What delicious --yet, ultimately, deeply painful -- unintended irony is conveyed by the image that graces the NHS web-page containing details of its publications for health care workers and patients about its much vaunted electronic database of patient records.
This irony is especially piquant in light of a report in today’s Times about the concerns Health Secretary Patricia Hewitt has publicly expressed that potentially compromising information about Muslim women given by them in confidence to their GPs might be, or has been, leaked to those in their own communities who would make violent reprisals against them, upon learning of what they had disclosed. The kind of information at issue is that that which concerns ‘domestic violence or sexual health problems of these women.’
Given all that we have recently learnt about honour-killings in the Muslim community, as well as about how some imams teach the legitimacy of wife-beating, clearly Ms Hewitt is right to be concerned about the danger Muslim women face from information given in confidence to their GPs finding its way into the wrong hands.
The same news item also reports the shocked reaction of several Asian GPs to the suggestion that any of them might breach confidentiality in this fashion. One is quoted as saying: ‘No GP would break confidentiality because if they break it, they are liable to be sued.’ Another, reported to have found the accusations offensive, is quoted as having said: ‘I am a Muslim doctor. Confidentiality is paramount not just for the GP, but for the whole practice. To breach confidentiality in my practice is a sackable offence.’
What the second GP said is not exactly true, or rather is only true in the rather dubious strained sense which the NHS attaches to the notion of ‘medical confidentiality’ whereby all health care professionals may legitimately share information about patients that they deem germane to their treatment. In any common-sense and more restricted sense of the term, even those working in a medical practice to place confidential patient records into electronic format are arguably in breach of patient-confidentiality.
Setting that terminological point aside, however, the fact is that the proposed electronic system, currently on trial in Bolton, poses a great security risk that confidential patient information might find its way into the wrong hands. The source of the problem has been well explained by Paul Thompson, a GP from Kingsbury who is both a self-confessed computerisation enthusiast, yet also a medical practitioner with an interest in patient privacy.
Dr Thompson writes: ‘The biggest security risk in a [National NHS] database arises from illegitimate use by individuals with otherwise legitimate access to the data-base’. As he has further and more recently explained: ‘Staff will not be allowed to access records unless a “legitimate relationship” exists, but they will be able to access records. It will have to be a rapid and easy process to create a “legitimate relationship” (whether or not it is authentic) else the justification for the service -- care in an emergency – will be unworkable.’
However convinced the Muslim GP quoted earlier was who said she found it inconceivable any health care workers would breach their trust by unwarrantably obtaining and leaking confidential patient information, her faith in their integrity is apparently not widely shared by her colleagues. According to a Medix opinion poll of GPs commissioned by the Guardian, no fewer than 60% of them thought that confidentiality of the records was at risk and 50% threatened to defy instructions to upload the data.
All this leads me back to my starting point – the irony conveyed by the image the NHS uses on its webpage with details of its publications about the database. For what that shows is a hijab-clad woman of clearly Asian extraction teaching her fellow-health care professionals how to use it.
Admittedly, Muslim women form an especially vulnerable patient-group, should the data-base be open to abuse in this fashion. So, perhaps, of all NHS workers, they are least likely to be prone to misuse it in this way. But not all Muslims working in the NHS who would have access to the system are women. Nor are all Muslim women working in it necessarily liable to be sympathetic to fellow Muslim women who might have entered into an illicit sexual relationship or suffered ill treatment at the hands of their husband or father.
Even if all Muslim GPs and all who work in their practices are absolutely scrupulous in their use of the data-base, can anyone seriously suggest the NHS contains no unscrupulous employees who would not hesitate to misuse it to check up on what certain patients might be telling their GPs?
As a matter of fact, Ms Hewitt’s concerns appear to be directed at this wider systemic level, rather than at GPs, for she is quoted as saying: ‘This is not a direct accusation against Muslim GPs – it is a call for sensitivity from all parts of the health service.’
If Ms Hewitt thinks a mere call for sensitivity from all parts of the health service is going to fix this fundamental flaw in the database, then she is as much in urgent need of the services of certain sections of it as the GP is who is quoted as having said that ‘No GP would break confidentiality because if they break it, they are liable to be sued.’
The present rapidly disintegrating administration might well have given up on its promise of joined-up government. But Ms Hewitt’s reported concerns and the concerns others have expressed about the vulnerability to abuse of the database all relate to her own patch. She should join up these sets of concerns and realise just how vulnerable it is going to leave Muslim women to reprisals for what they might disclose to their doctors. If she is genuinely concerned about their plight, let alone that of other groups of patients, she should call for a moratorium on further work on the database until after a full-scale independent public enquiry has been had as to the risks as well as benefits that it poses to patients.