One of my drivers for patients' access to records was my desire to reduce
my errors and adverse events. If I inadvertently omitted a referral or test I wished the patient to be able to point the omission out to me.
I also wished for other doctors to be able to use my notes and results to give a second and better opinion if necessary or a more nuanced opinion if further clinical events or results accrued in the patient's history. As my partners did not wish to pursue this shared record approach, I moved to a single handed practice in 1993 to develop the new culture. While we were trialling patient access to records for the NHS Electronic Database
(Hansard, 17 November 2000) (parliament.uk) (https://api.parliament.uk/historic-hansard/written-answers/2000/nov/17/e...)
Fate intervened during our NHS Information Authority ERDIP (Electronic Record Implementation Pilot) when I was asked to give police evidence against a fellow family doctor. I had signed a second part of a cremation that this doctor had issued after murdering one of over 200 patients. The doctor altered the medical records of his murdered patients before asking doctors to sign the secnd and third parts of the cremation forms. After giving evidence at his trial and after his conviction, it was an obvious act to suggest to the NHS that similar adverse events might be reduced or prevented by patients and ther families having full access to records and audit trails.
A strong and wise medical regulator supported these views and supported consultation for the production of a new safer medical record system.
It may be worth sharing the "errors" that the doctor was making to add to the adverse events list:
• Wrong diagnosis
• Wrong choice of therapy
• Wrong dose of therapy
• Administration of treatment without truly informed consent
• Lack of transparency
• Incorrect completion of the GP records
• Incorrect completion of death certificates
• Incorrect completion of cremation forms
• Incorrect communication of clinical details to GPs
• Inaccurate audit figures
• Absent clinical governance in all of the above areas
We suggested that:
Patients should be able to have access to their contemporary record before during and after the consultation
• Patients should be able to access research and data about local treatment outcomes
• The patient should be able to request corrections to their medical records when they detect errors and omissions
• Interested patients should be involved in the clinical governance cycle
• Interested patients should be involved in clinical service development
This last was a doctor protective suggestion and in fact supports the requirements of consent for treatment-
• Patients could be denied treatment if they have not checked and understood their data and outcome and side effect information – an on line MCQ to pass before they have an operation?
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 gmail.com
