Dr Laurence Miles wrote:
>
> Until I received the reply below (posted to GP-UK, not private e-mail), I had
> actually thought that the presence of lawyers specialising in medicolegal cases
> would enhance the banter on GP-UK. Now I am not so sure at all. I wonder if
> their presence may cause serious limitation of genuine dialogue....
>
> I enclose the full original conundrum posed by me, and the reply from Graham
> Ross is interjected by me.
>
> [log in to unmask] wrote:
> > Dear Dr Miles
> > I ought to first of all advise you that I am a lawyer with an associated
> > practice in St Helens  that is  very prominent in criminal work (J Keith
> > Park & Co).
>
> Are you a member of J Keith Park & Co?
> If so, have you been in contact with the St Helens branch regarding my message?
> If not, have you contacted J Keith Park?
>
> > I say this as it may well be that my colleagues have today
> > been instructed in this very case, if, as I assume, it is last night's
> > Anfield vicarage murder (St Helens suspect arrested after 'tip off').
>
> You are making assumptions which I will neither answer or refute, in view of
> the above comments, but I am alarmed at how readily you have leapt to those
> conclusions on such little information...
>
> > I do not know what information it is that you wish to impart, but
> > clearly it would be a dangerous practice.
>
> Dangerous for whom? The public? Me? or Your client?
>
> > My concern would be that incorrect information, eg a psychiatrist's incorrect
> > assessment of a violent and unbalanced mental state, entered for purely
> > health diagnostic reasons, could be misused as evidence to convict an
> > otherwise innocent man.
>
> I would have thought that a professional opinion entered in a patient's medical
> records by a qualified consultant psychiatrist was usually a very valid opinion
> in assessing someone's nature. Pardon me for being so naive.....
>
> > If you believe you have something of importance in identifying guilt,
> > then you perhaps ought to indicate that fact alone, without saying what
> > it is, to the police,
>
> Possibly...
>
> > to the suspect/his solicitors
>
> Are you seriously suggesting that someone who believes that he has information
> regarding a patient who has committed a serious crime e.g. murder, rape, should
> attempt to contact the patient and his lawyer? So that the "innocent man" can
> come after us to get rid of the evidence?
>
> > to any other doctor whose opinion is contained in those records
>
> And should I be contacting everyone else in the patient's notes (whose writing
> I cannot read) as well?
>
> > and then leave it to the lawyers and the police to sort out by perhaps some
> > court order.
> >
> > But I do sympathise with any doctor found in this predicament.The
> > principle of confidentiality however should not be set aside in reaction
> > to the horror of the murder.
> >
> > Graham Ross
> > ********************
> IMPORTANT BIT
> It has been suggested elsewhere that information on GP-UK should not be
> disclosed elsewhere without the consent of the originator of the message.
> I suspect that Graham Ross would have no compunction in using information on
> GP-UK to institute legal proceedings or investigations against a member of
> GP-UK. Will he give us a guarantee that he will not do so?
>
> Many of the topics aired on GP-UK at are the cutting edge of medicine, where
> there may not be (currently) right or wrong answers. If lawyers are waiting in
> the wings to "attack" when someone steps (unwittingly) a little over the edge,
> then I would also consider leaving this list (see previous messages)
>
> I was very alarmed at how a general message posted by myself was replied to by
> Graham Ross with such specific details and "advice", which might for all we
> know be specifically designed to protect a client of his firm. We have always
> kept discussion at a more general level, never talking about named patients
> (although often talking about named Trusts :-))
>
> You will see from my original posting below that I originally intended to post
> my thoughts on the conundrum in a day or two. I now feel that I _cannot_ do
> this, in case this sparks off legal repercussions (and, Graham Ross, this is in
> no way an admission/acknowledgement/confirmation/refutation or anything similar
> that you are in any way right in your assumptions above). So, legitimate
> discussion of ethical issues has been curtailed by the presence of alawyer here
> on GP-UK.
>
> Dr Laurie Miles
>
> All parts of this message not attributed to Graham Ross are (Copyright) 1996 Dr
> Laurence Miles, and are not to be reproduced on any forum or medium other than
> GP-UK without the express permission of the author, Dr Laurence Miles
>
> **************
>
> > Dr Laurence Miles wrote:
> > >
> > > What do GP-UKers think is the "right answer to this?
> > >
> > > You hear on the radio that an ex-patient of yours is wanted and on the
> > > run for murder. You know that you have very detailed computer records on
> > > him, up to the time that he left your list, which might be of assistance
> > > to the police.
> > >
> > > Do you ring the police and tell them his confidential past history?
> > >
> > > I'll post my answer in a day or two....
> > >
> > > Dr Laurence Miles
> > >
> > > GP, St Helens


Dr Miles has over-reacted and I suspect more out of personal fear of
reprisal than as to the issues themselves.

He has raised an extremely important ethical issue on which there seems
to be little clear understanding by doctors. It was he who chose to
raise it in a public arena and I fail to see how the reply ought not to
be for all to see. Before I read his response I have earlier today
posted a message on the general issues of confidentiality.

I believe that what he was intending to do was highly unethical. If it
really was that important then what was clearly right and proper to do
was to make known to all parties that he had information so that the
question of forced disclosure could be raised in a way in which the
views of all parties could be offered before any damage was done. The
idea that a doctor should disclose confidential medical records without
the knowledge of his patient is a serious issue. Does he advocate a new
Government sneak line to add to the recent welfare cheats line? Do we
want doctors ringing up every time they read of a crime to read out
items in the records of patienst they think are a little 'dodgy'. What
if the police started to consider  medical records a useful new source
of evidence and paid doctors regular visits. I  hope Michael Howard is
not on this list because this would be in the next manifesto before you
could say Cracker.  Do you really want that?

The further outrage by Dr Miles at the suggestion that his desire to
give information from confidential records should  be reported to the
suspect and his lawyer, simply out of fear of personal reprisals, only
makes matters worse. No of course I would not knowingly and
unnecessarily put someone at risk of reprisal and I resent the
suggestion that I might. But, if I was acting, I might want to take
action to prevent such a wrongful disclosure, but that would have been
with his knowledge. The whole point of my suggestion that he inform all
parties of what he would like to do is to enable him to act at least at
a professional arms length and give an opportunity for his patient, to
whom after all he does owe a very strong professional and ethical duty,
to make a challenge if so advised.

Yes, our experience shows that psychiatrists, to use my example, but
without any knowedge of the matter with which he is really concerned, do
make mistakes on diagnosis from time to time. Who tells us?....other
consultant psychiatrists acting as experts in our cases.

I was being frank as to the link with JKP&Co, really in his own interest
and to be fair to him.  Maybe that aspect could have been covered by
private e-mail and if it has put him in an embarrassing position then he
has my apology. (Incidentally I am told JKP&Co is not acting)

But this is surely not the point. I cannot say that information given on
ths public list would not be used by me because, not being given in
confidence, I have an ethical duty to make use of it if it relates to a
client. If his conscience troubles him, then talk to a colleague in true
confidence, don't post it for the world to see. What this message
reveals is a misunderstanding by many on this list as to its public
nature.

If my assumption as to the case is wrong, fine. But you must understand
that the one I referred to was headline national news that morning and
the connection was obvious. All should read my earlier posting today on
confidentiality. Dr Miles needs to look at these issues from both sides.
Just for a moment think about the damage if innocent people are arrested
simply because of information in a medical record the release of which
they had no knowledge.

Graham Ross


Graham Ross


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