Staff that gossip about patients and break patient confidentiality


imagesWorking in a surgery or hospital you get to see and hear all sorts of situations that occur everyday. Patients come in all shapes and sizes and all have a different story to tell – but just how confident are you that their “story” is kept within the surgery/hospital walls.

Figures show that in the past 12 months (figures taken at October 2011) doctors, nurses and admin workers breached patients’ confidentiality some 802 times and that is probably a small amount of what is being breached. ***

There were at least 23 incidents where staff had openly discussed patients with colleagues, friends and family on websites such as Facebook.

There were also 91 incidents where NHS staff admitted to snooping through the medical files of their own colleagues.

I actually had the unfortunate task of speaking to, and going through the correct procedures and dismissing a member of staff due to her looking at a neighbours records, (to what she admitted doing) and then commenting on them to another member of staff. Sadly it wasn’t the first time she had been seen to have done this – staff grew concerned about the amount of time she was taking to doing the scanning – it later came out that she was reading most of the letters to gain information on people she knew in the local area then discussing this with other reception staff.

This receptionist had no excuse as she had gone through several training sessions one of them being patient confidentiality where she was clearly told that situations like this would be a breach of patient confidentiality. Unfortunately she didn’t feel that she had actually done anything wrong and it involved a tribunal case – to which she didn’t win.

We produced documents that she had signed a patient confidentiality statement, and also produced proof that she had been given appropriate training in patient confidentiality. There was no way she could have said that she “didn’t know”

This wasn’t nice for me as a Manager to have to deal with, for the Receptionist that lost her job (albeit it she was in the wrong). It also caused a lot of upheaval for her fellow team members as they had been witness to her doing this and of course having to make written statements accordingly.

It caused the practice lot of expense and extra workload for the staff doctor and myself. But most of all a patient at our practice had information about him discussed within staff members – which just isn’t good enough.

It is also not just admin staff that I am talking about, I have also overheard Doctors and other healthcare professionals discussing patients in a way other than in the manner they should have been – and most of these time I don’t think for one moment that they realised that they had broken patient confidentiality.

How can you ensure that your staff are not discussing patient details at work, at home and perhaps sharing information on social networking sites?

You cant!

But what you can do is ensure that you staff are fully trained on patient confidentiality, ensure they understand what actually is patient confidentiality and that they understand the implications of what happens if they do this and update training on a regular basis.

Ensure that staff are fully aware of  What is Patient Identifiable Information? http://wp.me/p1zPRQ-7b

Does your staff sign a confidentiality statement when then start working for you? Do you include cleaners and porters in this? Are your cleaners and porters contracted by an outside agency? If so ensure that the agency are getting these forms signed before they start working for you.

Do you have a confidentiality clause in your visitor’s book?  Local trades people might often have access to your surgery to carry out work – they too could be privileged to patient information (notes on desk, computer screen left on, patients in the room) they should also be signing a confidentiality statement – and the best way for this is when then sign the visitors book at reception – have a confidentiality clause in the book for them to read before signing the book.

A lot of the time people do not realise they are breaching patient confidentiality – but if someone can identify a patient through a name, date of birth, address or whatever then the confidentiality is broken – and the patient would have ever right to complain.

Are you confident that ALL your staff are fully aware of the meaning “patient confidentiality.”

***Here is the link to the article that I speak about above

http://www.dailymail.co.uk/news/article-2054436/The-nurses-gossip-patients-Facebook-spying-loved-ones.html

 

© 2011-2017 Reception Training all rights reserved
Advertisements

3. DNA and the Patient’s Experience


I have had several people contacting me regarding my posts on DNA’s.

The first blog I did was the impact DNA appointments have on Hospitals and Surgeries.

The second blog was in response to a comment made by a Reception Team Leader and how her surgery is proactive in dealing with this problem, which I might add I think is a great system.

This the 3rd blog on DNA’s is from a patients point of view.

Someone contacted my regarding DNA’s and how this impacts on the health service resulting in people having longer waiting times for appointments.

