Best Practice & Research Clinical Anaesthesiology
Volume 20, Issue 4 , Pages 525-543 , December 2006

Confidentiality, ‘No blame culture’ and whistleblowing, non-physician practice and accountability

  • Stuart M. White, FRCA, BSc, MA (Consultant Anaesthetist)

      Affiliations

    • Corresponding Author InformationTel.: +44 1273 493216.

References 

  1. White SM, Baldwin TJ. Confidentiality, and access to medical records. In: Legal and ethical aspects of anaesthesia, critical care and perioperative medicine. Cambridge: Cambridge University Press; 2004;p. 89–105Chapter 7
  2. Kottow MH. Medical confidentiality: an intransigent and absolute obligation. Journal of Medical Ethics. 1986;12:117–122
  3. General Medical Council . Good medical practice. http://www.gmc-uk.org/guidance/good_medical_practice/index.aspMay, 2001;(accessed 12.07.06)
  4. General Medical Council . Confidentiality: protecting and providing information. http://www.gmc-uk.org/guidance/library/confidentiality.aspApril, 2004;(accessed 12.07.06)
  5. British Medical Association . Confidentiality and disclosure of health information. http://www.bma.org.uk/ap.nsf/Content/Confidentialitydisclosure~introOctober, 1999;(accessed 12.07.06)
  6. British Medical Association . Confidentiality as part of a bigger picture. http://www.bma.org.uk/ap.nsf/Content/ConfidentialityBiggerPictureMay, 2005;(accessed 12.07.06)
  7. World Medical Association . International code of medical ethics. http://www.wma.net/e/policy/c8.htmOctober, 1983;(accessed 12.07.06)
  8. American Medical Association . Declaration of medical responsibility. http://www.ama-assn.org/ama/pub/category/7491.htmlDecember, 2001;(accessed 12.07.06)
  9. Australian Medical Association . Code of ethics. http://www.ama.com.au/web.nsf/doc/WEEN-5WW5982004;(accessed 12.07.06)
  10. Samanta A, Samanta J, Gunn M. Legal considerations of clinical guidelines: will NICE make a difference?. Journal of the Royal Society of Medicine. 2003;96:133–138
  11. White SM, Baldwin TJ. Consent for anaesthesia. Anaesthesia. 2003;58(8):760–774
  12. A-G v Guardian Newspapers (No 2) [1990] 1 AC 109.
  13. W v Egdell [1990] 1 All ER 835 (CA).
  14. White SM, Baldwin TJ. The Mental Capacity Act, 2005. Implications for anaesthesia and intensive care. Anaesthesia. 2006;61(4):381–389
  15. Gillick v West Norfolk and Wisbech Area Health Authority [1986] AC 112 (HL).
  16. X v Y [1988] 2 All ER 648.
  17. Health Protection Agency. Diseases notifiable (to Local Authority Proper Officers) under the Public Health (Infectious Diseases) Regulations 1988. http://www.hpa.org.uk/infections/topics_az/noids/noidlist.htm (accessed 12.07.06).
  18. Committee on Regional Health Data Networks , Institute of Medicine . Health data in the information age: use disclosure and privacy. In:  Donaldson MS,  Lohr KN editor. Washington DC: National Academy Press; 1994;http://darwin.nap.edu/books/0309049954/html1994;(accessed 12.07.06)
  19. Hodge JG, Gostin LO, Jacobson PD. Legal issues concerning electronic health information privacy, quality, and liability. The Journal of the American Medical Association. 1999;282:1466–1471
  20. White SM, Baldwin TJ. The Human Rights Act, 1998: implications for anaesthesia and intensive care. Anaesthesia. 2002;57(9):882–888
  21. Data Protection Act, 1998. http://www.hmso.gov.uk/acts/acts1998/19980029.htm (accessed 12.07.06).
  22. Department of Health. Data Protection Act, 1998. Protection and use of patient information. http://www.doh.gov.uk/dpa98/ (accessed 12.07.06).
