[Closed] Prescriptions and Breaching Patient Confidentiality

Sigh.

Yes this is personal data, but it has not been mis-used, or used for any purpose apart from that which it was gathered. That is, to give you your medication, and make sure the right person gets the right meds. These people all have a need to see that data on order to carry out their job.

What would you do if you got given the wrong meds ? Sue if you were still alive ??

Now, if they were shouting out over a loudspeaker:

"MR SMITH, OF 23 BRICK LANE, PLEASE REPORT TO THE COUNTER FOR YOUR CLAP MEDS" then you might have a point.

And what makes you think the admin staff either notice or care ? I suspect they have seen much more interesting cases.

That is outrageous and to my eye also not respectful of your understandable preference which you have articulated to them... My doctor doesn't do it and I have never experienced it. I would change doctors if they did...

Tell them not to do it and see what happens.

Is that a superior hey Im in the know` type of sigh ?

What's the embarrasing medical problem?

Sigh indeed
It clearly bothers me (and another, younger member of my family with a very personal and some what embarrasing condition) more than it bothers you then.
I know what i'm getting copious amounts of meds. for and I know what those meds are and should be. Why does every bugger else need to know?

It's not a breach. It's only appeared to you and people involved in delivering your care.

Even if they had just left it at the pharmaceutical name for whatever anti-fungal suppository you've just been given, they'd still have a fairly good idea.

Yes. I have been Data Protection officer for a few orgs, never health info mind, but I would think it is more important in that world that things are properly labelled. Everyone is an expert these days and thinks it's a liberty if their name appears in print anywhere. Favorite was a staff member moaning that their name had to go in the accident book. Duh.

Thing is though DPA Officer Hels, this is symptoms as well as the name of the condition! Properly labelled with the name and amount of meds, when to be taken etc. is fine by me, I'm a mentalist. Without this I might forget but a description of symptoms? It's an outrage!

monksie - quite a few buggers need to know so that you don't get the wrong medication, it passes through a few hands and the possibility of mix-ups is clearly a much more dangerous situation, liable to cause considerably more real and actual (not imagined) harm than that to your delicate sensibilities that a few assistants have seen your name, among hundreds of others each day, and have checked that the medication is correct.

quite a few buggers need to know so that you don't get the wrong medication,

Nope - name of patient, name of med, instructions for taking them.

OK, description of symptoms I would rule as a bit much, if I was called to investigate, although probably borderline on the old "adequate and necessary". They probably gave somebody the wrong drugs once and got sued.

They probably gave somebody the wrong drugs once and got sued.

So the receptionist / pharmacist need to know to check the GP's diagnosis / treatment regime? 🙄

Is it not preferable that a mistake is picked up by a professional than missed?

One of the people in that line might question the med/strength/regularity which might lead to a better/cheaper/change in meds. I would guess that all of these people are pros and know their responsibility.

It doesn't matter how many people know a secret as long as they all know it is a secret.

This is probably a bimbo question but is this anything to do with the NHS Summary Care Records? Could the information have come from there?

I agree with your thoughts monksie, perhaps a letter to the Practice Manager or the PALS office may be in order?

Edit: isn't the PIL good enough?

