Practice dilemma - Mother asks for her daughter's results

The Dilemma: An endocervical swab result comes back from the laboratory showing one of your patients has chlamydia and needs to come in for treatment. The patient is the daughter of one of your receptionists, and she asks you what her daughter's result shows. She tells you that she was aware her daughter had had the test and reassures you that her daughter would not mind her knowing. What should you tell her?

A GP's response
Dr Alison Glenesk is a GP trainer in Aberdeen

There is really only one solution.

GMC guidance allows us to breach confidentiality under exceptional circumstances, but this is not one of them. In the case above, the rules of confidentiality are absolute and cannot be broken.

It is possible, though unlikely, that my patient is indeed happy for her mother to collect her results. However, I am unable to divulge even the most innocuous of data, let alone anything as sensitive as a chlamydia result, be it positive or negative.

Equally, my receptionist also works by these rules, and should know better than to ask me. I would find it necessary to point this out to her.

There may be a staff training issue here, and it might be sensible to discuss this with the practice manager.

The bigger issue is the problem of colleagues and employees being registered as patients. It used to be possible to keep paper notes locked away but, of course, this is not possible with computerisation.

We are bound by the Data Protection Act, but even this may not deter the over-inquisitive mother. The best solution is to encourage staff and their relatives to register elsewhere, if possible. This is easy in a town, but may be more difficult in rural areas.

It is possible that whatever the GP says, the receptionist will be able to access her daughter's results herself. This is not an ideal situation, and one we should make every effort to avoid.

A medico-legal opinion
Dr Angelique Mastihi is a medico-legal adviser at the Medical Protection Society

Confidentiality is central to the doctor-patient relationship. Any information about your patient, even the fact they are your patient, is confidential. You need a patient's consent to disclose their information to anyone else.

In this scenario, which is not uncommon, the doctor should not release the result, or even confirm whether or not the swab was taken, to the receptionist without her daughter's permission to do so.

Although the receptionist believes that her daughter would not mind, this is not adequate. Express consent is required.

Family members can find this difficult to understand and some believe they have a right to the information, particularly when it relates to a child or parent. However this is not the case.

This case demonstrates the potential difficulties when staff members and their families are patients at the practice, as the potential for a breach in confidence is increased. Staff must understand that they should only access patient information as required to fulfil their role. Just because a receptionist can access the information does not mean she is permitted to do so.

Clearly sensitivity is needed when explaining to the receptionist why you are unable to provide the result.

In our experience, providing the reasons why this is the case and reiterating that you are happy to discuss any results with her, with her daughter's express permission, will go a long way in maintaining good relationships between all concerned.

A patient's response
Elizabeth Brain is a member of the RCGP patient partnership group

Lord Scarman's test is generally considered to be the test of 'Gillick competency' for a child under the age of 16.

He required that a child could consent if they fully understood the medical treatment that is proposed: 'As a matter of law the parental right to determine whether or not their minor child below the age of 16 will have medical treatment terminates if and when the child achieves sufficient understanding and intelligence to understand fully what is proposed.'

This may be challenged if the child was not properly informed of the risks of withholding treatment.

There have been several developments since. One of these is that a child who is deemed Gillick competent is able to prevent their parents viewing their medical records. As such, medical staff will not make a disclosure of medical records of a child who is deemed Gillick competent unless consent is manifest.

With this background, a common sense approach should be taken. If, in your opinion, your young patient was able to thoroughly understand the implications of her situation, and you had, of course, explained the consequences of not receiving treatment, then you would be under no obligation to inform her mother without her daughter's prior consent.

Therefore, you should tell the mother that you cannot discuss the matter any further with her unless her daughter has given you prior permission. If the daughter were to give her permission, it would be sensible for the three of you to be present at the disclosure.

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