This lady had a hospital appointment a couple of weeks ago, she realised the week before that due to unforeseen circumstances she was unable to keep the appointment the following Monday afternoon, and working in the healthcare sector knew how important it was to cancel the appointment and give someone else the chance of the appointment.

On the Wednesday the week before her appointment she tried to call the consultants secretary to cancel the appointment.

She was greeted with a recorded message saying that the secretary was on holiday and the secretary actually said in the recorded message there was no facility to leave a message. She asked that people call back on her return in 10 days time.

Obviously this would be too late to cancel the appointment. So this lady phoned the hospital and asked for outpatients department, the switchboard put her through and it rang and rang and no one answered. So she had to phone the main switchboard back again. She explained that no one was answering in outpatients, but she was put through again anyway – and again no one answered. So, she had to phone back yet again, she explained about wanting to cancel her appointment, before she could say much more she found she was put through to the “secretary” again, and heard the message she originally heard – and the fact she couldn’t leave a message!

She gave up at this point and left it until the next day when she tried again. She said that she was put through to several different departments, no one wanting to take responsibility for the call she was even told to phone the secretary on her return in 10 days time. She explained that the appointment was in fact in 4 days time and wanted to cancel it and not have a DNA against her name.

She got nowhere – so tried again on the Friday – the same run around.

Monday morning the day of the appointment she phoned the hospital and finally got put through to someone – she explained that she was unable to attend her appointment that afternoon and could they cancel it and ask the secretary to send her out a new appointment.  After taking the woman’s name said she would.

Two weeks went by and this lady had heard nothing so she telephoned the consultants secretary who was not back from her holidays – and to no surprise she found that they appointment had NOT been cancelled, she in fact had a DNA against her name, and the secretary did not get the message about her wanting another appointment made.

To say she was fuming was an understatement.

So, in order to get the DNA rates reduced it takes time and effort from all involved.

Patients have to be more responsible for cancelling appointments and this needs to be dealt with in a delicate manner.

Surgeries and Hospitals need to ensure that if a patient does cancel their appointment that it is recorded and cancelled and the patients does not received a DNA against their name.

Hospitals and Surgeries cannot moan about the amount of DNA’s they have unless they have a policy in order that will actually deal with this when the patients requests to.

And systems have to be in place that these messages are getting through to the right people.

The lady involved felt that no one wanted to listen to her – the operator just didn’t listen to what she was saying which resulted in her being put through to departments that if she had been listened to could have been avoided.

I would suspect that most patients after the first 2 or 3 phone calls would have simply given up trying to cancel the appointment.

Straight from the heart


 

imagesCATMPJJAToday is Fathers Day and what I would give to be able to telephone my dad and wish him a lovely day – something I did every year and took for granted. Sadly my dad died last year and I never got to be with him in time – to have that one last conversation with him. To tell him how much so many people loved him, to tell him what strength he was to me and to tell him simply that I loved him – but I know he knew that anyway.

This blog is a bit different from normal. It is straight from the heart and its one of those stories that left me and my family but more so my lovely dad badly let down by the system that I believe is one of the best in the world – but can show perhaps without the right communication how things can go so badly wrong.

I had a lovely Saturday afternoon, we had been celebrating a friends baby shower and there was lots of laughter and fun, the afternoon had ended and the clearing up underway. My daughter telephoned me to say that she had spoken to my dad (her beloved granddad) and he had commented that he felt unwell – he had been backwards and forwards to the doctors for some weeks with a chest infection and put on various different medications.

My dad asked my daughter to phone a doctor for him – this had alarm bells ringing, my dad would NEVER make a full and in all his life he had never ever phoned a doctor outside of surgery hours, and had never had a home visit. He was of the “old school” he never complained.

My daughter asked if I would phone and speak to him, she knew that I had a good understanding of how the out of hours worked and felt that I would be the best person to speak to someone.

Unfortunately I was not in the UK on this occasion and was phoning from another country. I telephoned my dad and it was pretty obvious he was very poorly he also was very confused – he asked if I could phone the doctor and his wishes were that no one called him as he felt he was not able to have a conversation with someone at this stage. He was confused and he was in pain. He sounded really poorly.

