I was contacted recently by a patient who felt she was being unfairly treated by her insurance company. The problem was that she had had a brief episode of depression some years ago when her marriage was breaking up, and this was recorded in her medical notes. When applying for cover the patient had not even reported it. Not surprisingly she felt it was a normal reaction to the circumstances and not indicative of any ongoing health issue. Unfortunately, the insurer saw it differently and wanted to exclude any mental health condition from her policy, probably indefinitely. We drafted a letter to push back on this, but I’m not sure if it worked.
I’m not bagging the insurance companies here. Their job is to manage risk, and we are all happy for their help when something bad happens. But it reinforces a point made by Mat Sturge in his recent Hibiscus Matters column (HM, 19 Sept). We sometimes don’t appreciate that when we apply for insurance, or even make an ACC claim, we are giving them pretty wide permission to access our medical records. Doctors are very aware of this and try and manage the situation in different ways. I have heard of GPs avoiding the D word for low mood and using “feeling up and down” instead. I think this is problematical because it only works if everybody understands the code! On the other hand I do sometimes warn a patient if I think some particularly sensitive information is going to be released to a third party. At least they are making a fully informed decision then and don’t get any nasty surprises.
Another privacy issue which comes up regularly in general practice is whether parents can have access their children’s notes. People often assume they can but in fact children have the right to privacy just like everybody else. Surprisingly there is no set age of consent for medical procedures. The assessment of whether a young person is competent to give consent (and entitled to privacy) rests with their doctor. So even patients in their early teens may ask for their medical information not to be shared with their parents, and we doctors have to honour that.
The other tricky privacy issue is when somebody gives information to a doctor regarding another patient. “Please don’t tell them that I said this, but I think you should know…” This kind of intelligence can be really helpful, but you must make it clear if you don’t want it entered in the notes. Otherwise the patient may access it at a later date and your cover will be blown.