Sigh. (Heard this all before...?)
Yes this is personal data, but it has not been mis-used, or used for any purpose apart from that which it was gathered. That is, to give you your medication, and make sure the right person gets the right meds (That is an argument for prescriptions not one for stating a diagnosis.). These people all have a need to see that data on order to carry out their job (Great justification - or it would be if it was appropriate. Kind of like saying a person on the production line needs to know the height/weight/build of the person who will be driving the car they make)
What would you do if you got given the wrong meds ? Sue if you were still alive ?? (Or perhaps trust that a doctor should be competent to provide the medication and the pharmacist to dispense it...?)
Now, if they were shouting out over a loudspeaker:
"MR SMITH, OF 23 BRICK LANE, PLEASE REPORT TO THE COUNTER FOR YOUR CLAP MEDS" then you might have a point. (But the OP does have a point - their diagnosis is between them and the doctor. No one else needs to know at that point!)
And what makes you think the admin staff either notice or care ? I suspect they have seen much more interesting cases.(A variant of that kind of argument has been used before when depriving patients of dignity. Let's change an elderly patient with an inco pad like we are changing a baby. Let's walk straight in to a private consultation after knocking but not waiting to be asked to enter. Let's leave patients in a state of undress which is unnecessary but convenient to us. All of which justified by the "We're professionals, we've seen it all before, we don't think anything of it..." The thing is - its not about how the pharmacist, nurse, doctor, receptionist or anyone else feels or thinks appropriate. It's about how the patient feels - in this case the OP.)

Yes. I have been Data Protection officer for a few orgs, never health info mind, but I would think it is more important in that world that things are properly labelled. Everyone is an expert these days and thinks it's a liberty if their name appears in print anywhere. Favorite was a staff member moaning that their name had to go in the accident book. Duh.

Loving this! You shouldn't have accident books! You should have records and store data for those for sure but not where they are accessible to all staff or visitors - as incident/hazard reporting mechanisms should be...

Seriously if I want an opinion on ethical use of medical information - a data protection officer is not someone I would ask. Maybe a patient advocacy group, PALs or a medical professional who has a clear understanding of their responsibilities against their codes of conduct.

What the others have said - Pharmacists are highly skilled professionals, and it puts an extra layer of safety in the system - especially where prescriptions have been handwritten rather than printed!

Its a great example of teamwork - Your local pharmacy works in tandem with your doctor to ensure the effective and safe use of the correct medicine, whats not to like!

As mentioned above it's a fairly good bet that anyone who sees the med name will be able to deduce what it's for. However saying that there are some meds where knowing what they're prescribed for may be useful. For example amoxicillin can be prescribed for a number of infections and the dose can vary.

If the pharmacist knows why it's been prescribed they can double check that the dose and medication is appropriate.

What the others have said - Pharmacists are highly skilled professionals, and it puts an extra layer of safety in the system - especially where prescriptions have been handwritten rather than printed!

If you are not sure of the prescription details - clarify before dispensing. Don't dispense based on a stated condition. You are likely to make more mistakes that way not less... (Bangs head in frustration...)

 

op if we play guess the medical condition will you tell us if we get it right?

Lots of organisations still have accident books, it's the only practical way. HMSO bought out a special one last DPA update that has a new page for each incident, so not even the next person along sees the last persons details. If this lives under lock and key in the H & S Managers office thats perfectly fine, they can transcribe the data into electronic system if they want, and that's generally what happens.

P.S and don't reductio ad absurdum me mr 1974 cos I'm not going to bite.

If you are not sure of the prescription details - clarify before dispensing. Don't dispense based on a stated condition

One of the lessons of human error analysis - errors don't happen because because people are not sure, people make errors because they [b]are[/b] sure - but sometimes see what they want to see, rather than what was actually there.

I don't think anyone is proposing dispensing on a stated condition - its there because if the condition does not match the medication, it provides a safety net to prompt the dispenser to check with the GP.

Was the prescription for Picolax?

Let's be a little grown up for a minute.
Here's an example. Sorry to disapoint but it [b]really is an example[/b]
Wife goes to gp's to collect 'scripts. Husband's 'script says "100mg of cough mixture to be taken twice weekly for the treatment of genital crabs"
Wife does not have and never has had genital crabs. Was also wondering why husband was keeping his hands (and other body parts) to himself lately.
Just to be clear. THIS IS AN EXAMPLE 🙂
Breach of patient confidentiality or a little overly sensitive Hels?

In your "example" surely if the guy went to the quacks and got diagnosed with a case of crabs, then he wouldn't send his wife to pick up the prescription would [s]you[/s] he?.

I thought people wi' piles just went on embarrassing bodies...