I have a brother and unfortunately we were unable to contact him – but we left a message.

At 17.30 I telephoned the out of hours service. I explained to the operator it was my dad’s wishes that I spoke to them, as my dad was too poorly to speak to anyone. I explained that he was confused in a lot of pain and had not passed urine since the day before. I gave a list of my dad’s medication to the operator. I offered my telephone number to the operator and he said as it was an international telephone number he was unable to take it – this concerned me as I was the point of contact – I offered it again and he again said that he was not able to take the number.

I gave every single bit of information that the operator would have needed to assess the call appropriately. I know if my dad had made that call he would have not given all the facts.

After speaking to the operator and all the details taken into consideration it was confirmed that my dad would need an ambulance. As the operator couldn’t take my telephone number he actually put me through directly in touch with the ambulance service. I explained the circumstances and my concerns that my dad was confused, along and in a lot of pain. They confirmed that an ambulance would be called.

The next hour was a nightmare – worried that I had no news – still no contact from my brother so I telephoned my dad house to find that he was still there and no ambulance had been. The only reassuring thing was my brother had just arrived so at least he had someone there with him.

Concerned that no ambulance had arrived I contacted the out of hours again. I was told that the ambulance had been cancelled – yes cancelled!

Concerned that Dad had been confused perhaps someone had phoned him and he might have told them not to bother – that is something dad might have done if he thought that he was causing a fuss – but speaking to my brother no one at Dad’s had phoned or no one had cancelled the ambulance.

My brother told me that he would take my dad straight away to A&E himself in the car.

Had my dad gone in an ambulance he would have gone straight through – but my brother had to find a car parking space, walk my poorly dad into A&E and wait until the drunks and people with colds were booked in before them – it took over half an hour waiting to be checked in – and as you can imagine a while before he was seen – my dad was finally admitted the doctors told my brother that they would keep him in for a few days.

Sadly my dad died the next evening.

When we got back to my dads house in the early house of the morning the answer machine was flashing – the message was received after 19.00 saying it was the ambulance service calling – and apologised for the delay in the ambulance and if anything has changed please call us back on 999 – thank you. I was confused at this stage to say the least.

I contacted and the ambulance on the Monday to find out what had happened – how my dad was sadly let down by the system. The gentleman dealing with the call was extremely helpful and he assured me he would look into it for me.

I then telephoned the out of hours and asked them why the ambulance had been called – to which I was told because of patient confidentiality I would have to get written permission from the patient before they could release any information. For goodness sake the patient was dead! How on earth was I suppose to do that? I did find that very upsetting. This took me a while to get sorted – there was every chance that they were not going to discuss this with me – but I got there after several stern words.

As you can imagine there was a lot of correspondence backwards and forwards – taking forever to get answers.

The out of hours was blaming the ambulance service for not prioritising the call appropriately and the ambulance was blaming the out of hours – it took a long time to finally find out what had happened. But we finally got to find out what had actually happened.

The out of hours said in their letter that the ambulance service categorisation process resulted in an inappropriate C2 response that on review they acknowledge should have been a C1 priority for a 20 minutes response. The ambulance service also stated this in their letter – but also followed it up with it was one of their busiest nights and went on back that up with figures on calls throughout that day.

As for the cancellation of the ambulance it was confirmed that the reason the call was cancelled was due to the fact that the operator had inaccurately quoted the wrong call number he quoted 3392 instead of 3329. As this point the demographic details should have been confirmed by both parties to ensure the correct call log was being looked at. In this case it did not happen. The call number given to the ambulance service actually related to another call transferred by the out of hours service. The call log that the ambulance service operator was looking at was told that this patient had in fact contacted the out of hours requesting the ambulance to be cancelled. So my dad’s ambulance was cancelled and the gentleman that phoned to cancel the ambulance more than likely still got a visit from the ambulance service.

