The use of ‘family files’ – where the notes of members of one family are kept together in one file – is quite common across general practice in South Africa.
The recent MPS caseload has demonstrated that there are significant risks attached to the use of family files, and as a result MPS advises against their continued use. Although there are no official guidelines against their use, the potential problems are fairly self-evident and include an increased risk of one family member having access to the records of another – therefore breaching confidentiality – and difficulty in providing records of only one family member when these are requested, for example by a solicitor when preparing a clinical negligence claim.
Family files can take on various appearances. Sometimes separate records are kept for each family member but they are all kept in one physical folder, often in the name of the primary member of the medical aid scheme concerned. Other times the clinical notes are entered chronologically on the same card or piece of paper, irrespective of which family member they relate to. Both approaches are examples of potentially risky record-keeping.
A man made a claim against his GP for a missed diagnosis. An expert witness was instructed to provide advice on the case, and in keeping with normal practice she was supplied with the notes of the claimant – only the notes were mixed in with other family members, and the expert attributed some of the notes of the claimant’s son to the claimant himself.
This resulted in some of the expert’s conclusions incorrectly assuming that the claimant had a history of diverticulitis, and that the doctor in question should have taken this into account when he treated/diagnosed the patient. The confusion was identified before the trial commenced and the claim was ultimately withdrawn – although there were additional factors in this decision – and the doctor in question narrowly avoided unwarranted criticism.
The disclosure was also a clear breach of the confidentiality of the claimant’s son.
A female patient at a medical centre consulted GP Dr F and was subsequently sent for further treatment at another department within the building. Dr F supplied the patient with her medical notes, to be passed on at her next consultation. The notes were contained in a ‘family file’ and the patient flicked through it with curiosity. She discovered her husband’s notes and a diagnosis – three years earlier, and unknown to her – that he was HIV positive.
The husband complained to the medical centre about the violation of his patient confidentiality. He also sent a complaint to the HPCSA, who strongly criticised Dr F over his practice of keeping ‘family files’.
In what was a related issue, the wife complained that she should have been informed of her husband’s HIV diagnosis, as she would have taken the necessary precautions to protect herself. MPS advised Dr F that at the time of the HIV diagnosis, he should have counselled the husband on disclosing his status to his wife, who should then have been offered testing (with the necessary counselling). If he refused to disclose his status to her, consideration should have been given to this being disclosed to the wife by Dr F, after having warned the husband that this would be done.
Although it is a breach of patient confidentiality, such a disclosure is justified if somebody else’s (the wife’s) health (and life) is at risk. See the MPS factsheet on “Disclosures without consent
It is not good practice to have ‘family files’. Each family member should have their own file, which will assist in preventing accidental disclosures of one family member’s details to another family member.
It also means that when faced with a request for copies of any individual family member’s records (for example, if someone changes practitioners, or requires his/her records for medicolegal purposes), doctors may supply these without compromising the other family members’ confidentiality.