Well it's a perfect "example" of an unbelievably stupid husband! Why on earth would you send to collect a repeat prescription the very person you are trying to keep the details from.

So no, I'd say it's not a breach of patient confidentiallity as "he" sent his wife to collect the prescription thereby granting her access to a lot of "his" medical information.

Who cares about patient confidentiality in your example? The husband is so stupid he deserves to get caught.

Can't believe you've admitted to having crabs on an internet forum.

All that's needed on the prescription is name of patient, name of med, instructions for taking them.

The pharmacist has no need to know that monksie has crabs.

It was a highly unlikely example used to over emphasise but make abundantly clear my thoughts that this is a breach of confidence and I am right to be outraged ( 🙂 )!
and hahaha at McAitch up there 🙂
OK then. Wife calls in foe her own script and asks in a helpful way. "Any for any other family members? I'll take them all while I'm here".

Wife goes to gp's to collect 'scripts. Husband's 'script says "100mg of cough mixture to be taken twice weekly for the treatment of genital crabs"

Then the pharmacist could see that cough medicine is not the correct treatment for genital crabs, and check with the doctor about the mistake. Perfect example of why its a good idea for the information to be on the script.

The basis of your complaint seems to be the premise that you need to keep secrets from your wife. So for those of us who don't cheat - is there really a problem?

Then the pharmacist could see that cough medicine is not the correct treatment for genital crabs, and check with the doctor about the mistake. Perfect example of why its a good idea for the information to be on the script.

😆

Wife goes to gp's to collect 'scripts. Husband's 'script says "100mg of cough mixture to be taken twice weekly for the treatment of genital crabs"

Your crabs are coughing? Seems like your may also be suffering from dry, flakey skin around your crotch region. Best get some kind of skin cream as you're already at the pharmacy 😉

Now it's my turn to sigh.
I've not cheated, I've not got crabs, and I would much rather all and sundry didn't see my diagnosis, symptoms and treatment of/for Bipolar.
And with that, I thank you and bow out.
(I'm still trying to find a reference to the WHO and NICE guidelines though).

I don't know why you're bothered about them writing your ailment on the prescription, everyone knows what Viagra is for anyway.

[i]OK then. Wife calls in foe her own script and asks in a helpful way. "Any for any other family members? I'll take them all while I'm here".[/i]

Gets told no ( v politely, and explained why if she persists)

Edit: unless she's been authorised to, now, who do you think has to give that permission....?

You can collect a prescription for anyone, just need their name and address, no id required.

Was it printed on or hand written.

If it was printed it would be down to the GP IT system and so would have gone thru loads of stuff related to data protection.

If I had Bad Aids, I'd probably be embarassed too.

Unless it's a very unusual treatment then surely anyone could look up the name of the drug/cream whatever and find out what it is prescribed for?

They don't treat people with Bad Aids. Only those with Good Aids get given drugs....

Never heard of this round our way. (before current super-nichey nursing job I was a community mental health nurse for a few years and as such 'friendly' with a number of local gp's and pharmacies).

scotroutes - Member

Unless it's a very unusual treatment then surely anyone could look up the name of the drug/cream whatever and find out what it is prescribed for?

With regards to 'guess the illness from the prescription' there are quite a few common drugs that can be used in the treatment different illnesses/conditions with different levels of (unfair of course) stigma attached to them.

Diazepam: back pain/spasms and a host of mental illnesses and drug/alcohol dependency.
Carbamazepine/Lamotrigine: Epilepsy, bipolar affective disorder.
Gabapantin: as above plus pain relief for neuropathic pain eg within MS.
Amitryptiline: Depression, sleep disorders, insomnia, bedwetting (in children, much smaller dose), IBS (also much smaller dose).
Clotrimazole: Athlete's foot, 'jock itch', male or female thrush.
Malathion: Head lice, scabies, pubic lice.
the list goes on.....

