Practice dilemma: Waiting room confidentiality

Is calling a patient to a clinic in front of other patients a breach of her confidentiality?

THE DILEMMA

A new patient comes to see you to make a complaint about a breach of confidentiality.

The practice employs an experienced and highly qualified nurse who holds a weekly clinic, at which she deals with family planning matters, fits IUDs and undertakes cervical cytology.

The patient came to have an IUD check at her own request and saw the specialist nurse.

Her complaint is that when she was called from the waiting room to see this particular nurse, everyone could hear and this meant everyone knew she was attending with a 'woman's problem'. She considers this to be a breach of confidentiality. Is this a valid complaint?

What should you do?

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

This sort of complaint seems bizarre but can occur. It set me wondering, what is the nature of confidentiality?

It is implicit from the GMC advice on this topic that a breach of confidentiality constitutes disclosure of details about a patient to a third party who does not have the right to this information. Would simply calling a patient into a particular clinic constitute such a breach?

The closest guidance comes from paragraph 13 of the GMC guidance, 'Accidental breaches of confidentiality', which discusses the disclosure of actual patient information.

In my opinion, simply calling a patient's name at a women's health clinic, particularly when she has asked to attend that clinic and presumably is familiar with the workings of the practice, cannot be seen as a breach of confidentiality. All women are called in for screening procedures from time to time, and the nurse has not given any information apart from the patient's name.

However simple the complaint might seem, it is worth the GP running it past their medical defence organisation before responding.

It would then be important to meet the patient, listen to her concerns and perhaps ask her how she would have preferred to be informed that the nurse was ready to see her.

It would be important to emphasise to her how seriously the practice takes its duty of confidentiality and that it would never knowingly breach this. The patient is at liberty to take her complaint further, but one would hope that with sensitive handling, this would not occur.

A medico-legal response: Jane O'Brien is head of standards at the GMC

Any disclosure of information about a patient's health, including that they are receiving care from a particular individual or service, may technically be a breach of the GMC's Confidentiality (2009) guidance.

Clearly, however, not all breaches are of the same seriousness or have the same consequences for the patient. This appears to be a minor breach of confidentiality.

Nonetheless, the patient is upset and the GP should make sure her concerns are listened to and taken seriously. The GP, nurse or practice manager should apologise for the distress caused and offer to review the system for calling patients to avoid this problem in the future.

One way to do this is for patients to be given the room number of their clinician when they arrive at reception for their appointment. In that way, only their name needs to be called by reception when their clinician is free. Of course, that still identifies the patient - but that should be acceptable in a general practice.

Doctors in more specialised areas, such as GU clinics, may need to take extra steps to protect confidentiality.

A patient's opinion: Stella MacPherson is an expert patient

I do not believe this is a valid complaint, because attending any clinic necessitates patients waiting in the designated area.

This is a problem faced by many specialist clinics. The handling of the situation depends on how the complaint arises.

Take time to explain that all specialist clinics are arranged with the smooth running of the service, as well as the convenience of the patients, in mind, and no confidential information is actually released publicly in the waiting area.

Ask the patient if she has any specific suggestions about how the clinic waiting area could be changed or rearranged to make it more acceptable. In this way, any future visits would be less stressful and hopefully, she would then feel confident that her personal information would remain private.

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