last updated:22/11/2017 @ 10:07 am

Good Occupational Medical Practice 2017

To emphasise that occupational physicians share many obligations in common with other doctors, the original words and passages of Good Medical Practice (displayed in black), and selected abstracts from supplementary guidelines of the GMC (displayed in red), are retained and presented. Where appropriate, extra commentary, written specifically by the Faculty of Occupational Medicine, then follows in a distinguishing (blue) typeface.
ForewordIntroductionDomain 1: Knowledge, skills and performanceDomain 2: Safety and qualityDomain 3: Communication, partnership and teamworkDomain 4: Maintaining trustAfterword

Apply knowledge and experience to practice Part 6

Disclosing information for insurance, employment and similar purposes

There are, however, many circumstances in which you might be asked to disclose information from existing records or after examining a patient, and in which you face dual obligations. By this we mean that you have obligations both to the patient and to the person or organisation that has requested the information. … Usually, dual obligations arise when a doctor works for, is contracted by, or otherwise provides services to:

  1. a patient’s employer (as an occupational health doctor)
  2. an insurance company
  3. an agency assessing a claimant’s entitlement to benefits
  4. the police (as a police surgeon)
  5. the armed forces
  6. the prison service, or
  7. a sports team or association.

Alternatively, a person or organisation you have previously had no direct relationship with, such as your patient’s employer or insurance company, might ask you to provide a medical report or information about a patient. You might be offered payment for your own or your staff’s time and effort, giving rise to an obligation in addition to the one you have to your patient.

[If asked to provide information in such cases], you should:

  1. be satisfied that the patient has sufficient information about the scope, purpose and likely consequences of the examination and disclosure, and the fact that relevant information cannot be concealed or withheld
  2. obtain or have seen written consent to the disclosure from the patient or a person properly authorised to act on the patient’s behalf. You may accept an assurance from an officer of a government department or agency or a registered health professional acting on their behalf, that the patient or a person properly authorised to act on their behalf has consented
  3. only disclose factual information you can substantiate, presented in an unbiased manner, relevant to the request. You should not usually disclose the whole record, although it may be relevant to some benefits paid by government departments and to other assessments of a patient’s entitlement to pensions or other health-related benefits
  4. offer to show your patient, or give them a copy of, any report you write about them for employment or insurance purposes before it is sent, unless:
    1. they have already indicated they do not wish to see it
    2. disclosure would be likely to cause serious harm to the patient or anyone else
    3. disclosure would be likely to reveal information about another person who does not consent.

You do not need to ask for separate consent to release a report following an examination as long as you are satisfied that the patient has given informed consent both for the examination and for the release of any subsequent reports … You should, however, usually offer to show your patient or give them a copy of any report you write about them for employment or insurance purposes before it is sent.

If a patient asks you to amend a report, you should correct any errors of fact and any opinion that is based on errors of fact. You should not remove information, opinion or advice if you believe the report would be false or misleading as a result.

If a patient withdraws consent for the report to be disclosed, it may be appropriate for you to tell the patient that their decision may lead to adverse consequences for them. For example, the absence of occupational health information could disadvantage the patient in negotiations with their employer. You must, however, abide by the patient’s wishes unless the disclosure is required by law … or can be justified in the public interest … If a patient withdraws consent for a report to be disclosed, or fails to attend an appointment, you can let the report commissioner know but you should not disclose any further information.

You may still disclose information if it can be justified in the public interest (see GMC Confidentiality paragraphs 63-70).  You must disclose information if it is required by law (see GMC Confidentiality paragraphs 87-94).