The Gazette 1964/67

It is a breach of professional privilege for a doctor to disclose to an insurance company information concerning a patient obtained as a result of a patient and doctor relationship. The prohibition against disclosing such information clearly applies to any practitioner on the staff of a local authority or other public or private hospital who obtains information concerning a patient in the hospital either by casual observation or in the course of treatment of the patient by virtue of his position on the hospital staff, just as it applies to a doctor who is engaged speci– fically by the patient to make an examination and report for that patient's use. Where a doctor conducts an examination of an injured person on behalf of an insurance company for the benefit of the company and disclosed to the patient or his advisers that he is acting in the interests of the insurance company different considerations naturally apply. In cases not within the Workman's Compensation Act the patient's medical adviser will be present at the examination. In examinations under section 33 of the Workmen's Compensation Act, 1934, where the patient attends without his medical adviser the following is a statement of what the Association regard as the proper professional practice (i) the duty a of medical practitioner who is in– structed by an employer or an insurance company under section 33 of the Workmen's Compensation Act, 1934, is to ascertain the medical condition and state of health of the workman, (2) the medical practitioner should not accept instructions from the employer or the insurance company which would oblige him to exceed his professional duty under head (i). (3) Questions put to the workman in the course of the medical examination are in the discre– tion of the medical practitioner but should be restricted to the workman's physical condition and state of health except inasmuch as it may be necessary to ascertain the surrounding circumstances and background for the purpose of forming an opinion on his medical condition and state of health. (4) Irrespective of any questions put to the work– man in the course of the examination any written or oral report by a medical practitioner to the em– ployer or insurance company should be restricted to the medical issue and any information on the issue of legal liability ascertained in the course of the examination should not be disclosed. This statement was drawn up after consultation with representatives of the Incorporated Law Society." Examining Medical Officers. It often happens that a doctor's patient has to be examined for some particular purpose by a medical officer representing an interested third party. These

examinations may occur in connection with life assurance or superannuation, entry into certain em– ployment, litigation, or requests from the police. The following ethical code governing special situations was approved by the Representative Body in 1957. It does not apply to examinations performed under statutory requirements, and paragraphs (2) and (3) do not apply to pre-employment examinations or to those connected with superannuation, or with proposals for life or sickness assurance. For the purpose of this code an examining medical officer is a practitioner undertaking the examination of a patient of another practitioner at the request of a third party with the exception of examinations under statutory requirements. (i) An examining practitioner must be satisfied that the individual to be examined consents, person– ally or through his legal representative, to submit to medical examination, and understands the reason for it. (2) When the individual to be examined is under medical care, the examining practitioner shall cause the attending practitioner to be given such notice of the time, place and purpose of his exam– ination as will enable the attending practitioner to be present should he or the patient so desire. (Preferably such notice should be sent to the attending practitioner through the post, or by telephone, but in certain circumstances a com– munication might properly be conveyed by the patient.) Exceptions to this are : (a) When circumstances justify a surprise visit. (b) When circumstances necessitate a visit within a period which does not afford time for notification. Where the examining practitioner has acted under (a) or (b) he shall promptly inform the attending practitioner of the fact of his visit and the reason for his action. 3. If the attending practitioner fails to attend at the time arranged the examining practitioner shall be at liberty to proceed with the examination. 4. An examining practitioner must avoid any word or action which might disturb the confidence of the patient in the attending practitioner and must not, without the consent of the attending practitioner, do anything which involves interference with the treatment of the patient. 5. An examining practitioner shall confine himself strictly to such investigation and examination as are necessary for the purpose of submitting an adequate report. 6. Any proposal or suggestion which an examining practitioner may wish to put forward regarding treatment shall be first discussed with the attending practitioner either personally or by correspondence.