510
Journal of the Royal Society of Medicine Volume 85 August 1992
Assisting the police with their enquiries Mr Marsden's editorial (April 1992 JRSM, p 187) suggests that a doctor could disclose confidential information to the police whenever a serious arrestable offence is involved. However, the GMC guidelines1 on the disclosure of medical information in the public interest were changed in November 1991 to: Rarely, cases may arise in which disclosure in the public interest may be justified, for example a situation in which the failure to disclose appropriate information would expose the patient or someone else to a risk of death or serious harm. [my italics]
The changed guidelines suggest that it would be wrong for a doctor to disclose information on the basis of the legal seriousness of a crime alone. Other factors are also important. For example, when an offender has already been remanded in custody, the case may fall outside the GMC's new guidelines. On the other hand, a relatively minor crime in a legal sense, such as that committed by an epileptic who drives a car without a valid licence, could conceivably fall within the guidelines. Patients are sometimes not in a fit state of mind at the time of examination to give valid consent to disclosure, either because they are too drunk or for any number of other reasons. The doctor may feel justified in giving some information to the police in the patient's best medical interests, particularly where the patient is held in custody. With rare exceptions to that principle, the doctor must obtain proper consent when the patient becomes fit enough to give it and before the information is given to the police. Where a doctor's duty of confidentiality precludes voluntary disclosure of information, the course of justice need not be compromised. The doctor may be summoned to court and it is open to the police to apply for a Court Order under the provisions of the Police and Criminal Evidence Act 1984 for the disclosure of medical information. However, a circuit judge will not always agree with investigating officers that such disclosure is appropriate. The description of one such case involving a brutal murder has been published2. I am here constrained by space, but there are other aspects of Mr Marsden's editorial which conflict with the advice of the Medical Defence Union3. P SCHUTTE Medical Defence Union Secretariat 3 Devonshire Place London WiN 2EA
References 1 Guidance for Doctors on Professional Confidence, General Medical Council, November 1991 2 Schutte PK. Medical confidentiality and a police murder inquiry. J Med Def Union, 1989;5:21 3 O'Donovan C. Confidentiality. The Medical Defence Union Ltd, 1992
The one-track mind The charming article by Dr Solomon Posen 'The portrayal of the physician in non-medical literature the one-track mind' (February 1992 JRSM, p66), deserves perhaps one more addition: the farce, which made Jules Romains' (1885-1973) name as a comic playwright: 'Knock, ou le Triomphe de la m6decine' in 1923. Dr Knock takes over a very run-down practice at Saint-Maurice, a small backward mountain town. There are no patients. The locals are healthy and
skinflints. He secures the services of the town-crier, telling people how excellent he is and advanced in knowledge. He offers free consultations on certain days, which is eagerly accepted by a number ofpeople. He manages to get propaganda to show the local inhabitants that there is poor hygiene and the locals are soon in the throes of fevers, colics and nervous conditions, making them eager to pay for treatment. He succeeds in building up an enormous practice, which his predecessor Dr Parpalaid - on a return visit - notes with disbelief, surprise and admiration. C MEDVEI 38 Westmoreland Terrace London SW1V 3HL
Treatment of glue ear by postural drainage If I may be allowed to comment on the paper by Shah (October 1991 JRSM, p 581) I would like to say that a few years ago I got a 'glue ear' but was able to clear it by lying on my good side and repeatedly swallowing. I could hear the bubbles rising through my middle ear and striking my eardrum with a dull thud. Admittedly this a series of only one case and not selected at random, nevertheless I obtained 100% success and there are not many treatments like that around these days. As it is simple and immediate it might be worth trying on a larger scale perhaps. It certainly will not prejudice any other subsequent treatment and it might save expensive hospital admissions as well as putting a few ENT surgeons out of work. Perhaps when the ENT registrar sees a letter requesting an outpatient appointment for glue ear he might send off a printed slip that advises the GP or parents that in the interim postural drainage might be attempted and describes how it should be performed. BRENNIG JAMES Cherry Orchard, Marlow Common, Bucks SL7 2QP
Familial adenomatous polyposis Dr Armitage (February 1992 JRSM, p 63), in his interesting account of the genetics and related aspects of this condition, does not mention whether chromosomal manipulation might affect not only the disease itself but also its transmission to the next generation. Such a possibility was foreseen 40 years ago by the late Dr Cuthbert Dukes as is evident from the splendid contribution to poetry (with apologies to Lewis Caroll) that he incoporated in his Hunterian lecture in 19521: 'You are old, Father William,' the young surgeon said, 'And your colon from polyps is free. Yet most of your sibling are known to be dead A really bad family tree'.
'In my youth,' Father William replied with a grin. 'I was told that a gene had mutated, That all who carried this dominant gene To polyps and cancer were fated.' 'I sought for advice from a surgical friend, Who signed and said -'Without doubt Your only escape from an untimely end Is to have your intestine right out.'
