Hi Bob - I wonder if this difference of views reflects differences in
experience?  I've perhaps been very fortunate in that my requests for
information from treating doctors have been entirely within the context
of a consultation between myself and the patient.  Trust and confidence
is built up and I can think of only one example (outlined in a separate
email to the list) where a patient did not wish me to approach her
treating doctors. 

But I am aware from post inspections as RSA, and in particular from
talking to OHAs working as lone practitioners, that many OHSs make
requests for reports from treating doctors as a paper-based exercise
without seeing the patient.  Although I recognise that this process is
pragmatic in many situations, no-one would describe it as "best
practice" for occupational doctors or nurses.  In the paper-based
assessment situation, I agree that it is vital to provide very clear and
unambiguous information to patients - because they don't have the
detailed and rich interaction with an OH professional that they have in
a face-to-face consultation.  

I am happy to concede the point!  But I hope you agree with me that it
is much more important that the patient clearly understands their right
to prevent their treating doctor disclosing information to an OH
professional?  (Many non-medical managers, for example, don't appreciate
this rather fundamental right of all patients.)

Best wishes - Kate

>>> [log in to unmask]
03/11/05 08:44:06 >>>
Alan, 

Your opening sentence in(1) seems to agree with Kate. However, I still
stand
by the Act as written which states quite clearly in that (Chapter 28),
Para
(3), Sub section (2):   "Any notification given under subsection
(1)(a)
above must inform the individual of his right to withhold his consent
to the
making of the application".  A statement which is designed with to
protect
the individual from employers or insurance companies asking for
reports
without consent, and a practice which the OH profession has been
following
for the last 17 years since AMRA became law.

Furthermore, the subsection (1)(b) "unless" clause makes the
application for
any report totally dependant on the consent of the individual.  Without
this
consent (as stated in subsection (1)(a)) "A person (a definition which
includes OH Physicians/Advisers as they are the employers
representative,
and I can find nothing in the act which exempts OH professionals from
this
definition of 'A person') shall not apply to a medical practitioner for
a
medical report relating to any individual to be supplied to him for
employment or insurance purposes" unless etc....

Regards, Bob



-----Original Message-----
From: Higher Education Occupational Physicians
[mailto:[log in to unmask]] 
On Behalf Of Swann, Alan B
Sent: 02 November 2005 17:52
To: [log in to unmask] 
Subject: Re: Access to Medical Records Act 1988 query

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