On Fri, 19 Jun 1998 21:34:32 +0000, you wrote:
>I'm getting a bit of 'flack' from my HA for voicing local GPs
>opposition to a diabetic centre at the local trust.
Quite right too - I had a very bad experience in a part of London a
while ago.
As usual the problem related to confidentiality of the patient's
records.
>I pointed out that there are 41 diabetic centres i.e. surgeries and
>perhaps some investment in them was more appropriate.
>
This is more appropriate judging from my experience.
(See the cautionary tale about HA owned databases below.)
>Also raised an objection to a district diabetic register on the
>grounds of patient confidentiality and unnecessary bureacracy.
The way I specified the London arrangement, the HA was to set up and
run the core system. (They had time money and IT staff).
Individual surgery/optometrist/podiatrist/community nurse/consultant
network links would register patients and update the database after
each diabetic checkup.
The doctors, and all those with different kinds of clinical
involvement like chiropodists optometrists etc, would each be able see
on their own terminal a subset of the notes appropriate to their
needs, with individuals from the HA able to look at registration,
aggregated clinical data sets and de-identified individual records
for epidemiology/clinical research.
After specifying the system and spending 6 months getting GP and
hospital doctor approval, I told the HA medical advisor he in common
with the rest of the HA management would naturally only get the
'management' view of the data as they had no clinical 'need to know'.
His response was that he had the right to access and keep any data
from anywhere he wanted within the HA-owned systems and would give it
to anyone in the HA he saw fit.
When I pointed out that there was an ethical problem with this and
that I couldn't recommend the clinical use of the diabetic system to
clinicians on these terms, he sacked me on the spot.
>
The revised version of the scheme on HA's terms then failed to pass
the LMC's scrutiny and eventually failed to be funded for lack of
interest from the same clinicians who had previously been so
enthusiastic.
Please note those of you who may be involved in these diabetic
registers. There are some HA administrators and I am sorry to say some
very senior (professorial) diabetologists who are prepared to
blatantly ignore ethics in a bid to enforce new levels of surveillance
for diabetics.
I believe (and I hope you do) that this laudable end can be achieved
without using unethical means to do so.
We just need to convince the professors and the
administrators..........
Kind regards,
Paul
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