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An end to TATP in the UK.

On 1 November 1991, patients in Britain became able to see what is written about them in their medical records. Well, sort of! Whereas the 1984 Data Protection Act permits access to all information held on computer, the Access to Health Records Act will only require doctors (along with dentists, opticians, nurses, midwives, health visitors, occupational and physical therapists, and psychologists) to divulge what gets written down after the act came into force. So doctors who once described their patients as TATP (thick as two planks), or diagnosed their condition as Amentia totalitatis or as Plumbi oscillans (is "swinging the lead" American as well as British slang for malingering?) will still be safe; unless, that is, they are subject to litigation.

One may suspect that, as in the case of the Data Protection Act, not much will change as a result of the new legislation. Patients wishing access to their records must apply in writing to those holding them and may be changed a fee of up to 10 pounds sterling, about $16, each time (by comparison, the state Window's Pension is 57 pounds sterling per week)--two circumstances which may effectively discourage those whose first language is not English and/or those who are poor. Moreover, as is the case with computerized records, providers will be able to continue to withhold information if in the provider's view its disclosure "is likely to cause serious harm to the physical or mental health of the patient or any other person," of if the information "was provided by, or relates to, another person who could be identified." (As "another person," the act explicitly includes "a health professional who has cared for the individual.") Finally, as it is not clear if the provider is obliged to inform the patient whether the record being transmitted is complete, the appeal process regarding a provider's decision not to disclose information is weak to say the least. In any case, at the present time an appeal can only be made through the courts--a provision that places it beyond the financial reach of the vast majority.

It is perhaps not surprising in the light of the recently adopted Children's Act, that the chief beneficiaries of Access to Health Records may be Britain's young people. Those under the age of sixteen now have full access to their records, subject to the same caveats as for adults, provided that the record holder judges them capable of understanding the nature of their application. Information concerning children may not be made available to their parents or guardians if the holder judges that such a denial is in the patient's best interest, or if the information contained in the record was given in confidence; and in any case, children judged capable of doing so must consent before others gain access to their record.--Ross Kessel, Malborough, Devon, England
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Title Annotation:access to patient records may force British physicians to stop using classifications such as 'thick as two planks'
Author:Kessel, Ross
Publication:The Hastings Center Report
Date:Nov 1, 1991
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