So, errors all round – would it have saved my dad’s life if the ambulance had arrived – and within the 20 minutes target? We will never know but what was more upsetting is the fact that if my brother had not been able to get to him when he did, and I had not phoned back thinking he was being taken to hospital he would have been waiting for the ambulance and perhaps have collapsed at home when he was on his own, because my dad would not have complained or wanted to have been a nuisance in any way.

When talking to the out of hours service I did share my concerns that they had nor wanted to take my telephone number – the only point of contact they had. The woman who I was dealing with at the out of hours did say that from this incident they would be looking at reviewing their system and every call would have the facility to take a contact telephone number. For me this should have been such an easy process and should have been put in place right from the start.

For me if ever I took a call from a patient, or someone calling on behalf of a patient my first priority would always be to get a contact telephone number. To me this is basic communication.

I sadly still see on the news and read in the papers that this out of hours service that I dealt with are always in the news for all the wrong reasons. Why are they still getting it wrong?

So for my today Fathers Day it’s always a sad reminder that this beautiful man – my dad is no longer here.

 

DNA Appointments (did not attend)


 

We all know how scarce hospital and doctors appointments are and what is more frustrating is the number of DNA’s (did not attend) appointments that are wasted day in and day out – week in and week out – amounting to hundreds every year. 

What does your surgery or hospital do to try to keep on top of DNA’s? Do you do anything at all?

Some surgeries and hospitals display in the waiting room the number of DNA’s in the month – and this can be pretty horrifying when you see just how many appointments are wasted.  But it does get the message over to people if they do not want their appointment please cancel it and let someone else have the appointment. But of course the people who did not turn up for their appointments do not see these statistics.

Some hospitals will send out a text message a few days before your appointment to remind you and if you do not want the appointment they ask you to cancel it. A good reminder especially if the appointment was booked some time ago, but this only helpful for those with mobile phones, perhaps not so good for some of the elderly that do not use such technology. 

I have even heard some doctors confessing that they “do not mind” the DNA’s as this gives them time between patients to “catch up”.

One surgery that I worked in decided to be proactive and look at the amount of DNA’s every month – the partners were shocked to find that there were several hours wasted over the month through patients not turning up for their appointments.

So, they decided that if a patient DNA they would write them a polite letter pointing out that they missed an appointment, and would appreciate if the patient could not make a future appointment that they phone and cancel the appointment.

If the patient had a 2nd DNA the doctors would write again, this time telling the patient it was the 2nd time that they had done this, and if they DNA again for a 3rd with without good reason they “may” be asked to leave the practice list. The letter would go on to explain the amount of DNA’s the surgery was experiencing and the fact that patients were experiencing problems booking appointments and this was not being helped by the fact that so many appointments were being wasted by patients not attending.

This seemed to work well. Patients that received the first letter would phone to apologise, some would just ignore it and receive a 2nd letter – but no one actually got as far as getting a 3rd letter so hopefully the exercise did actually do some good.

All was going well until……………………..

I received a call from reception. There was a patient on the telephone wanting to make a complaint. This obviously concerned me as I prided myself on the very few complaints that we had at the surgery and I was obviously concerned.

The receptionists put the caller through.

The lady was pretty angry. She had received a letter from the surgery regarding her not attending an appointment the previous week.

She went on to say she actually took the time to cancel the appointment the day before the actual appointment, she said that she realised that someone else could have had the appointment.

I asked her what day and what time she called and she confirmed it was on the previous Tuesday at 8.30 (one of our busiest times). I asked her if she could remember who she spoke to (this is way why we get Receptionists to give their names) she confirmed the name of the Receptionists she had spoken to.

I apologised for our error and said that I would look into it for her.

I went down to Reception and checked the rota; it confirmed that the Receptionist in question was actually on duty that day and she was actually on the telephones that same morning, which pretty much confirmed that the patient was correct.

I spoke to the Receptionist and she confirmed that she was on the phones that morning, and that it had been a particularly busy morning reception.  She couldn’t remember the call but she also said that it could have very easily happened – someone could have come up to her and her attention was drawn to something else.

If this had happened before (and more than likely it had) the DNA would have just gone by unnoticed – the patient thinking they had cancelled her appointment, the surgery thinking we had yet another DNA.

