
The patient wanted to confirm the name of the hospital consultant to whom the referral had been made.
However, when the GP dialled the number she heard a female voice on an answerphone message. She was unsure if she should leave a message or not and so telephoned the Medical Defence Union for advice.
Your duty of confidentiality means you need to ask yourself if you can guarantee any message you leave will remain confidential and will reach the patient.
- Dr Cuzner is a medico-legal advisor at the Medical Defence Union.
- The cases mentioned are fictitious, but based on cases from the MDU's files. Doctors with specific concerns are advised to contact their medical defence organisation for advice.