Disclosure of reflective notes – guidance for doctors and medical students

It should be rare for a reflective note to contain factual details that have not been recorded elsewhere, or already discussed with the patient and/or their family. Reflective notes should focus on the learning, not a full discussion of the case or situation.

Disclosing records to the courts

Recorded reflections, such as in learning portfolios or for revalidation or continuing professional development purposes, are not subject to legal privilege. Disclosure of these documents might be requested by a court if they are considered relevant.

The GMC guidance Confidentiality: good practice in handling patient information says that information must be disclosed if it is required by statute, or if ordered to do so by a judge or presiding officer of a court [20].

The guidance explains that, if disclosure of confidential patient information is required by law, ‘you should:

  • satisfy yourself that personal information is needed, and the disclosure is required by law
  • only disclose information relevant to the request, and only in the way required by the law.’ [21]

Where a disclosure request is received, the owner of the learning portfolio or other reflective note should seek advice from their employer, legal adviser, medical defence organisation or professional association.

Reflective notes and fitness to practise concerns

We do not ask a doctor to provide their reflective notes in order to investigate a concern about them. Our focus in a fitness to practise investigation is on facts and evidence relating to a serious allegation. Following a significant event or a serious incident, factual details should not be recorded in reflective discussions but elsewhere, in accordance with each organisation’s relevant policies.

Evidence of insight and remediation may reduce the need for us to take action. It plays an important role in how we assess whether a doctor’s fitness to practise is impaired. Doctors are invited to provide evidence of insight and remediation as part of their defence, but whether they do this and the form it takes is for the doctor to decide. We advise doctors to get legal advice before sending any documentary evidence.