BMJ: Unintended consequences of open access to medical notes (3)

11 July, 2022

Information is central to the ambitions of patients' access to records. The paper "The view of a general practitioner on immediate access for patients to their laboratory test results (ref 1) was presented on behalf of Dr Amir Hannan at the European Federation of Laboratory Medicine In Mannheim, Germany in 2018.

Many of the principles of patient access to records and to results mentioned in the paper "The view of a general practitioner on immediate access for patients to their laboratory test results" come from three books “Clinical thinking and Practice”, “The New Consultation” and “The exceptional potential of each primary care consultation”. These books analysed the use of information processing within British General Practice consultations. Members of the Record Access Collaborative believed that these processes could be augmented through patient training, empowerment and access to and contribution to the clinical record.

The Record Access Collaborative led by Dr Brian Fisher (Ref 2) in England promoted a move towards open records.

The Record Access Collaborative extended the use of medical knowledge and skills and practice of doctors to patients and their families through the use of digital and mobile media. Patients were encouraged (an important stage usually ignored by doctors) to undertake some care themselves but not abdicating responsibility and creating a communication and team hub through the common record.

Book 1: Churchill Livingstone 1979 "Clinical thinking and Practice" by HJ Wright and Douglas Mcadam (who I was trained by in 1977) has three parts:

Part 1- Who consults the doctor and why

1. The apparent and the real conversation

2.Consultation and disease

3. Consultation and illness

4. The doctor's contribution to consulting areas

5. Unreported disease

6. Unreported symptoms

7. Pathways to consultation

Part 2.

8. Context and methods (Contrasts between hospital and general practice)

Part 3. Diagnosis and decision making

Collecting the evidence - selectivity

Selecting the evidence communication

Collecting the evidence the use of the examination

The interpretation of clinical data- symptoms and probabilities

The interpretation of clinical data- information, measurement and counting

The interpretation of clinical data- normality

Summarising clinical data: diagnosis, naming and classification

Book 2: The New Consultation: Developing Doctor–Patient Communication-

Rogers, 2004, Health Expectations, Wiley Online Library (

Pendleton, Schofield, Tate and Havelock – ‘The Consultation – An approach

to Learning and Teaching’

Pendleton, Schofield, Tate and Havelock published ‘The Consultation – An approach to Learning and Teaching’ in 1984. This is now widely referred to as the ‘Pendleton’ model of the consultation. It was updated and revised in ‘The New Consultation’ in 2003.

This model described seven tasks, which taken together form comprehensive and coherent aims for any consultation:

1. To define the reason for the patient’s attendance

2. To consider other problems

3. To choose an appropriate action for each problem with the patient

4. To achieve a shared understanding of the problems with the patient

5. To involve the patient in the management and to encourage the patient

to accept appropriate responsibility

6. To use time and resources appropriately

7. To establish or maintain a relationship with the patient which helps

to achieve other tasks

Book 3: 1) Stott NCH, Davis RH (1979).The exceptional potential of each primary care consultation.JRCGP,(29), 201-5.

Stott and Davis outlined four areas which can be explored each time a

patient consults:

1. The identification & management of the presenting problem

2. Modification of the patient's help-seeking behaviour

3. The management of continuing problems

4. Opportunistic health promotion

Ref 1. "The view of a general practitioner on immediate access for patients

to their laboratory test results ( (


Ref 2. The record access collaborative was developed as a service to the

public, patients, the NHS and industry. The aim was to bring together those

who have an interest in seeing record access more widely available and

maximising benefits that flow from it.

The NHS had made a clear statement of principle that patients should be able to access their records, subject to legal safety restrictions. There was good evidence of substantial benefits for patients.

The aim of the collaborative-

- to raise awareness of record access (RA) nationally and internationally

- to make RA as useful to patients as possible by linking data to facilitate understanding and empower patients to share decisions if they want to

- to increase the take-up of RA by patients and practices

- to support the development of national standards for RA

HIFA profile: Richard Fitton is a retired family doctor - GP. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data

Email address: richardpeterfitton7 AT