Journal of the Royal Society of Medicine Volume 85 August 1992
Assisting the police with their enquiries Mr Marsden's editorial (April 1992 JRSM, p 187) suggests that a doctor could disclose confidential information to the police whenever a serious arrestable offence is involved. However, the GMC guidelines1 on the disclosure of medical information in the public interest were changed in November 1991 to: Rarely, cases may arise in which disclosure in the public interest may be justified, for example a situation in which the failure to disclose appropriate information would expose the patient or someone else to a risk of death or serious harm. [my italics]
The changed guidelines suggest that it would be wrong for a doctor to disclose information on the basis of the legal seriousness of a crime alone. Other factors are also important. For example, when an offender has already been remanded in custody, the case may fall outside the GMC's new guidelines. On the other hand, a relatively minor crime in a legal sense, such as that committed by an epileptic who drives a car without a valid licence, could conceivably fall within the guidelines. Patients are sometimes not in a fit state of mind at the time of examination to give valid consent to disclosure, either because they are too drunk or for any number of other reasons. The doctor may feel justified in giving some information to the police in the patient's best medical interests, particularly where the patient is held in custody. With rare exceptions to that principle, the doctor must obtain proper consent when the patient becomes fit enough to give it and before the information is given to the police. Where a doctor's duty of confidentiality precludes voluntary disclosure of information, the course of justice need not be compromised. The doctor may be summoned to court and it is open to the police to apply for a Court Order under the provisions of the Police and Criminal Evidence Act 1984 for the disclosure of medical information. However, a circuit judge will not always agree with investigating officers that such disclosure is appropriate. The description of one such case involving a brutal murder has been published2. I am here constrained by space, but there are other aspects of Mr Marsden's editorial which conflict with the advice of the Medical Defence Union3. P SCHUTTE Medical Defence Union Secretariat 3 Devonshire Place London WiN 2EA
References 1 Guidance for Doctors on Professional Confidence, General Medical Council, November 1991 2 Schutte PK. Medical confidentiality and a police murder inquiry. J Med Def Union, 1989;5:21 3 O'Donovan C. Confidentiality. The Medical Defence Union Ltd, 1992
The one-track mind The charming article by Dr Solomon Posen 'The portrayal of the physician in non-medical literature the one-track mind' (February 1992 JRSM, p66), deserves perhaps one more addition: the farce, which made Jules Romains' (1885-1973) name as a comic playwright: 'Knock, ou le Triomphe de la m6decine' in 1923. Dr Knock takes over a very run-down practice at Saint-Maurice, a small backward mountain town. There are no patients. The locals are healthy and
skinflints. He secures the services of the town-crier, telling people how excellent he is and advanced in knowledge. He offers free consultations on certain days, which is eagerly accepted by a number ofpeople. He manages to get propaganda to show the local inhabitants that there is poor hygiene and the locals are soon in the throes of fevers, colics and nervous conditions, making them eager to pay for treatment. He succeeds in building up an enormous practice, which his predecessor Dr Parpalaid - on a return visit - notes with disbelief, surprise and admiration. C MEDVEI 38 Westmoreland Terrace London SW1V 3HL
Treatment of glue ear by postural drainage If I may be allowed to comment on the paper by Shah (October 1991 JRSM, p 581) I would like to say that a few years ago I got a 'glue ear' but was able to clear it by lying on my good side and repeatedly swallowing. I could hear the bubbles rising through my middle ear and striking my eardrum with a dull thud. Admittedly this a series of only one case and not selected at random, nevertheless I obtained 100% success and there are not many treatments like that around these days. As it is simple and immediate it might be worth trying on a larger scale perhaps. It certainly will not prejudice any other subsequent treatment and it might save expensive hospital admissions as well as putting a few ENT surgeons out of work. Perhaps when the ENT registrar sees a letter requesting an outpatient appointment for glue ear he might send off a printed slip that advises the GP or parents that in the interim postural drainage might be attempted and describes how it should be performed. BRENNIG JAMES Cherry Orchard, Marlow Common, Bucks SL7 2QP
Familial adenomatous polyposis Dr Armitage (February 1992 JRSM, p 63), in his interesting account of the genetics and related aspects of this condition, does not mention whether chromosomal manipulation might affect not only the disease itself but also its transmission to the next generation. Such a possibility was foreseen 40 years ago by the late Dr Cuthbert Dukes as is evident from the splendid contribution to poetry (with apologies to Lewis Caroll) that he incoporated in his Hunterian lecture in 19521: 'You are old, Father William,' the young surgeon said, 'And your colon from polyps is free. Yet most of your sibling are known to be dead A really bad family tree'.
'In my youth,' Father William replied with a grin. 'I was told that a gene had mutated, That all who carried this dominant gene To polyps and cancer were fated.' 'I sought for advice from a surgical friend, Who signed and said -'Without doubt Your only escape from an untimely end Is to have your intestine right out.'
