We recommend patient access to their medical records as an extra layer of patient safety. Patient access to records is an increasingly common opportunity for patients to raise the level of safety of patient care.
The discovery of Dr Harold Shipman a family doctor who had murdered patients during his career. I knew Dr Harold Shipman as a neighbouring family doctor and as chairman of my children’s Parent Teacher Association and I gave evidence at his trial. On 31 January 2000, he was found guilty of the murder of 15 patients under his care; his total number of victims was approximately 250.
Dr Shipman had made many purposeful errors of clinical governance in medical management of his murdered patients including altering their medical records after their death to show diagnoses supporting his falsified death certificates. Some of these altered records might have been detected families of patients had they had access to the contemporary medical records kept by Dr Shipman.
The Institute of Medicine’s 2001 report “Crossing the quality chasm” https://journals.sagepub.com/doi/10.1177/152715440100200312 was helpful when we dealt with an unfortunate and serious safety issue –
The Institute’s 10 guiding rules for patient-clinician relationships were:
New rules to redesign and improve care
1. “Care based on continuing healing relationships. Patients should receive care whenever they need it and in many forms, not just face-to-face visits. This rule implies that the health care system should be responsive at all times (24 hours a day, every day) and that access to care should be provided over the internet, by telephone, and by other means in addition to face-to-face visits.
2. Customisation based on patient needs and values. The system of care should be designed to meet the most common types of needs, but have the capability to respond to individual patient choices and preferences.
3. The patient as the source of control. Patients should be given the necessary information and the opportunity to exercise the degree of control they choose over the health care decisions that affect them. The health system should be able to accommodate differences in patient preferences and encourage shared decision-making.
4. Shared knowledge and the free flow of information. Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information.
5. Evidence-based decision-making. Patients should receive care based on the best available scientific knowledge. Care should not vary illogically from clinician to clinician or from place to place.
6. Safety as a system property. Patients should be safe from injury caused by the care system. Reducing risk and ensuring safety require greater attention to systems that help prevent and mitigate errors.
7. The need for transparency. The health care system should make information available to patients and their families that allows them to make informed decisions when selecting a health plan, hospital, or clinical practice, or when choosing among alternative treatments. This should include information describing the system’s performance on safety, evidence-based-practice, and patient satisfaction.
8. Anticipation of needs. The health system should anticipate patient needs, rather than simply responding to events.
9. Continuous decrease in waste. The health system should not waste resources or patient time.
10. Co-operation among clinicians. Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and co-ordination of care.
Dr Harold Shipman’s clinical governance “mistakes” included:
– Wrong diagnosis
– Wrong choice of therapy
– Wrong dose of therapy
– Administration of treatment without truly informed consent
– Lack of transparency
– Incorrect completion of the GP records
– Incorrect completion of death certificates
– Incorrect completion of cremation forms
– Incorrect communication of clinical details to GPs
– Inaccurate audit figures
Absent clinical governance in all of the above areas
Part of the General Medical Council’s response was to promote, quality assure and write professional guidance for health professionals in the UK to share contemporary records with patients and the Royal College of General Practitioners followed this initiative on to produce instructions, detailed guidance for family doctors to share contemporary digital records with patients: https://www.rcgp.org.uk/clinical-and-research/
If Dr Harold Shipman’s patients had access to their personal medical records, some or all of the deaths might have been prevented
HIFA profile: Richard Fitton is a retired family doctor – GP, British Medical Association. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data
Email address: richardpeterfitton7 AT gmail.com
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