We spoke about this at our next Receptionists meeting, and the girls all agreed that it could be something that could have got overlooked, something that they all felt that they might have done at some point.

This didn’t cause any problems UNTIL we started monitoring the DNA’s and sending letters out.

So, from then we make sure that any patient that cancelled an appointment that it was done immediately so as not to have a repeat complaint.

You cannot be sending out such letters to patients that had actually taken the time and trouble to phone in and cancel their appointment.

I wrote to the patient apologising and admitting the error was on our part, and ensuring her that we had looked at our procedures and were making every effort in the future that it would not happen again. 

My Live BBC Radio Interview on Being A Doctors Receptionist


vb

Last Thursday I was approached from BBC Radio via my blog to do a live radio broadcast in response to a broadcast the previous evening. The previous evening there was a GP speaking about patients and the “stiff upper lip of the British” and that they should go and see their Doctor “sooner rather than later”.

The radio station received several replies from some “unhappy” listeners saying that they have often found it difficult to get appointments at their surgeries. They mentioned lack of appointments, and rude Receptionists.

I was asked along to talk about the role as a Receptionist. Whilst I didn’t have enough time to answer some of the emails sent to the radio station I would like to share a couple with you and what I feel would be a response I would have made.

LETTER FROM A MALE LISTENER

Sender’s message

“Stiff upper lip? Certainly not.

Over crowded surgeries, unapproachable doctors (and receptionists) creaking overloaded health service not working on a Saturday YES YES YES”

My response would be

I agree that surgery clinics can often be extremely busy. Practices do acknowledge this and will try all avenues to spread the various clinics over the day/week. As the healthcare service continues to expand into general practice unfortunately the surgeries get busier. Many Practices offer baby clinics, various Nurse Clinics, minor surgery clinics, Health Visitors Clinics and many more and are often scheduled to run outside normal Doctors appointment clinics. Most Surgeries these days do have extremely pleasant waiting areas. Patients often have TV’s or a radio in the waiting room, magazines to read, an area for children, water drinks dispenser and other items  hopefully making  any waiting time as pleasant as they can. Many also have free wifi. Unlike not so long ago when you just had a waiting room and nothing else.

A busy surgery is often one that is offering several different healthcare services under one roof meaning patients do not have to travel to their local hospital for treatment.

Just because you might “see” a busy or “crowded” surgery does not mean it is not being run efficiently.

It saddens me to read that the gentleman finds the doctors and receptionists unapproachable – to this I cannot comment as I don’t have pacific details , if I was dealing with this gentleman at my surgery I would be asking in what way he found them unapproachable and would deal with it from there. Of course he also has the choice to move to another surgery if he is very unhappy with his present practice.

And as for not working on a Saturday – many surgeries that I know of certainly do work on a Saturday morning. But, is this gentleman aware that there is always the out of hours service and they are there every evening and weekend after the surgeries have closed and therefore he has access to either speak or see a GP or healthcare professional 24/7. Many surgeries are now open to accommodate people who are working and often open from 07.00 through to 20.00 – 5 days a week. A pretty good service I think!

LETTER FROM A FEMALE LISTENER

Sender’s message

I phoned for an emergency appointment when I realised I was suffering from depression. I was so distressed that I blurted out that I had been having suicidal thoughts. The receptionists’ response was to repeat “sorry to hear that, you’ll have to phone back in the morning”.

My response would be

The patient I am sure was pretty distraught by this conversation. Only she knew just how bad she felt – the Receptionist had no way of knowing how bad she actually was – but she was saying she was having suicidal thoughts – bad enough in my opinion.

.My advice to her if she was refused an appointment was to ask if she could speak to a Doctor. In the event that there was no Doctor available to speak to her she should ask to speak to the Practice Manager or someone else in charge. As a patient if you feel that it is urgent enough that you need to see a Doctor that same day and the Receptionist cannot offer you an appointment ask to speak to someone about it or ask for a Doctor to call you back.

 As a manager I would be alarmed if this had been a Receptionist at my Practice but I feel very confident that this would not have happen. All of our Receptionists would have received training in dealing calls similar to this.

