Hi Alan - you've mentioned the grey areas and the employees' right to
make decisions, even unwise ones.  I completely agree with you on this. 
I find it helpful to pick apart the generic issues first until they are
black and white and clear, and then respond to the human issues on a
case-by-case basis.

I well remember a lady with terminal Ca who refused permission for me
to contact her treating doctors, and for them to contact me.  With
sensitivity, compromises, and goodwill all round, sufficient information
was exchanged in a manner which was both transparent and also met the
patient's specific wishes.

Best wishes - Kate

>>> "Swann, Alan B" <[log in to unmask]> 02/11/05 17:52:21 >>>
Dear Kate,

There is a recent editorial in JSOM you might like to read.

My views:

1. AMRA does not give the right for a patient/ client to withhold
consent for an OH Adviser to get in a report from their own Doctor, but
there is a ethical duty on physicians not to go against a clients
expressed wish on something like this. And physicians should have clear
evidence of consent before releasing info to an Employers medical
adviser: which is what we primarily are, irrespective of our duty of
care.
2 It should be in an employees best interest for us to get in info from
their doctor: but what if the employee has been dishonest in the
disclosure of health information to the employer.
3 Yes, they do, but usually on a form brought by the patient, where
implicit consent can be assumed 
4.The power of veto might be used badly, but writing to an employees GP
against their expressed will would be daft & possibly construed as
misconduct unless there was a strong justification such as the avoidance
of harm to another.
5. Employees have the general human right to be stupid, even if it
jeopardises their job (I cite recurrent absence ascribed to sickness as
an example)

Toodle Pip.


Dr. Alan Swann, BM, AFOM
Director of Occupational Health
Occupational Health Service
Imperial College London
Level 4 Sherfield building
South Kensington Campus
London
SW7 2AZ
Tel:	+44 (20) 7594 9401
Fax:	+44 (20) 7594 9407
 https://www.imperial.ac.uk/spectrum/occhealth 
***The College OH Service has moved. we are now based on Level 4 of the
Sherfield Building****


-----Original Message-----
From: Higher Education Occupational Physicians
[mailto:[log in to unmask]] On Behalf Of Kate Venables
Sent: 02 November 2005 02:59 PM
To: [log in to unmask] 
Subject: Access to Medical Records Act 1988 query

Dear colleagues - I was wondering if any legally-minded people have a
view on the issue outlined below?

The OHS I used to head and still work in occasionally has an
explanatory note for patients about the Access to Medical Reports Act.

It pre-dated my time.  I noted only today that it states that the
patient has the right to refuse consent for the occupational physician
to request a report from their treating doctor.  This seems to me to
be
wrong and that the correct wording is the reverse - that the patient
has
the right to refuse consent for their treating doctor to supply a
report
to the occupational physician.  I checked in the recent Kloss (4th
edition, page 94) and it confirms that the patient has the right to
refuse consent for their treating doctor to supply a report to the
occupational physician.

I have no idea why my predecessor used this wording and can only
assume
it is a mistake.  But I am also aware that some occupational
physicians
feel that they are obliged to to seek consent from the patient to
request a report from their treating doctor.  I feel this is wrong for
the following reasons:

(1) if the patient wishes not to disclose information to the employer,
that is covered by the patient refusing consent to the GP to provide a
report.  There is no reason for the patient also to refuse consent
even
for the request.

(2) there is no potential detriment to the patient in an occupational
physician requesting information from a treating doctor (whereas there
is potential detriment to the patient in the reverse - the treating
doctor providing information to the occupational physician).

(3) non-medical third-parties (eg employers, insurance companies, the
local leisure centre!) frequently request reports from GPs without
necessarily seeking consent and there is no reason why a request from
a
doctor should be treated more stringently in law.

(4) doctors have a positive GMC-mandated duty to share information
with
each other and with other health professionals to the benefit of the
patient and a request for a letter/report is often only a small part
of
a correspondence which includes the occupational physician
communicating
information to the treating doctor.  It would be quite wrong if the
patient could veto such information being shared with their treating
doctor.

Thoughts welcome!

Best wishes - Kate