  23. Council of Europe . Convention for the protection of individuals with regard to automatic processing of personal data (Treaty 108). http://www.coe.int/T/E/Legal_affairs/Legal_co-operation/Data_protection/1981;(accessed 12.07.06)
  24. Office of Legislative Drafting, Attorney-General's Department, Canberra. Privacy Act, 1998. http://www.privacy.gov.au/publications/privacy88_030504.doc (accessed 12.07.06).
  25. Parliament of Canada . Personal information protection and electronic documents act (PIPEDA). http://www.parl.gc.ca/36/2/parlbus/chambus/house/bills/government/C-6/C-6_4/90052bE.html2000;(accessed 12.07.06)
  26. Remarks of Senator Hilary Rodham Clinton on Privacy to the American Constitution Society. http://clinton.senate.gov/news/statements/details.cfm?id=257288&&June 16, 2006;(accessed 12.07.06)
  27. 104th Congress of the United States of America. Health Insurance Portability and Accountability Act of 1996. http://aspe.hhs.gov/admnsimp/pl104191.htm (accessed 12.07.06).
  28. Lo B, Dornbrand L, Dubler NN. HIPAA and patient care. The role for professional judgment. The Journal of the American Medical Association. 2005;293:1766–1771
  29. Health and Social Care Act 2001. http://www.opsi.gov.uk/ACTS/acts2001/10015--g.htm#60 (accessed 12.07.06).
  30. Health Service (Control of Patient Information) Regulations 2002. http://www.opsi.gov.uk/si/si2002/draft/20029890.htm (accessed 12.07.06).
  31. Department of Health . Confidentiality. NHS code of practice. http://www.dh.gov.uk/PolicyAndGuidance/InformationPolicy/PatientConfidentialityAndCaldicottGuardians/AccessHealthRecordsArticle/fs/en?CONTENT_ID=4100550&chk=1w6ljhNovember, 2003;(accessed 12.07.06)
  32. Access to Health Records Act 1990. http://www.hmso.gov.uk/acts/acts1990/Ukpga_19900023_en_1.htm#end (accessed 12.07.06).
  33. Boyd P. The requirements of the Data Protection Act 1998 for the processing of medical data. Journal of Medical Ethics. 2003;29:34–35
  34. Kennedy I, Grubb A. Medical records, and confidentiality. In: Medical law. 3rd ed.. London: Butterworths; 2000;p. 990–1047Chapters 7 and 8
  35. The Caldicott Report. http://www.publications.doh.gov.uk/ipu/confiden/report/December, 1997;(accessed 12.07.06)
  36. Freedom of Information Act 2000. http://www.opsi.gov.uk/ACTS/acts2000/00036--a.htm#1 (accessed 12.07.06).
  37. Freedom of Information (Scotland) Act 2002. http://www.opsi.gov.uk/legislation/scotland/acts2002/20020013.htm (accessed 12.07.06).
  38. Meredith B. Data protection and freedom of information. British Medical Journal. 2005;330:490–491
  39. Merry A, McCall Smith RA. Errors, medicine and the law. Cambridge: Cambridge University Press; 2001;
  40. Institute of Medicine . To err is human: building a safety health system. Washington: National Academy Press; 1999;http://www.nap.edu/catalog/9728.html1999;(accessed 12.07.06)
  41. Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. 1991 Quality & Safety in Health Care. 2004;13(2):145–151
  42. Kopp BJ, Erstad BL, Allen ME, et al. Medication errors and adverse drug events in an intensive care unit: direct observation approach for detection. Critical Care Medicine. 2006;34(2):415–425
  43. Gaba DM. Anaesthesiology as a model for patient safety in health care. British Medical Journal. 2000;320:785–788
  44. Runciman WB, Sellen A, Webb RK, et al. Errors, incidents and accidents in anaesthetic practice. Anaesthesia and Intensive Care. 1993;21:506–519
  45. Australian Patient Safety Foundation. http://www.apsf.net.au/ (accessed 12.07.06).