This should never have happened. What is to say that there would not have been an appointment the following day? Why ask her to phone back again only to be told there are still no appointments.  The patient requested an urgent appointment. That needed to be taken into consideration straight away. The Receptionist didn’t even have to ask why she needed the appointment, the patient explained why she needed the urgent appointment.

Someone suffering with depression and admitting that she was having suicidal thoughts should have had alarm bells ringing.

If the Receptionist really could not offer the patient an appointment that same day she should have tried her utmost to either speak to a Doctor or nurse and ask their advice. In the event she was going to get a Doctor to call the patient back the Receptionist should not have let the patient end the call without taking a contact number first. (Even if the patient has a number on her records always check – because it has happened many times that patients change their telephone number and do not notify the surgery)

If Surgery had finished and perhaps there was no doctor on the premises (lunchtime) then the Receptionist should have called the duty doctor for advice.

Receptionists are dealing with calls like this on a regular basis, especially for “emergency” and “same day” appointments, it is a difficult task for them as they only have so many appointments that they can offer to patients on a daily basis. A good Receptionist will often be able to give a helpful solution to the patient by either offering an alternative appointment/day or perhaps offering an appointment with another healthcare professional i.e. the nurse or getting someone to call the patient back.

But at the end of the day if the patient insists they need an urgent appointment and the Receptionist is unable to give them one then the Receptionist needs to speak to her Senior Receptionist or perhaps a Doctor for advice.

And then there was a letter from a listener that goes to show that there are many patients out there that are more than happy with the service that we give.

imagesCAX7OJIP

LETTER FROM A MALE LISTENER

Sender’s message

Can I – as a patient – stand up for those receptionists who are anything but rude, especially those in our local surgery in Hillsborough, Co. Down who are simply exceptional. As a family with two young children we have all had our fair share of visits and always been treated with the utmost courtesy and care.

My response

Whilst we take on board the negative comments , and hopefully deal with them in the appropriate way, it is always nice to get positive feedback. You don’t know how much that means to staff to hear that they are appreciated and the job they are doing are doing it well. Everyone thrives on good feedback.

Thank you.

As a Receptionist and a Manager I am still always overwhelmed at the positive comments and feedback that we get on a regular basis from the patients. This is what makes the job so very special.

 

Patients Letters for Collection


As a Receptionist/Supervisor how would you deal with the scenario below:

A patient consulted her GP requesting a referral to a gynaecologist for a termination.  She stated in the consultation that she did not want her husband to find out. The GP wrote a referral letter, which was placed in the “for collection” box in reception. For some reason the letter was not collected.

The patient then visited the surgery 3 months later to ask for a letter for the clerk at the Magistrates court, explaining that she could not attend court due to a medical reason. The GP had the letter typed and this was also placed in the box for collection.

The patient’s husband came into the surgery 3 days later to collect the letter to take to the Magistrates court but the wrong letter was given to him. The letter he was given was the one typed 3 months previously for the Gynaecologist.

The husband took the letter to the Magistrates Court. When the Court clerk opened the letter and found it was not for them she handed the open letter back to the husband who then read the letter.

There are several issues here – can you identify what could have happened and what action could have been taken to ensure that it does not happen again.

