> Having said that, we too try and comply with the patient's wish not to
> inform the GP if they insist, but not always successfully!

I'm quite concerned by this thread.

I don't think anything should happen to my patients in the NHS without me
hearing about it.  Seriously.

> My personal
> aim is to try and persuade the woman of the importance of GP or FPC
> involvement, if only because emergency contraception is NOT 100%
> effective.

You've also got to ask why does the patient not want the GP to know.  If
they have genuine concerns about confidentiality then that is a serious
issue that would warrant further urgent investigation.

If they are worried without good reason (e.g.: parents go to same doctor)
then they should be reassured, or encouraged to see another GP as a TR, or
go to FPC for follow up / in future.  Primary care problems should be dealt
with in A+E only as a last resort ("I wish!", I hear everyone say).

It is always possible that the GP "knows too much" which would lead to
awkward, but important, questions.  E.g. this is the 4th request for
emergency contraception in 4 months, or the sister was being abused by a
family member who is just recently out of prison etc..

> My concern would be that other professionals in primary care may see
> such letters during filing etc. Without denegrating their own standards,
> would it be fair to say that receptionists / filing clerks etc. may not
> understand the full implications of confidentiality as well as GPs?

Not usually a valid concern.   GP's and their staff are pedantic about
confidentiality.  In all the practices that I have covered (or been
parachuted into) I've yet to come across a major confidentiality breech
(although, see below).  The contracts for practice staff with access to
notes have a confidentiality clause which is stressed very strongly.

Any breach of confidentiality on the part of practice staff is one of the
few grounds for instant dismissal.

Some staff are excluded totally from areas with confidential documents, or
are chaperoned, if they are not considered fully trustworthy.

Like hospitals, they are still careless at responding to telephone queries
from other services and the risk of being duped into giving info is a real
one.  However, this is getting better with more education of the risks.

Having said all that, there is a GP on the Isle of Harris who is a staunch
Free Presbyterian and who won't give contraception to unmarried women.  They
all used to come to us in Stornoway for their contraception services.  I'm
not aware of any actual instances of breach of confidentiality on his part,
but I don't think we told him about it because of their concerns about the
social stigma.

> I look forward to the day when a GP letter about emergency contraception
> is stigmatized no more than a letter about a sprained ankle.

No stigma on my part (but, then you already knew that;)

Robbie Coull

email: [log in to unmask]             website: http://www.coull.net


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