  46. National Confidential Enquiry into Patient Outcome and Death. http://www.ncepod.org.uk/ (accessed 12.07.06).
  47. Adams H. Where there is error may we bring truth. Anaesthesia. 2005;60(3):274–277
  48. Wheeler SJ, Wheeler DW. Medication errors in anaesthesia and critical care. Anaesthesia. 2005;60(3):257–273
  49. White SM. Death on the table. Anaesthesia. 2003;58(6):515–518
  50. White SM, Akerele O. Anaesthetist's attitudes to intraoperative death: questionnaire survey. European Journal of Anaesthesiology. 2005;22(12):938–941
  51. Association of Anaesthetists of Great Britain and Ireland . Catastrophes in anaesthetic practice. http://www.aagbi.org/pdf/catastrphes.pdf2005;(accessed 12.07.06)
  52. Runciman WB, Merry AF, Tito F. Error, blame and the law in health care – an antipodean perspective. Annals of Internal Medicine. 2003;138:974–979
  53. Davis RM, Pless B. BMJ bans “accidents”. British Medical Journal. 2001;322:1320–1321
  54. Ferner RE, McDowell SE. Doctors charged with manslaughter in the course of medical practice, 1795-2005: a literature review. Journal of the Royal Society of Medicine. 2006;99(6):309–314
  55. Edwards N, Kornacki MJ, Silversin J. Unhappy doctors: what are the causes and what can be done?. British Medical Journal. 2002;324:835–838
  56. Lawton R, Parker D. Barriers to incident reporting in a healthcare system. Quality & Safety in Health Care. 2002;11:15–18
  57. Smith AF, Goodwin D, Mort M, et al. Adverse events in anaesthetic practice: qualitative study of definition, discussion and reporting. British Journal of Anaesthesia. 2006;96(6):715–721
  58. Woods I. Making errors: admitting them and learning from them. Anaesthesia. 2005;60(3):215–217
  59. Barach P, Small SD. Reporting and preventing medical mishaps: lessons from non-medical near miss reporting systems. British Medical Journal. 2000;320:759–763
  60. Lamb R. Open disclosure of medical errors. Quality & Safety in Health Care. 2004;13:3–5
  61. Evans SM, Berry JG, Smith BJ, et al. Anonymity or transparency in reporting of medical error: a community-based survey in South Australia. The Medical Journal of Australia. 2004;180(11):577–580
  62. Gallagher TH, Waterman AD, Ebers AG, et al. Patients' and physicians' attitudes regarding the disclosure of medical errors. The Journal of the American Medical Association. 2003;289:1001–1007
  63. Amalberti R, Auroy Y, Berwick D, et al. Five system barriers to achieving ultrasafe health care. Annals of Internal Medicine. 2005;142:756–764
  64. Helmreich RL, Davies JM. Human factors in the operating room: interpersonal determinants of safety, efficiency and morale. Baillière's Clinical Anaesthesiology. 1996;10:277–296
  65. Lilleyman J. A blame-free culture in the NHS: quixotic notion or achievable ambition?. Perfusion. 2005;20:233
  66. Higton P. Safety lessons from aviation. Perfusion. 2005;20:191–193
  67. Department of Health . Making amends: a consultation paper setting out proposals for reforming the approach to clinical negligence in the NHS. http://www.dh.gov.uk/assetRoot/04/06/09/45/04060945.pdfJune, 2003;(accessed 12.07.06)
  68. Department of Health. NHS Redress Bill [HL]. http://www.publications.parliament.uk/pa/cm200506/cmbills/137/2006137.htm (accessed 12.07.06).
  69. Department of Health . An organization with a memory. Report of an expert group on learning from adverse events in the NHS chaired by the Chief Medical Officer. http://www.dh.gov.uk/assetRoot/04/06/50/86/04065086.pdfJune, 2000;(accessed 12.07.06)
