Working with doctors Working for patients

 

Introduction

Mr Jessop is 70 years old and has come to see Dr Williams today because he's concerned about his wife, Shirley, 72, who is also a patient of Dr Williams.

Mr Jessop has been telling Dr Williams his concerns about his wife's state of mind.

Mr Jessop

Mr Jessop

I mean she's just been getting so forgetful...friends' names...where we went on holiday... I know your memory's bound to get worse as you get older but there's something a bit more worrying about this that I can't quite put my finger on. Like when she's cooking she'll sometimes turn the gas on but forget to light it. Or when she's driving - and she's always been such a confident driver - she'll stop at a roundabout and look really confused and anxious about what to do next.
Have you noticed anything yourself doctor? You don't think it could be Alzheimer's do you? Her own mother died from it, years ago now. I convinced myself that Shirley wouldn't get it - she's always been so active.

Dr Williams

Dr Williams

As I said at the beginning, Mr Jessop, I'm afraid I can't discuss your wife's care with you - not without her consent. That's not to say you can't tell me your concerns about her - I can listen to whatever you have to say. But I do have to be careful to protect Mrs Jessop's confidentiality. You said she doesn't know you're here today? Well I'm afraid I can't promise to keep your visit confidential - if Mrs Jessop were to ask me directly I couldn't lie to her.

Mr Jessop

Mr Jessop

But she'd be so upset if she knew I was going behind her back. She's been getting really tetchy about keeping her independence. Like with the driving - but I'm worried she's just not safe any more. I've tried to tell her but she just won't listen to me. Would you try, doctor? I'm sure it'd have more clout coming from you.

What should the doctor do...? (Select A,B or C)

A

Ask Mr Jessop if she can tell his wife about his visit and concerns so that she can ask her to come to the surgery?

B

Do nothing - Dr Williams has no direct evidence of the concerns reported by Mr Jessop and they are relatively low level?

C

Contact the DVLA1 to alert them to Mr Jessop's concerns that Mrs Jessop may not be safe to drive?

1. Mrs Jessop does not live in Northern Ireland, where the Driver and Vehicle Agency (DVA) is the equivalent body.

Dr Williams

See what the doctor did

Dr Williams explained to Mr Jessop that she could not act on his concerns without revealing to Mrs Jessop where the information had come from - in other words disclosing to Mrs Jessop that her husband had spoken to her about his concerns.

Mr Jessop said he needed to think about what would be best and promised to contact Dr Williams again within the week.

Dr Williams resolved that - if Mrs Jessop should visit the surgery before she heard from Mr Jessop - she would make a tactful enquiry about Mrs Jessop's state of mind.

References

In most cases, discussions with those close to the patient will take place with the patientís knowledge and consent. But if someone close to the patient wants to discuss their concerns about the patient's health without involving the patient, you should not refuse to listen to their views or concerns on the grounds of confidentiality. The information they give you might be helpful in your care of the patient.

You should, however, consider whether your patient would consider you listening to the views or concerns of others to be a breach of trust, particularly if they have asked you not to listen to specific people. You should also make clear that, while it is not a breach of confidentiality to listen to their concerns, you might need to tell the patient about information you have received from others - for example, if it has influenced your assessment and treatment of the patient. You should also take care not to disclose personal information unintentionally - for example, by confirming or denying the personís perceptions about the patient's health.

(Confidentiality: good practice in handling patient information, paragraphs 39-40)

Section 27 of the Data Protection Act gives patients the right to have access to their personal information; but there are some exceptions. For example, you do not have to supply a patient with information about another person or that identifies another person as the source of the information, unless that other person consents or it is reasonable in the circumstances to supply the information without their consent. See the Information Commissioner's technical guidance note on Dealing with subject access requests involving other people's information.

The Driver and Vehicle and Licensing Agency (DVLA) and Driver and Vehicle Agency (DVA) are legally responsible for deciding if a person is medically unfit to drive. This means they need to know if a driving licence holder has a condition or is undergoing treatment that may now, or in the future, affect their safety as a driver.

You should seek the advice of an experienced colleague or the DVLA or DVA's medical adviser if you are not sure whether a patient may be unfit to drive. You should keep under review any decision that they are fit, particularly if the patient's condition or treatments change. The DVLA's publication Assessing fitness to drive - a guide for medical professionals, includes information about a variety of disorders and conditions that can impair a patient's fitness to drive.

The driver is legally responsible for informing the DVLA or DVA about such a condition or treatment. However, if a patient has such a condition, you should explain to the patient:

(a) that the condition may affect their ability to drive (if the patient is incapable of understanding this advice, for example, because of dementia, you should inform the DVLA or DVA immediately), and

(b) that they have a legal duty to inform the DVLA or DVA about the condition

(Confidentiality: patientsí fitness to drive and reporting concerns about patients to the DVLA or DVA, paragraph 6)