What you might see
When we talk about ‘medical records’, we often talk about things like prescriptions, appointments, allergies, or possible test results.
But medical records can be a lot more detailed than that. Here are some examples:
- Records of consultations with Doctors, Nurses, or other clinical staff, including any free text notes added.
- Your coded record – markers identifying you as having a health condition or other criteria, plus any free text.
- Test results, potentially including diagnoses, if you have been referred to a specialist.
- All documents related to your health, such as letters to and from third parties like counselling services or insurance providers.
Let’s look at some examples that could be difficult or upsetting for patients:
- A letter from a specialist to a GP confirming a diagnosis. The letter is written factually and to the point, with the intention of the Doctor delivering the news in person where they can provide support and empathy. Without that context, the letter could be very upsetting or scary.
- A coded record, shorthand, abbreviation or jargon in free text. Without any explanation, this could lead to confusion or distress.
- A letter from a counselling or mental health service to a GP that describes a traumatic event in a patient’s past. It may be distressing for a patient to see the details repeated.
Minimizing risk
As a practice we have taken steps to avoid making inappropriate information available when the automatic switch on happened in October 2023, including redacting third-party data where necessary.
However, there are other risks that we cannot mitigate and there are concerns around the safeguarding of vulnerable adults and children and the risk of harm if patient information is revealed to a third party under coercion or threat.
Deleting the NHS App will not prevent this data from being visible if another person has your login details.
If this is a concern for you, please get in touch with us.
Before you see your medical health record there are some things to consider.
Although these instances may be rare please read and understood the following when you sign up for online services.
It is your responsibility to ensure you are keep your information safe and secure. Sharing information is at your own risk.
Your records are safe and secure within the app. You may choose to share this information with others including friends, family or carers. This is your choice but also your responsibility to ensure this information remains safe and secure. You share this information at your own risk.
Do you understand you may see abnormal results or bad news?
If your GP has given you access to test results or letters, you may see something you find upsetting or do not understand. This may occur before you have spoken to your doctor or while the surgery is closed and you cannot contact them. This may also include something you have forgotten in your record.
Medical records are not always written with a patient in mind. Your medical records are designed to be used by clinical professionals to ensure that you receive the best possible care. Some of the information in your medical record may be highly technical, written by specialists and not easily understood. If you require further clarification please contact the surgery for further clarification in a routine appointment.
Your records are about you – but errors happen. Please report to the surgery any information that does not belong in your record. If you spot something in your record that is not about you or you notice other records, please log out of the system immediately and contact the practice as soon as possible.
Can you confirm that access to your records is your wish alone and you are not being coerced into doing so? If you are being pressured to gain access to your records and revealing their details by others we would recommend not gaining access at this time.
You should use your records responsibly and utilise services appropriately. It may be possible that you see something in your record which you are concerned about but a clinical professional has not placed the same amount of importance/urgency on it. It is important in these circumstances that you work with the practice to book an appropriate appointment to discuss the issue rather than access emergency services including 111,999 or A&E who do not have access to your full notes and may not be able to help.