PMA reports may cause difficulties in General Practice for a variety of reasons, and we often deal with queries about them here in Medisec.
It’s important to remember that if the GP omits medical information when completing a PMA report, which could subsequently be judged ‘relevant’ to a patient’s clinical status, then a claim could subsequently be rejected years later.
Paragraph 40.5 of the Guide to Professional Conduct and Ethics for Registered Medical Practitioners says:
“If you are asked to conduct an examination and give the results to a third party such as an insurance company, employer or legal representative, you should explain to the patient that you have a duty to the third party as well as the patient, and that you cannot keep relevant information out of the report. You should be satisfied that the patient understands the scope and purpose of the report…”
The medico-legal risks surrounding PMAs and medical assessments for insurance companies are often in the context of consent an extent of disclosure, but other aspects can also cause difficulties for the GP. Some common issues are highlighted below:
This can cause significant difficulty to a patient keen to have insurance in place for example for a mortgage approval.
The Irish Medical Council Guide to Professional Conduct and Ethics 2016 says: “40.3 You should provide reports promptly so that the patient does not suffer any disadvantage.”
It is not unknown for an insurance company to request a PMA report and omit any signature of consent to release medical information from the patient. It is important to ensure full, valid and informed consent. See further details below.
A faded photocopy of a patient’s signature is often the only indication that the patient has consented to disclosure of all his medical details. How can the GP know whether this patient understood the relevance of this permission?
Did the patient realise that they were giving permission for disclosure of all their medical history, including long forgotten illnesses and ailments, etc.? Was the consent truly ‘informed’, and did the patient understand the extent of the disclosure? We recommend that the GP offers to go through the completed PMA report with the patient to ensure the patient understands the information that is being disclosed and the scope and purpose of the report.
The Disability Act 2005 and the Code of Practice on Data Protection for the Insurance Sector directs that an insurance company cannot take the results of an applicant’s genetic screening into account whatsoever when considering an application for an insurance policy.
A GP is not obliged to reveal the results of any genetic screening to the insurance company, and if they do so, the insurance company cannot take these into account.
However, where a patient is the sufferer of a genetic illness, then his clinical condition and diagnosis can be disclosed. A common condition would be where a patient has been identified as a carrier of the gene for haemochromatosis. If clinically well, and suffering no sequelae the result need not be disclosed. If the patient is suffering any consequences of haemochromatosis, say, cirrhosis and diabetes, or is goingfor regular venesection, then this may be revealed.
If a GP has information about a member of the patient’s family, and that person is identifiable, then the GP should have the consent of that person in order to reveal their medical past. It is recommended therefore to leave it to the patient themselves to offer their family history to the insurance company if requested. The GP should inform the patient of the need to disclose all relevant information and to act in utmost good faith.
The issue of confidentiality and extent of disclosure raises its head so often here in Medisec, that in order to comply with the Medical Council Guidelines and ensure the patient consents to release of the report and “understands the scope and purpose of the report”, we recommend that the GP offers sight of the report to the patient and at an absolute minimum informs the patient what will be in the report before it is submitted to the insurance company. If a patient unreasonably objects to any findings in the report, the patient is effectively not consenting to disclosure of the report. The GP should not compromise their position by omitting any relevant details from the report and should simply write on the relevant section of the form “no consent from the patient to disclose” or decline to submit the form in such circumstances. The GP should document his or her discussions with the patient carefully in the medical records.
If you have any queries about preparing PMA reports, contact us for further advice.