In the last edition of Medisec On Call, we considered some of the difficulties that can be caused for GPs in completing private medical attendance (PMA) reports.
Specifically the article considered the issue of consent and disclosure.
In this article, we look at some case studies that have arisen over recent years and where we have encountered issues with PMAs, and discuss what lessons GPs can learn from these scenarios.
At the outset, GPs need to recognise that PMA reports form part of a patient’s clinical records. If there is a request for disclosure of a patient’s records (either under Freedom of Information Act, Data Protection Acts or through the discovery process through the Courts) the reports will be disclosed as part of the patient’s records. There will be no distinction between the clinical notes and the PMA reports. Both will be regarded as an accurate and contemporaneous record of the patient’s health, diagnosis and treatment plan.
A patient of a rural GP called to have a PMA form completed in connection with a short-term loan which he intended taking out from a financial institution.
The GP was aware that, many years beforehand, the Plaintiff had been diagnosed with a form of cancer for which he had been in full remission in the intervening years.
The patient was concerned that, if the GP disclosed this condition in the PMA report, he would either be refused life cover or, alternatively, would be heavily penalised.
The GP therefore did not include his knowledge as to the patient’s relevant medical history.
He was confident that, during the short term of life cover required (three years) over the repayment of the loan, the underlying condition was most unlikely to recur.
Tragically, the patient died very suddenly from a completely unrelated medical condition (myocardial infarct).
The insurance company sought a copy of the Deceased’s GP records and immediately saw that the diagnosis of cancer many years beforehand had not been disclosed to them.
Notwithstanding the fact that the cause of death was completely unrelated to the information not disclosed, the non-disclosure allowed the insurance company to declare the policy null and void and refused to pay out benefit under the policy to the Deceased’s widow and children.
The Next of Kin brought an action against the GP for his failure to disclose the relevant medical history leading to a failure for them to collect a payment under the policy.
Whilst there was a legal argument that, even if there had been full disclosure, the policy would have been declined, and hence no payment would have been made, the fact that there was a non-disclosure of a previous medical condition caused a difficulty for the GP.
Provided the facts not disclosed to the insurer are highly material to the insurer (and a previous diagnosis of cancer would fall within this category) then it is irrelevant that the non-disclosed facts are unconnected with the event triggering cover under the policy (the heart attack).
This case illustrates a particular difficulty for GPs practising in a close community. If they disclose material facts to an insurer against the wishes of a patient, they are at risk of not only jeopardising the goodwill of their practice but also breaching the duty of confidentiality to the patient.
As outlined in the previous article, it is essential that a full consultation take place with the patient before any PMA be completed, and that the patient is aware of what information is being disclosed.
If a patient is resistant to material facts being disclosed, then the GP should not complete the PMA form and should simply indicate that they do not have the patient’s consent to complete the form.
A patient attended her GP with a complaint of eczema on her arms.
The doctor carried out an appropriate clinical examination and wrote up very comprehensive notes of the examination, the diagnosis and treatment.
Almost one year later the patient was diagnosed with malignant melanoma.
The patient attended the doctor for the purpose of completing a PMA report in respect of a critical illness policy which she held.
At this stage, there was no criticism being made of the GP by the patient.
However, some 12 months later, the patient claimed that, at the first visit when the diagnosis of eczema was made, she drew the attention of the doctor to a mole on the back of her neck which was asymmetrical, bleeding and had a large diameter.
The doctor was adamant that there was no such complaint made by the patient, nor any suggestion that the patient had shown him the mole one year previously.
Alternatively, the criticism that was made of the doctor is that if he had any concerns about the nature of the mole (as one would have expected of him to have if the mole was as described by the patient) then he should have taken a sample for biopsy.
The doctor in question was a very careful note-taker and readily volunteered that he only signed-off on the patient’s version of the first consultation to assist her in her claim for critical illness benefit.
He did not consider the claim form to be part of the patient’s clinical records. Effectively, he was now exposed to a finding of negligence against him simply due to goodwill on his part
The patient had herself completed the Critical Illness questionnaire and, when asked “When were symptoms of the disease (in respect of which a claim was being made under the policy) first seen by a medical attendant?” the patient had written “Almost one year ago” and named the GP as the medical attendant who had first seen the mole.
The GP was concerned for his patient and anxious that he do everything possible within his power to ensure that she would be paid under the terms of the policy and so he signed off the form on what was essentially inaccurate information at variance with his notes.
Subsequently, a claim was brought against the GP on the basis that he had failed to either diagnose the mole as a malignant growth one year earlier and therefore denied the patient an opportunity to have treatment initiated at an earlier date.
He did not consider the claim form to be part of the patient’s clinical records. Effectively, he was now exposed to a finding of negligence against him simply due to goodwill on his part without realising that he was completing a clinical record in respect of his patient.
The PMA form, whether it is an application for insurance or an application for benefit under an insurance policy, should be treated by GPs as requiring as much accuracy in its completion as the patient’s clinical notes. A failure to do so, or treating the forms as separate and distinct from the clinical records, exposes the GP to a potential finding of negligence.
As always, please seek the advice of Medisec in the event that you have any issues in relation to completion of PMAs.