The exchange of information between doctor and patient

25 July, 2021

Family doctors find it difficult if not impossible, to educate a patient within the ten minutes of a consultation, especially when educating about an emotive subject such as sex and contraception. It is also difficult to always remember every aspect of advice, instruction, possible failures and follow up. So family doctors like to link patients to high quality, assured, information for patients to study before patients make an often difficult decision about contraception. (hence why adolescents consulting about contraception would benefit from access to thire records, letters, correspondence etc)

This is in accord with the GMC's excellent Decision making and good practice guidance concerning exchange of information between doctor and patient:

https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/dec...

"The exchange of information between doctor and patient is central to good decision making. It’s during this process that you can find out what’s important to a patient, so you can identify the information they will need to make the decision.

"9 The purpose of the dialogue is:

a to help the patient understand their role in the process, and their right to choose whether or not to have treatment or care

b to make sure the patient has the opportunity to consider relevant information that might influence their choice between the available

options

c to try and reach a shared understanding of the expectations and limitations of the available options.

The information you give patients

"10 You must give patients the information they want or need to make a decision.

This will usually include: a diagnosis and prognosis b uncertainties about the diagnosis or prognosis, including options for further investigation c options for treating or managing the condition, including the option to take no action d the nature of each option, what would be involved, and the desired outcome the potential benefits, risks of harm, uncertainties about and likelihood of success for each option, including the option to take no action.

"11 You must try to make sure the information you share with patients about the options is objective. You should be aware of how your own preferences might influence the advice you give and the language you use. When recommending an option for treatment or care to a patient you must explain your reasons for doing so, and share information about reasonable alternatives, including the option to take no action. You must not put pressure on a patient to accept your advice.

"12 You should not rely on assumptions about: a the information a patient might want or need b the factors a patient might consider significant c the importance a patient might attach to different outcomes.

"13 Other examples of information that might be relevant and, if so, should be shared with patients include: a whether an option is an innovative treatment designed specifically for their

benefit b whether there is a time limit on making their decision and what the implications of delaying might be c the names and roles of key people who will be involved in their care, and

who they can contact (and how) if they have questions or concerns d their right to refuse to take part in teaching or research heir right to seek a second opinion f any bills they will have to pay g any conflicts of interest that you or your organisation may have h any treatments that you believe have greater potential benefit for the patient than those you or your organisation can offer.

Exceptional circumstances in which you may decide not to share all relevant information

"14 There may be circumstances in which you decide not to share all relevant information with a patient straight away. If you delay sharing information necessary for making a decision, you should let the patient know there’s more to discuss and make sure arrangements are made to share the information as soon as it’s appropriate to do so. You must make a record of the

information you still need to share, your reasons for not sharing it now, and when it can be shared.

"15 You should not withhold information a patient needs to make a decision for any other reason, including if someone close to the patient asks you to. In very exceptional circumstances you may feel that sharing information with a patient would cause them serious harm and, if so, it may be appropriate to withhold it. In this context ‘serious harm’ means more than that the patient

might become upset, decide to refuse treatment, or choose an alternative. This is a limited exception and you should seek legal advice if you are considering withholding information from a patient.

HIFA profile: Richard Fitton is a retired family doctor - GP, British Medical Association. 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 gmail.com