Showing papers by "General Medical Council published in 2003"

Epidemiology of cutaneous melanoma and non‐melanoma skin cancer in Schleswig‐Holstein, Germany: incidence, clinical subtypes, tumour stages and localization (epidemiology of skin cancer)

Abstract: Summary Background Population-based figures on skin cancer are essential for a realistic assessment of the personal disease burden, prevention modes and the need for caring. The Robert Koch Institute in Germany estimates the incidence of melanoma skin cancer as seven cases in 100 000 persons (age-standardized by the European standard rate). Population-based studies presumably show higher incidence rates of 10–16 cases in 100 000 persons. Few data exist for non-melanoma skin cancer (NMSC) as this is not systematically registered in Germany. Objectives To present the first population-based results from the Schleswig-Holstein (Germany) Cancer Registry on incidence, stage distribution, clinical types and localization of skin cancer and to compare the results with other studies. Methods The Cancer Registry of the Bundesland Schleswig-Holstein with 3500 registering institutions, 100 of which are dermatological institutions, investigates all notifiable incident cancer cases according to international standards. From the recorded data all melanoma and NMSC cases were identified and evaluated. Results Between 1998 and 2001, 1784 malignant melanoma (MM) and 12 956 NMSC cases underwent diagnostic and analytical evaluation. For MM, age-standardized incidence rates were 12·3 and 14·8 in 100 000 men and women, respectively, and the mean age of men was greater than that of women (56·6 vs. 54·9 years, P < 0·05). Superficial spreading melanoma was the most frequent clinical type (39·1%). The tumours were predominantly located on the trunk in men (46·8%) in contrast to leg and hip in women (39·5%). For NMSC, the age-standardized incidence rates were 100·2 and 72·6 in 100 000 men and women, respectively. More than 80% of all tumours were basal cell carcinoma. Conclusions The first population-based data from Schleswig-Holstein on the characteristics (age, sex, histological subtypes, localization and stage) of skin tumours agree well with the existing literature and may thus be regarded as representative. However, markedly higher incidences for MM and NMSC in the north of Germany compared with other parts of the country were observed. As the incidence rates from the north of Germany fit well into the European geographical pattern, we assume no regional increase. Therefore, the official German estimates on cutaneous tumours may largely depend on regional factors and may not be regarded as representative for all regions in Germany.

Confidentiality and the duties of care

Abstract: Doctors have an ethical and legal duty to respect patient confidentiality. We consider the basis for this duty, looking particularly at the meaning and value of autonomy in health care. Enabling patients to decide how information about them is disclosed is an important element in autonomy and helps patients engage as active partners in their care. Good quality data is, however, essential for research, education, public health monitoring, and for many other activities essential to provision of health care. We discuss whether it is necessary to choose between individual rights and the wider public interest and conclude that this should only rarely be necessary. The paper makes some recommendations on practical steps which could help ensure that good quality information is available for work which benefits society and the public health, while still enabling patients' autonomy to be respected.

The view of the General Medical Council.

Abstract: Information about a patient's health is recorded in order to provide for that patient's care. Most patients will not think about the other uses for their data and many assume that the information they provide will go no further than the health care professionals who have been caring for them. Information collected about patients is essential for developments in our understanding of health and health care. Most patients will be happy to allow their data to be used for these purposes, once this has been explained. Health care professionals have an obligation to ensure that patients know when identifiable data about them are to be used and to get their agreement about making disclosures. We know that this is not easily achieved; doctors, nurses and others providing care are already over-stretched. Patients may be anxious about their condition and treatment. They may not, for a variety of reasons, read leaflets or letters sent or given to them. This does not mean our obligations to respect patients by keeping them informed and seeking their agreement can be ignored. Openness about how health care professionals work and partnership with patients are essential to the continued trust of the public in the professions. The challenge is not to answer the question whether we need consent but rather how we can best obtain it.