Pallavi Bradshaw: Should employers have access to employees medical records?

pallavi_bradshawFlying has become an integral part of modern life, whether for pleasure or business. I have never been a nervous flyer although I would be lying if I said that I don’t get a little nervous, like most, when there is unexpected turbulence. For that split second, you worry about engine failure or a terrorist act, but never that the pilot is going to down the plane. The suicide and mass murder by Andreas Lubitz of the Germanwings plane shocked the world and ignited a debate about privacy and medical confidentiality.

Many were dismayed that the pilot’s employer had no idea about his apparent recent ill health and state of mind. Questions were being asked about how such information was not available to Lufthansa, Germanwings’ parent company. There was also consternation that he had recently seen a doctor who had advised him that he was not fit to fly, but that this information was not relayed directly to the employer or aviation authority. In fact, it is reported that police found a torn up “sick note” covering the day of the crash at Lubitz’s home. While rare, pilot suicide is not unheard of and medically caused fatal accidents over the past three decades shows that about half have been a result of state of mind or psychiatric conditions, including drugs and alcohol. In all these cases, it is apparent that the pilot should not have been flying. But is mandatory sharing of medical records for all commercial pilots with employers or regulators a proportionate response? More importantly, how many other professions could the principle that public safety overrides privacy be extended to; police, teachers, doctors, or even politicians?

As a medicolegal adviser, I am constantly reminding doctors about their duty of confidentiality to patients, which extends even after death, and the principles of data protection. Allowing employers carte blanche access to personal sensitive information of all pilots, whether relevant or not to flying, is overly intrusive and can undermine a therapeutic relationship. In practice, it would simply not be possible to ensure the employer had up to date records. Simply printing off hard copies on an interval basis would miss acute events, unless every doctor and airline across the world used one electronic record system. Who would be responsible for monitoring and interpreting any changes? Would this be checked every time a pilot was about to take control of a plane?

It would also rely on the pilot being honest in the information provided to their doctor and could even deter them from seeking help or lead them to hide their job from healthcare staff, which would leave them far more vulnerable and potentially dangerous to the public.

In Europe, there is a legal obligation placed on pilots to see an aeromedical examiner (AME) and stop flying should they become medically unfit. In the UK, the AME can temporarily suspend a pilot’s license on health grounds, with this information available to the Civil Aviation Authority immediately. It is for the license holder to notify the employer and to refrain from flying.

While there may be no legal obligation for an AME, GP, or occupational health physician to notify employers or regulators, there may be a suspicion that the pilot may not comply with the suspension as per General Medical Council (GMC) obligations. A doctor would then be required to breach confidentiality and notify those who could prevent the pilot from flying.

No system is failsafe and there will always be an element of trust required that the patient is being truthful about symptoms, and notifying employers. This is not unique to pilots and we as doctors have an obligation to ensure our health does not affect the care we give to others. Our colleagues too must take action should they be worried about our fitness to practise owing to ill health. Doctors are already reluctant to seek help when they are unwell and that problem would be magnified if our medical records were shared with our employers and the GMC. In fact, it could lead to more self-diagnosis and treatment, leaving patients at risk.

I would certainly feel extremely uncomfortable about my employers or regulator having access to my medical records. After all, why should they know about my trip to A+E to remove a marble from up my nose (at age three, I hasten to add)?

There are already reasonable safeguards in place to protect the public and inform employers of concerns through sick notes, occupational health and in extreme circumstances, disclosing medical information directly. Granting employers access to medical records of certain professions is a disproportionate encroachment on the privacy of many. It is also clear to me that a person determined to cause such destruction would be able to do so, regardless of the systems.

Pallavi Bradshaw is a medicolegal adviser at the Medical Protection Society.

Competing interests: None declared.