  70. Reason J. Managing the risks of organisational accidents. Aldershot: Ashgate Publishing; 1997;
  71. Beatty PCW, Beatty SF. Anaesthetists' intentions to violate safety guidelines. Anaesthesia. 2004;59(6):528–540
  72. Smith AF, Goodwin DS, Mort M. Anaesthetists' violations of safety guidelines. Anaesthesia. 2005;60(2):201–202
  73. Walton M. Creating a “no blame” culture: have we got the balance right?. Quality & Safety in Health Care. 2004;13:163–164
  74. House of Commons. Committee of Public Accounts. A safer place for patients: learning to improve patient safety. Report 51, 6th July, 2006. HC 831.http://www.publications.parliament.uk/pa/cm200506/cmselect/cmpubacc/831/83102.htm (accessed 12.07.06).
  75. Miceli MP, Near JP. Blowing the whistle: the organizational and legal implications for companies and employees. New York: Lexington Books; 1992;
  76. Gillet G. The ethical status of whistle-blowers. Monash Bioethics Review. 2005;24:59–64
  77. Faunce T. Developing and teaching the virtue-ethics foundations of healthcare whistleblowing. Monash Bioethics Review. 2004;23:41–55
  78. Smith J. Public interest responsibilities of professionals. Medicine, Science, and the Law. 2006;46:93–98
  79. Kennedy I On behalf of the Secretary of State for Health. Learning from Bristol: the report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary 1984–1995. http://www.bristol-inquiry.org.uk/final_report/report/index.htmJuly, 2001;(accessed 12.07.06)
  80. UNISON and Public Concern at Work . Is whistleblowing working in the NHS?. http://www.pcaw.co.uk/policy%5Fpub/nhs.htmlMay, 2003;(accessed 12.07.06)
  81. Vinten G, Gavin TA. Whistleblowing on health, welfare and safety: the UK experience. Journal of the Royal Society of Health. 2005;125:23–29
  82. In:  Calland R,  Dehn G editor. Whistleblowing around the world: law, culture and practice. South Africa: IDASA; 2004;
  83. Public Interest Disclosure Act 1998. http://www.opsi.gov.uk/ACTS/acts1998/19980023.htm (accessed 12.07.06).
  84. Public Concern at Work. http://www.pcaw.co.uk/index.html (accessed 12.07.06).
  85. Public Concern at Work. Practical Guidance on Whistleblowing in the NHS from Public Concern at Work. http://www.pcaw.co.uk/news/press_23.html (accessed 12.07.06).
  86. Royal College of Anaesthetists. NWWA Quarterly Report May–July 2005. Document 71. http://www.rcoa.ac.uk/docs/NWWAreport.pdf (accessed 12.07.06).
  87. Smith AF. Anaesthetic practitioners in the UK: promise, perils and psychology. Anaesthesia. 2005;60(11):1055–1058
  88. Bolsin S, Patrick A, Colson M, et al. New technology to enable personal monitoring and incident reporting can transform professional culture: the potential to favourably impact the future of health care. Journal of Evaluation in Clinical Practice. 2005;11(5):499–506
  89. Smith AF, Kane M, Milne R. Comparative effectiveness and safety of physician and nurse anaesthetists: a narrative systematic review. British Journal of Anaesthesia. 2004;93(4):540–545
  90. Silber JH, Kennedy SK, Even-Shoshan O, et al. Anesthesiologist direction and patient outcomes. Anesthesiology. 2000;93(1):152–163
  91. Kane M, Smith AF. An American tale - professional conflicts in anaesthesia in the United States: implications for the United Kingdom. Anaesthesia. 2004;59(8):793–802

PII: S1521-6896(06)00052-8

doi: 10.1016/j.bpa.2006.09.002

Best Practice & Research Clinical Anaesthesiology
Volume 20, Issue 4 , Pages 525-543 , December 2006

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