BMJ: Access to online records and medical misconduct

12 December, 2022

BMJ: When patients are victims: access to online records and medical misconduct

When patients are victims: access to online records and medical misconduct

BMJ 2022; 379 doi: (Published 09 December)

A review into the records of 44 patients who died while under the care of former Belfast Trust neurologist Michael Watt was published on 29 November 2022.*1* <> In 2018, concerns about the quality of Watt’s care led to one of the biggest patient recalls in NHS history, and the largest ever in Northern Ireland. The review identified numerous concerns, including lack of proper clinical investigation, inaccurate diagnoses, poor prescribing practices, poor recording keeping, lack of openness and effective communication,

inappropriate treatment, and the risks of clinicians working in isolation.

Conducted by the Royal College of Physicians with the involvement of patients’ families, the review was commissioned by the independent Regulation and Quality Improvement Authority (RQIA). Although the report examined only a small sample of patients, potentially thousands may have been affected.

A central theme of the report was that Watt’s clinical records and documentation tended to be brief and lacking explanation of clinical decisions. Important information was omitted, and there was a “lack of openness” about patients’ diagnoses. Families reported witnessing the neurologist regularly writing clinical records on “scraps” of paper. Watt also failed to answer requests for information from other clinicians. The treatments he prescribed in many cases were “unnecessary and invasive.”

Watt’s patients and their families were kept in the dark about their diagnosis and the rationale behind their care. Meanwhile, coinciding with the RQIA report, NHS England further extended the 30 November deadline for giving all patients online access to their general practice records by default.*2* <>

Patients worldwide are increasingly being invited to access their full electronic health records online. Much attention has been paid to easing doctors’ anxieties about the potential risks of increased litigation after shared access *3* <>*4* <>Considerably less thought has been devoted to whether online record access might protect victims from medical negligence or intentional wrongdoing. This propensity to focus on doctors’ legal woes rather than patients is telling. Greater transparency and more eyes on the charts can help support patients and clinicians, especially when medical procedures are inconsistent, unnecessary, or when clinical documentation is at odds with expected practice.

HIFA profile: Richard Fitton is a retired family doctor - GP. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data

Email address: richardpeterfitton7 AT