A few weeks ago I visited my GP surgery as a patient for the first time since registering. It was the last appointment of the day and I was the only person in the waiting room.
A sign next to the reception desk read 'If you wish to discuss anything in private, please ask and you will be directed to the relevant area'.
I asked the receptionist how often this invitation was taken up. Rarely, she said. Did patients ever discuss private information without asking for privacy? Frequently.
I looked at the 'privacy area'. It was a small window, immediately adjacent to the main desk, with no discernable features designed to enhance privacy. With such a token effort, it was easy to see why it went unused.
Rash of legislation
Headlines about loss of confidential information, breaches of data protection regulations, disclosure of medical records and frequent media mentions of the Information Commissioner's Office - the independent public body set up to protect personal information - demonstrate that privacy has never been more important.
High-quality websites, such as Your Privacy, demonstrate public demand for information and reassurance. This concern has led to a welter of legislation on human rights and the protection of personal information and, also, to revisions of GMC guidance to doctors.
Last month the GMC published new guidance on confidentiality which came into effect on 12 October and can be downloaded from its website.
As a junior doctor, I am frequently worried by the lack of privacy afforded to patients in hospital. It is often forgotten that curtains are sometimes barely adequate to prevent other patients or visitors seeing examinations or treatment, let alone stop them overhearing private conversation.
Lack of privacy during examinations or treatment is not usually a problem in GPs' surgeries, but what about the lack of privacy in the waiting room and reception area?
Surprisingly, our modern privacy culture is almost unknown in the GP surgery. We take for granted the need to queue to speak to a receptionist, and that conversation between receptionists and patients often takes place within easy earshot of, often full, waiting areas.
Although some GP practices have made efforts to address this, some have not, and some have done so ineffectually. This is not simply my experience - colleagues, friends and patients I meet say this too.
Conversations at reception often involve disclosing confidential information, such as patients' addresses, contact details or reason for visiting.
While at a few practices patients can check in themselves (for example, using a computer touch screen), even so, receptionists often prompt patients to talk about their medical problems and circumstances in some detail.
This is particularly true during open (no appointment needed) surgeries, when a patient may feel the need to negotiate their place in the queue.
Aside from the danger of a straightforward breach of confidentiality, privacy has been established as a human right in the EU even outside of healthcare settings. And importantly for GP practices, a likely perception is that lack of privacy influences willingness to seek care - particularly about 'embarrassing' conditions.
Even if a patient merely enquires whether test results have arrived, they might not want the whole room to know they have had the tests.
A research project, 'Confidential Registration in Health Services', published in the Emergency Medicine Journal in 2006, backs the case for NHS as a whole to address these issues.
To find out whether confidential conversations with receptionists improve patients' experience, a randomised trial was carried out in an NHS trust's A&E department.
Patients arriving were directed to register as normal or to see a receptionist behind a 2.4m-high screen separating them from the waiting area. The results showed that patients who registered behind the screen valued the increased privacy and were less concerned about being overheard.
Patient concerns were not confined to information about why they were there, but also to others finding out who they were and how to contact them.
Although patient privacy is taken into account in NHS Estates guidance for A&E facilities, for example, it does not include arrangements in reception areas. With this aspect of building design, the NHS is lagging far behind other industries.
Learning from others
Post offices, banks, building societies, and even some railway station booking offices have facilities for private conversation between counter staff and customers. 'Stand behind this line until called forward' is an instruction we are now all familiar with.
In the light of improvements by other service sectors, the results of the study strongly suggest that steps should be taken to increase privacy in primary care. In A&E the research showed that patients worry if others can hear them say who they are, how to contact them and why they are there.
Good design for privacy, including screens, signage and distance between the reception desk and waiting area chairs, is usually both feasible and inexpensive. Patients will not be surprised by such changes, but their experience of healthcare will be improved.
- Dr Shepherd is a Foundation Year 2 doctor at the Royal Gwent Hospital, Newport
|Points to consider|