Ethics checklists and sharing patients’ information
Fiona Godlee, editor, BMJ
How often do you think "ethics" when seeing a patient? You may believe that ethical issues are always at the front of your mind, but is this really so, and would a checklist help? Our ethics commentator Daniel Sokol thinks it would (doi:10.1136/bmj.b879). Based on his recent experience of joining hospital ward rounds, he gives two cases where patients would have been better off if ethical issues had been raised routinely: a man with HIV infection whose views on disclosure to his wife and girlfriend were not known, and a demented man with cancer who was on intensive care because his advance directive had been overlooked. Sokol’s hosts, Washington Hospital Centre in Washington, DC, are now piloting the checklist, and Sokol hopes that others will follow suit. He asks a question similar to that posed in our editorial on the safer surgery checklist (BMJ 2009;338:b229): if you were a patient, would you prefer your medical team to use an ethics checklist?
An ethics checklist for legislators might have helped the UK government steer clear of its latest political banana skin—clause 152 of the Coroners and Justice bill. As Vivienne Nathanson explains in her editorial (doi:10.1136/bmj.b895), this proposed amendment would allow government departments to share data without observing the current legal restrictions on disclosing data—and without agreement from parliament. Nathanson says the current draft of the bill "suggests blindness to the special sensitivity of health data." If doctors thought that protective laws might be repealed with little notice they would have to warn their patients. This could dent confidence in medical confidentiality, making patients less willing to provide certain types of information, and reducing the value of doctor patie nt interactions and of epidemiological data for research. Justice secretary Jack Straw may have changed his mind by the time you read this. If not, send us your comments via bmj.com.
It turns out that one type of data sharing has the potential to greatly increase, rather than decrease, trust in the health professions—sharing patients’ records with the patients themselves. As Richard Smith highlighted in a blog last month (http://blogs.bmj.com/bmj/2009/02/18/demand-online-access-to-your-medical-records-says-richard-smith/#more-589), general practitioner Amir Hannan is offering his patients online access to their medical records. Dr Hannan took over the general practice of Harold Shipman, who was convicted 10 years ago of murdering 15 patients. Hannan talks of creating a "partnership of trust" with his patients.
The numbers taking him up on the offer are not huge (about 3%), but among those who have, and among respondents to Smith’s blog, there is untrammelled enthusiasm. You can hear an interview with Dr Hannan in our weekly podcast (http://www.bmj.com/podcasts). You might ask yourself why all patients are not currently offered online access to their records. Maybe, as one responder Glen Griffiths says, this is not just the flicking of a technological switch but a total change in approach, allowing patients to share more actively in their treatment. "It’s a wide chasm to cross but it appears from experience of those who have made the jump so far that it’s safe on the other side!"
Cite this as: BMJ 2009;338:b913