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Alison Godbolt on identity cards … invasion of privacy or commonsense?

10 Dec, 08 | by BMJ Group

Alison Godboult A few years ago I saw myself as a bit of a defender of privacy. Now I’m slightly older (and wiser?). I wonder whether identity cards – traditionally opposed by “defenders of privacy” – are in fact the way forward to improvements in healthcare.

In January this year I started working in Sweden after medical training in the UK and several years working in the NHS. My husband’s job had necessitated a move to Sweden, and after much soul searching I had decided that I really wanted to carry on being a doctor and that that was going to be really difficult if I didn’t work for another three years. So I learnt Swedish and got a job.

No system is perfect, but a few things in Sweden have really opened my eyes. One is the prescription system, which is almost entirely electronic. I meet a patient or speak to them on the telephone, write their prescription on the computer using their identification number (“personnummer”), press a button that says “send to every pharmacy in Sweden”, and that’s it. No paper at all is involved in the prescription – it’s up to me whether I print out a medication list for the patient’s information or not. With regards to the actual prescription, they leave with nothing – no paper, no password, nothing.

The patient then goes into whichever pharmacy they choose, states their personnummer which individually identifies them, shows their photo ID card (which everyone has and which confirms their personnummer) and gets their prescription.

There is a system for getting temporary identification numbers for non-Swedes. There seem to be good controls in place for getting a personnummer and an ID card in the first place. In fact the existence of the “personnummer” seems to make everything about healthcare simpler. It´s all you need to uniquely identify a patient and consists of their date of birth plus four extra digits.

So whether I am looking at their notes (all electronic of course), ordering investigations (also electronic) or contacting social services or government authorities on the patient’s behalf, all I need is that 12 digit number. It´s so simple I can’t quite believe it, but it seems to work.

Occasionally I have commented to colleagues or friends that we don’t have ID cards in the UK because people worry about privacy and individual freedoms. They look quizzical and ask “How do you identify yourself?”

I start to explain that I take in a couple of old gas or electricity bills and maybe my passport or birth certificate……and never get much further because they’re laughing with incomprehension.

Alison Godbolt is a specialist trainee in rehabilitation medicine, Uppsala University Hospital, Sweden.

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  • Starman

    I don’t know about Sweden, but here in the UK it is said that 85% of people have either driving licences, Passports or both. Most organisations I have dealt with seem to view either of these documents as official proof of identification and seem quite happy to dispence their services upon their production. Those 15% of us who have neither, can of course apply for a provisional driving licence as a convenient method of ID if they so wish. Why should the UK taxpayer cough up another 20 Billion plus so that everybody can have YET ANOTHER PLASTIC CARD to carry round in their wallets with them ? Here in the UK most people already have a personal medical number, its called an NHS number. Perhaps the medical authorities here could make much greater use of this number to steamline administrative processes.

  • Bella

    Not to mention the biometric database…

  • Peter Ward

    I worked in Sweden a few years ago and have since worked in New Zealand and Britain. Both NZ and Sweden seem much more informal generally than Sweden. Both have populations that are a fraction of the UK’s. A social consensus seemed to exist in Sweden that doesn’t in Britain, which is culturally much more varied ( Sweden having forced immigrants into taking Swedish language classes and taught actively about Swedens liberal traditions).

    I thought these sorts of things probably make a difference, although if UK Govt cock ups concerning IT and the worryingly authoritarian direction of the present govt were not factors, people in Britain might also swallow ID cards.

  • CD

    I agree with the responses here in general, but what is REALLY the issue is not so much the ID card but the huge database that the UK government is so obsessed about creating. Many people think it sounds so wonderful and the answer to all prayers concerning personal identification, but the fact is that it would be a citizen’s nightmare and a hacker’s paradise. Add to that the fact that the UK wants to share all our data around with every Tom and Harry and hey presto, within a year everyone’s lives are potentially laid bare to all and sundry. The UK has suffered enormous losses of data, in both public and private circles, as the result of slapdash, careless attitudes. Quite simply, Ms Godbolt, UK government cannot be trusted to safeguard such massive volumes of private and very sensitive data.
    British passports already require a fair amount of information to be handed over, to get one. If ID cards are ever forced onto UK folk, they ought to be far less intrusive AND not be subject to storage in a huge database.

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