It is useful for the pharmacist to know what as well as who the medicine they are dispensing is for (although there is still no requirement for a doctor to provide this information on the standard English FP10 green prescription form, even for many controlled drugs), as sometimes the dose or preparation/delivery route is different for different illnesses and/or age of patient. I'm not sure this information needs to make it all the way to the outside label of the paper bag your medicine comes in though...

Lots of organisations still have accident books, it's the only practical way.

Have to disagree with that one - books are not the only practical way. Do agree that books with separate pages, securely managed would work.

P.S and don't reductio ad absurdum me mr 1974 cos I'm not going to bite.

Not trying to do that - just making my point and disagreeing with yours. I don't find your justification compelling or reasonable. My pharmacist has a single need which is to see my prescription and dispense. They don't need to know my condition. From my prescription they would be idiots not to guess - but it is my choice to disclose and I choose not to disclose to a shop assistant in Boots or Lloyds - bearing in mind that not all people who receive and hand you your prescription are pharmacists, hold a professional qualification or professional code of conduct demanding confidentiality. Imagine you live in a small town and some child who goes is year eleven with your child is the person you hand your prescription for Viagra, Citalopram, Fucidin or Stelazine. Do I want them to have concrete information that tells them I have erectile dysfunction, depression, vaginal thrush or a significant psychiatric diagnosis... Not really! I only have one of those issues BTW...

The key aspects of my point are: -

- Patient-Doctor confidentiality is compromised
- Safe and legal dispensing requires no knowledge of the condition - just a clear diagnosis from a doctor and a straightforward approach from the pharmacist which may require checking of dosage to avoid overdosage or asking about other medications or conditions which the patient chooses to share.

I think all those people, receptionist, pharmacy etc would already know the condition based purely on the medication name

So the receptionist / pharmacist need to know to check the GP's diagnosis / treatment regime?

This +1

A fried who's diabetic only found out they were on the wrong (or at least not the latest combination/variety/whatever) medication when the pharmacist asked why they weren't getting something else as well.

I guess diabeties meds are pretty easy to guess the illness from, and pharmacists probably know most illness/drug combinations, but no harm in making it easier for them is there?

Would you be angry if your GP refered you to a consultant and forewarded on your notes? They're all (GP, consultant, pharmacist)part of the treatment process?

Imagine you live in a small town and some child who goes is year eleven with your child is the person you hand your prescription for Viagra, Citalopram, Fucidin or Stelazine. Do I want them to have concrete information that tells them I have erectile dysfunction, depression, vaginal thrush or a significant psychiatric diagnosis... Not really! I only have one of those issues BTW...

Yes, but they could only do it once, then they'd be fired, same as I get to play with patented processes, if I took a photocopy of a drawing or reverse enginered something I wasn't suposed to I'd be out on my arse quicker than you can say 'youre fired'.

Bessides, your ex GF/BF probably knows all that and more, and possibly has an axe to grind and nowt to lose.

The people who saw the medication name, dose, patient name and intended use are you, and a chain of medically qualified professionals.

This is a good thing. Reduces the risk of human error and makes things safer for patients. I would much rather this, than end up with something wrong that at best didn't help me get better, or at worst did me harm.

These are professionals, trusted every day with hundreds of people's medication information. That's very different to the general public.

Interesting point and one i have pondered.

It is current 'good' practice and encouraged by PCT's and community pharmacists along with problem linkage.

The only people who see it are you, the people directly involved in your care (and have a professional duty of confidentiality) and those who you nominate to pick up your prescriptions.

It's written in common language so that YOU can understand it.

You have to think of the greater good.

It helps people know what their medicines are for and encourages compliance.

There is a surprisingly large amount of people who do not even know what they are on let alone what they take their medicines for. When it says on a tablet "take one in morning for low mood" or "take one at night to reduce cholesterol" people know why they are taking them.

Don't forget that there are a lot of elderly people on 10+ meds and it can be confusing for them...and the Dr when he/she is making a change to their meds and they don't know which one they are talking about.

