John Horder

THREATS TO MEDICAL CONFIDENTIALITY

SIR,-As doctors and nurses, we write to express our concern about a number of threats to medical confidentiality. These are posed by certain extremist pressure groups and individuals who appear to be so convinced of the righteousness of their own dogmatic views that they are prepared to sacrifice the privacy to which all patients are entitled from their medical advisers. Confidentiality between patient and doctor has always been a fundamental tenet of good medical care, and is not something that the medical or nursing professions should allow to be eroded. The threats to confidentiality are occurring in three specific areas of medical practice: contraception for those aged under 16, late abortions, and the care of severely malformed newborn infants. These situations are difficult and distressing for all those involved. They require tact, understanding, compassion, sympathy, and, above all, an honest relationship based on mutual trust. This last is not possible if the patient has reason to believe that information freely passed in confidence is going to be revealed to third parties or the media. It is not sufficiently widely known that pressure groups have been attempting to recruit informers within hospitals and clinics. They seek out doctors, nurses, chaplains, and others whose privileged positions give them access to private medical information. The suffering of parents whose severely handicapped infant has died is grievous enough, even when decent conventions of privacy have been respected. It becomes quite unbearable when families are exposed to the fierce glare of television, radio, and press coverage. Sexual abuse of an under-age girl can be damaging in itself without being compounded by pregnancy. Late abortions carry their own traumas and publicity only adds to these. The wellbeing of patients is not best served by doctors and nurses continually having to look over their shoulders for informers, and their treatment should not be prejudiced by the opinions of a strident and well-organised minority. On these issues it may be that the majority of those in the caring professions should also ensure that its voice is heard. We would welcome it if those who share our concern would write to let us know. *

Requirements for technology. As seen by providers of primary health care.

This article is concerned with principles that might help to ensure that procedures and tools used in primary care are appropriate to peoples needs and expectations. It urges attention, not first to technology, but to the broad range of purposes served by primary care and to the relevance of procedures to them. Other criteria for ensuring appropriateness are also proposed.