  • All personal letters should be placed in a sealed envelope.
  • Each envelope should be dated on the back of the envelope and the “collection box” should be checked on a monthly basis.
  • Any letters that are over 4 weeks old should be opened and checked.
  1. Inform their GP that the letter has not been collected so they can follow this up. The GP might need to call the patient and ask if they still need the letter, and according to their reply the necessary action taken.
  2. If your practice asks you to follow the letter up ensure that you record the event. Enter on the patient’s records (or in a separate message log) that you have spoken to the patient about the letter and their response and the action that you have taken. Also remember to date and time the call.
  3. If the letter is not longer required remove the letter from the “collection box” and ensure that you have guidelines on what to do with it. Shred it, or other.
  4. If the letter is required and the patient is going to collect it cross off the first date and add the date you spoke to the patient on the back of the letter to avoid the same process happening again.
  • If you go to the “collection box” and identify two letters there look at the dates on the back of the envelopes, check the patient’s records and see which date corresponds with the envelope. If you are unsure open and check the letter and place it in a new envelope. remembering to add the dates on the back again.
  • In today’s society Patient Confidentiality is vital – we should be asking if we should have actually given such a letter over to her husband. But it was the patients choice to have her husband come in and collect the letter for the Court.
  •  Having it in a sealed envelope is definitely more secure than just handing over the letter without an envelope. So please ensure that all confidential letters are in sealed envelopes.
  • 99% of the time it would be safe to hand over such a letter  – but there is always that 1% that could backfire. But with everyone living such a busy life we always rely on family/friends helping out at such times. If you are in any doubt speak to your Supervisor/Manager or even phone the patient and ask if they are happy for you to give the letter to the person at the desk.
  • The 1% of this backfiring could be that when her husband read the letter which was meant for the Gynaecologist it could have caused a big problem, especially as she had already said she did not want her husband knowing about the termination. This could have led to the surgery being sued for breach of confidentiality.
  • Always think of the 1% and cover yourself as much as you can.

Does your practice have a policy on the collection of letters?

Patients Letters for Collection


As a Receptionist/Supervisor how would you deal with the scenario below:

 

A patient consulted her GP requesting a referral to a gynaecologist for a termination.  She stated in the consultation that she did not want her husband to find out. The GP wrote a referral letter, which was placed in the “for collection” box in reception. For some reason the letter was not collected.

The patient then visited the surgery 3 months later to ask for a letter for the clerk at the Magistrates court, explaining that she could not attend court due to a medical reason. The GP had the letter typed and this was also placed in the box for collection.

The patient’s husband came into the surgery 3 days later to collect the letter to take to the Magistrates court but the wrong letter was given to him. The letter he was given was the one typed 3 months previously for the Gynaecologist.

The husband took the letter to the Magistrates Court. When the Court clerk opened the letter and found it was not for them she handed the open letter back to the husband who then read the letter.

There are several issues here – can you identify what could have happened and what action could have been taken to ensure that it does not happen again.

  • All personal letters should be placed in a sealed envelope.
  • Each envelope should be dated on the back of the envelope and the “collection box” should be checked on a monthly basis. Any letters that are over 4 weeks old should be opened and checked. If necessary a phone call to the patient to ask if they still need the letter, and according to their reply the necessary action taken
  1. Inform their GP that the letter has not been collected so they can follow this up.
  2. Enter on the patient’s records (or in a separate message log) that you have spoken to the patient about the letter and their response and the action that you have taken. Also remember to date and time the call.
  3. If the letter is not longer required remove the letter from the “collection box” and ensure that you have guidelines on what to do with it. Shred it, or other.
  4. If the letter is required and the patient is going to collect it cross off the first date and add the date you spoke to the patient on the back of the letter to avoid the same process happening again.
  • If you go to the “collection box” and identify two letters there look at the dates on the back of the envelopes, check the patient’s records and see which date corresponds with the envelope. If you are unsure open and check the letter and place it in a new envelope. remembering to add the dates on the back again.
  • In today’s society Patient Confidentiality is vital – we should be asking if we should have actually given such a letter over to her husband.  Having it in a sealed envelope is definitely more secure than just handing over the letter without an envelope. So please ensure that all confidential letters are in sealed envelopes.
  • 99% of the time it would be safe to hand over such a letter  – but there is always that 1% that could backfire. But with everyone living such a busy life we always rely on family/friends helping out at such times. If you are in any doubt speak to your Supervisor/Manager or even phone the patient and ask if they are happy for you to give the letter to the person at the desk.
  • The 1% of this backfiring could be that when her husband read the letter which was meant for the Gynaecologist it could have caused a big problem, especially as she had already said she did not want her husband knowing about the termination. This could have led to the surgery being sued for breach of confidentiality.
  • Always think of the 1% and cover yourself as much as you can.

Does your practice have a policy on the collection of letters?