It might seem obvious that patients’ health information must be kept confidential, but what may be less obvious is that this duty of confidentiality applies to all the information you hold about them. This includes dates or times of appointments they’ve attended, or even the fact they are registered with a certain practice or have attended a certain hospital. It can be easy to let your guard down, particularly when you’re away from the clinical setting or out with friends.
Remember that discussing clinical care in public may appear unprofessional and give the impression of breaching confidentiality, even if patients’ names are not used.
Consent and respect
Patients will not always be in a position to tell the difference between you, as a medical student, and a fully qualified doctor. This is especially true for those who are unwell, anxious or distressed. So it’s up to you to make sure they know who you are and identify yourself as a medical student.
The GMC advises that patients must give informed consent to take part in teaching or research. It can be tough when doctors introduce you to patients simply as a ‘colleague’, but it is important that you identify yourself as a medical student and check that patients are aware of your role.
The GMC also says you should respect patients and treat them with dignity. Presenting yourself professionally, dressing appropriately, and being punctual, smart and alert are simple but important ways of showing patients and colleagues that you care. Try to be aware of your body language, and take every opportunity to develop your empathy skills. Don’t forget about relatives and those close to the patient, who should also be treated with consideration and offered support when needed.
Real life scenario
Morgan, a fourth year medical student, was completing a placement in an inner-city general practice. He was asked to take a history and examine a female patient in her early 30s, who had presented with upper respiratory symptoms of a few days’ duration. He took a full history, examined the patient’s chest, ears, nose and throat, and presented the case to the GP.
The day after the consultation, Morgan was contacted by the GP practice. The patient had complained about an inappropriate examination being performed. As part of their investigation, they required a written statement from Morgan. The medical school was also involved, and Morgan was told that he would not be allowed to undertake clinical work until the investigation had concluded.
Fortunately, Morgan had kept clear records of the consultation, and had documented the respiratory and ENT examinations that he had performed. With our assistance, Morgan was able to provide a written statement that satisfied the practice and the medical school of the proper nature of the examination. It appeared that the patient had misinterpreted his examination of the lymph nodes in her neck and axillae as being something more sinister. Morgan was allowed back to the practice two weeks later and was successfully signed off for the placement despite the time out.
This case highlights the need for good communication with patients, who might genuinely misunderstand the purpose of an examination, particularly when a medical student performs it differently to a more experienced clinician. Clear documentation of the consultation and examination will help to provide evidence where concerns arise. However, all doctors and students should consider the need for chaperones, even if no intimate examination is performed.
For more information or to talk to us about patient care, call our advice line on 0800 561 9000