Resilient GP: an ethically inappropriate survey report
Resilient GP posted a survey report yesterday about inappropriate patient demand. The ethics and methodology of what they did was questioned, and they reposted a (revised) version of the post today – justified for the purpose of “debate” and “educating patients not to use up appointments” inappropriately. I’m going to look at ethical problems with this survey report here, and look at problems with methology/write-up in a subsequent post. I’ll argue that it’s not ethical to have posted this, and that Resilient GP’s arguments for posting it don’t stand up.
It’s important for doctors to maintain patient confidentiality, except where there are very good reasons not to (for example, the patient might die if they don’t). However, the original version of the Resilient GP survey report contained some very specific information that could identify patients. Some of this has now been removed – and it wouldn’t be ethical for me to repost this information – but there was no good justification for posting this information in the first place. Resilient GP has not publicly reflected on the removed information – so I don’t even know whether this was done for ethical reasons, let alone if any lessons have been learnt. Some of the survey report (e.g. point 5.22) is still specific enough to identify patients.
Resilient GP argued today that “[c]areful reading of the report” will show that patient confidentiality hasn’t been breached. However, it’s not classy to make this argument after removing (but not noting the removal of) potentially identifying information – readers now are unlikely to know that information has been removed and may therefore reach an overly positive conclusion about how patients have been anonymised.
The doctor-patient relationship is important: mellojonny suggests that, for some, “a long-term relationship with a stable adult who knows them is literally life-saving”. One reason for maintaining patient confidentiality is so patients feel confident sharing very personal things with their doctors. Will patients now worry that what they say to their GP will be posted online? For doctors to post quite specific anecdotes about patients in what seems a derogatory way is hardly likely to help build a good relationship.
Generally, we ask research participants to give informed consent to taking part in research projects. I’d be very surprised if the patients featured in this survey report consented to this (I asked Resilient GP to confirm, but they haven’t). There are some cases where one might proceed without informed consent, but I can’t see how this is justified here.
Resilient GP’s defence of the ethics of their survey report
Resilient GP offers a defence of the ethics of posting this material. However, this is very weak. They argue that
ethics of utilitarianism are equally important here and it is a duty of doctors to challenge inappropriate use of resources
A utilitarian justification of posting this, though, would depend on having a reasonable expectation that it will have positive consequences. Resilient GP have not presented any good evidence that it will. As Betabetic has shown, it’s not at all clear whether (well-resourced, large-scale) campaigns again over-consulting will have the desired effect. It seems rather unlikely that the best way to address inappropriate demand is to post anecdotes about inappropriate demand on a website that seems largely aimed at GPs. There is significant potential for harm, though – for example, in breaching patient confidentiality or damaging the doctor-patient relationship.
Resilient GP also states that the ambulance service has “raise[d] real life examples of inappropriate appointment use” and appears to feel that this shows that it’s not unethical to do so. This is a really lousy argument, though – it might, for example, just be that others have acted in ethically problematic ways or that the GP-patient relationship is different to the ambulance-patient relationship.
Resilient GP should pull this post ASAP, at least till it can be revised to properly address issues related to patient confidentiality. They should also reflect on why a post with this issues was put up in the first place.
More broadly, if Resilient GP feel utilitarian ethics are the best lens to view this through, they should give more serious consideration to the consequences of their survey report: I haven’t seen good reason to expect the positive to outweigh the negative. Also, as I’ll argue in my next post on this, I don’t think the research they’ve posted is all that good – and I’m not sure that starting a ‘debate’ centred around low quality research is especially useful.
Note: I have contacted Resilient GP to suggest that they pull the post ASAP, at least till they can resolve issues with (non)anonymisation. They haven’t yet responded.