You need to think beyond yourself, that is not meant to sound too condescending or critical.

I am sure that your docs would make the wording vaguer or remove it all together at your request, but it is good practice and you will not get the practice/NHS to change the entire system to suit just you.

and a chain of medically qualified professionals.

As has previously been pointed out not all those at the dispensing counter are medically qualified, neither are all those behind the reception desk at the GP surgery nor the hospital clinic (though some like to think they are).

^ but 'medically qualified' or not (I think a more helpful phrase would be 'member of a professional body' -health-working and hospital/clinic based psychologists and social workers in particular would baulk at the idea of being medically qualified 😉 ) all the people in that chain are subject to rather rigorous rules about confidentiality/data protection/information governance.

Whether professionally registered or not, all are well aware that breaches of this (whether it is being overheard discussing patients, telling an employer what is (or isn't!) wrong with their off-sick employee, looking up your own blood results, looking up your neighbours/family on electonic health records etc.) are serious if not sackable offences.

Many thanks polarisandy. A considered and reasoned response and has put the whole thing into perspective for me.
I've spoken to the practice manager. They're toning down the wording but they won't remove it altogther.

[i]They're toning down the wording but they won't remove it altogther. [/i]

So instead of:

[b]Pills for Monksie to stop him being mad as a box of frogs.
(Note to pharmacist: Seriously, the fella's batshit insane, don't look him in the eye)[/b]

they'll now say

[b]Pills for Monksie to alleviate his mild eccentricity[/b]

🙂

Hahaha..... move to Bridge Hall. It'll be mint 🙂

Nope - name of patient, name of med, instructions for taking them.

Agree with PolarisAndy 100%. I had just written a post saying the same thing, but less eloquently, then saw his.

The last time i collected a prescription the pharmacist they asked what it was for across a busy counter.
I couldn't think of any code for "an infected left bollock".....

For chronic medications the prescription needs to be 'linked' to a medical ailment. This isn't necessarily printed on the script, however (more for GP computer records/coding).

However, it's good practice to have an indicator of why the medication is being prescribed, such as "Drug X for blood pressure", "Drug Y for anxiety" etc.
Yes, it does disclose your medical history, but this could be argued that it's not 'beyond those people needing to know'.
For example, when you ask for a repeat prescription, the clerical staff will simply open your records, and see all the reasons why the meds are prescribed anyway.

It would be different if the script came into the public 'eye'.

I can see why you'd be upset at the pharmacist knowing about your 'coughing crabs', but in reality, there is a safety/standard element to be upheld.

DrP

EDIT - the other day I gave a 'whopping' dose of a certain medicine, that in most cases would have been guffawed at. However, it was indicated in this case, and necessary, and if I hadn't alluded to it's use on the script, the pharmacist may not have issued.

[i]the other day I gave a 'whopping' dose of a certain medicine, that in most cases would have been guffawed at. However, it was indicated in this case, and necessary[/i]

WCA in for his clap cream again?

I told him not to share.

Do you need a top up too?

DrP

Might as well. In the interests of cutting down on packaging, I thought you could just refill my previous container:

[img] [/img]

Might as well. In the interests of cutting down on packaging, I thought you could just refill my previous container:

I can see why you'd be upset at the pharmacist knowing about your 'coughing crabs', but in reality, there is a safety/standard element to be upheld.

I don't see why you would be "upset" at the pharmacist knowing but not the surgery receptionist? Are you a dispensing doctor?

^^ Was that for me?

[b]I[/b] wouldn't hold issue with receptionist/pharmacist knowing (about my own health).
I was simply being understanding to the OP's post - the idea being I recognise his distress at pharmacist/receptionist knowing, but it's for a safety and communication reason.

DrP

Thank you DrP. A degree of perspective has been reached. I'll ring the practice manager back and apologise for my manic rant...if she'll take my call.