Speaking to a third party to obtain important information about the patient's presenting problem or background is often useful and sometimes vital. This may prove crucial in arriving at the correct diagnosis, for instance if the patient is withholding information about an alcohol problem, or in establishing the best management, for instance the capacity of a frail elderly patient to maintain independent living.
It is ideal if the patient suggests that the doctor speaks to the friend or relative but the stimulus lor third party involvement may have to come from the clinician. Sometimes it is not practical for the interview to take placc in the patient's presence, but this is generally preferable. It may be necessary to gain urgent information by telephone, again with the patient present, and the third party aware of that prescncc. The purpose of the third party interview should be made clear to the patient.
Rarely, a patient may refuse to agree to a relative being approached. This decision should he respected. If the patient is ambivalent, the problem may be resolved by agreeing on a different person from that suggested first.
In addition to those special situations in which it is necessary to obtain the history from a third party, sometimes the clinician is approached by a third party who is anxious to provide information without the patient's knowledge. In this situation, the doctor should first establish who the person is, the relationship wilh the patient and, crucially, the reason for the unwillingness to let the patient know about the approach. Depending on the responses, the doctor may wish to proeccd wilh Lhe conversation. In these circumstances the informant should be invited to continue on lhe clear understanding that this is to be a one-way cxchangc.
The topics involved arc often highly sensitive, for instance sexual abuse, offending behaviour, drug misuse, eating disorder or domestic violence, and the informant may be genuinely concerned for the patient and apprehensive about the outcome should Ihe patient discover the intervention. In these circumstances, clinically relevant information obtained from a third party should be written on a separate sheet of paper, clearly identified as such and, located separately in the clinical records, preferably behind a casenote divider headed Third Party Information". This ensures that the patient would not have access to this pan of the clinical record (under the Health Records Act 1990). and this assurance should be given to the informant.
• When the acquisition ol a good history proves difficult it is rarely lhe patient's fault, and the clinician should not react as if it is.
• Problems may vary, e.g. deafness, expressive dysphasia following a stroke. Mosl problems can be surmounted.
• Third party information is sometimes vital, often helpful, and rarely motivated by considerations other than the patient's welfare. The doctor needs to be aware of potential confidentiality problems and how to avoid or handle these-
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