Part 6 of this section makes special mention of information that doctors provide to third parties, including employers. When acting as an occupational physician you:
- should ensure that workers understand, clearly and fully, the purpose, context, and potential outcomes of the consultation
- should ensure that workers understand what information you propose to release, to whom, with what purpose, and the likely consequences associated with granting or withholding consent
- must be satisfied that, prior to a consultation or release of any information to employers or third parties, the worker consents to these proposed actions
- should offer to show the worker, or give them a copy of, any report you write about them before it is sent, unless: (i) they have already indicated that they do not wish to see it; or (ii) disclosure would be likely to cause serious harm to the patient or anyone else; or (iii) disclosure would be likely to reveal information about another person who does not consent
- must, when assessing a worker for the purposes of making a report to a third party, ensure that they have provided consent to the process, document this, and respect their right to withhold agreement to release of the report. Consent may be withdrawn at any stage (but occupational physicians do not need to seek consent repeatedly) during the process
- must, when seeking information from another clinical specialist, obtain informed consent from the worker and observe their rights under the Access to Medical Reports Act.
If consent is withheld special difficulties may arise. Further advice on consent and medical report writing appears in the Faculty’s publication Ethics Guidance for Occupational Health Practice 2012 (paragraphs 3.43-3.50). This guidance recognises that, while consent may be withdrawn at any stage in the process, this may not always serve the patient’s best interests (as employers, especially in safety critical situations, will then work with whatever information is available to them); careful counselling is therefore essential. It further recognises that there may be cases where there is “a legal requirement or a public interest justification” for disclosure without consent and an onus to advise workers about this possibility.
Some occupational physicians giving pensions advice have experienced the difficulty that an applicant, applying for pension benefit that falls under regulation, may withdraw their initially proffered consent because they disagree with independently provided professional opinion. The GMC has clarified that if a patient has both given consent at the time of a consultation and indicated that they did not wish to see the final report before supply then this such consent is valid and does not require to be rechecked; also, that informing an employer of the fact that an employee did not attend does not require consent (as it does not constitute clinical information). Updated GMC advice (2017) further clarifies that, while the patient should be counselled as to the potential impacts of non-disclosure, nonetheless, a physician must abide by the patient’s wishes (except in the unusual circumstances of disclosure required by law or disclosure that can be justified in the public interest).
If you provide services to a NHS employer, you must not abuse your privileged position as a doctor to gain access to the hospital/medical records of a patient: clinical information must be requested with the patient’s consent in the usual fashion.