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Sharing patient information electronically throughout NHS

Editor—As general practitioners in the brave new world of sharing patient information electronically throughout the NHS,1 can we still promise our patients that we will keep their secrets confidential? With the threat of central servers for our computers, practices would no longer be the keepers of their own data. The NHS would like easy access to our information—but who else would have such access? 
 
If out of hours and accident and emergency departments are able to tap into our computers, then no one would have any medical secrets. Unlike hospitals, histories in general practice contain very deeply personal information about patients (mental illness, marital problems, alcoholism, abortions, impotence, etc). Does anyone really believe that it would remain secret for long that a local politician (or doctor) had been mentally ill? 
 
Access for primary care trusts would mean that managers may be able to tap in and see the notes of their employees who are our patients. We will, of course, be promised that this will never happen. We may be promised that general practitioners can decide who has access and at what level, but for how long will the promise be kept when we don't own the equipment? Let no one tell me that lawyers and insurance companies will not hack in. 
 
I believe that we should fight to retain control of our own data since confidentiality and trust are the cornerstones of general practice, and not an optional extra. The job is impossible without it, and if we lose this, then general practice is truly dead. Can I trust my computer?