Cases/Continuity and Quality of Care, Safety and Prescribing

Woman Asking You to Delete Her Depression History Before A Job Medical — Free SCA Practice Case

Woman asking you to delete her depression history before a job medical

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Data Gathering

History, ICE & Diagnosis

Clinical Management

Diagnosis, Plan & Decisions

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Materials for Candidate

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Patient Profile

Full Name

Thandiwe Quayle

Age

35 years

Consultation Type

Telephone

Age

Situation

Telephone Consultation. Routine appointment booked by the patient.

Reason for Encounter

"I'm applying for a job and I'd like my depression taken off my records, please."

Medical Records

●PMH: Depression, first entered 10 years ago, listed as an active problem. Consultation notes: PHQ-9 score 14, sertraline 50 mg for six months, six counselling sessions, discharged well. No mental health consultations since.
●Medications: None.
●Allergies: NKDA.
●Social: Housing officer with the local council. Non smoker, drinks little.

Patient Script

For the friend playing the patient role

Character Overview: You are Thandiwe Quayle, a 35 year old housing officer at the local council. You live with your partner in a rented flat and your sister Zodwa lives nearby. For years you have wanted to be a police officer. You have passed the assessment centre and received a conditional offer, and the next stage is a health declaration and a medical check run by the force's occupational health service. Ten years ago, at 25, you had about six months of depression after your dad died and you were working long hours. You took sertraline, had a short course of counselling and got better. You have not needed any help since, and you feel well now. You are articulate, organised and quietly determined, and you talk quickly when you are anxious. You have rehearsed this call and expect it to be a simple admin request. You are polite but you become tight and defensive if the doctor sounds judgemental, and you soften quickly if the doctor takes your career seriously. You are not angry with the practice. You are frightened that one line in your records could cost you the job you have wanted for ten years.

Opening Sentence: "Hello, doctor. I'm applying to join the police and there's a health form coming up. I had depression about ten years ago, and I'd like it taken off my records, please, so it doesn't come up."

History if Asked (Data Gathering Phase)

●The episode: "It was ten years ago, when I was 25. My dad had just died and I was doing silly hours at work. I stopped sleeping, I cried at nothing and I couldn't see the point of anything. It lasted about six months."
●Treatment: "My GP at the time put me on sertraline, 50 milligrams. I took it for about six months, then we stopped it. I also had six sessions of counselling. After that I was discharged and I've never needed to come back."
●The worst point: "If I'm honest, for a couple of weeks I thought people would be better off without me. I never had a plan and I never did anything. It passed once the tablets kicked in."
●Since then: "Nothing. No relapses, no tablets, no counselling, no appointments about it. I've had a smear and a coil check, that's all."
●How I am now: "I'm fine. Mood is good, I sleep well, I'm enjoying work and running most weekends. I'm nervous about the application, but that's all."
●Thoughts of harming myself now: "No, never now. Not for ten years."
●Why now: "The police have sent a health declaration and they said their occupational health team may contact my GP. I read the form and it asks whether I've ever had treatment for a mental health condition. That's why I rang."
●What the form asks: "Whether I've ever been treated or seen anyone for a mental health problem. I haven't filled it in yet. I've printed it, and it's sitting on my kitchen table."
●Consent so far: "I haven't signed anything for them to contact you. I don't really know what I'd be agreeing to."

Ideas, Concerns, Expectations

Gating note: Thandiwe does not raise any of the following herself. Each part comes out only when the doctor asks what she thinks, what is worrying her, or what she was hoping for.

●Ideas: She believes that because her data belongs to her, she has a legal right to have anything deleted. She thinks that if the entry is gone then nobody can see it, and the declaration will be simple. "It's my information, isn't it? Under the data protection rules, I thought you had to delete it if I asked."
●Concerns: Her main fear is that the history will count against her. Her cousin was turned down by another force a few years ago, and she believes it was because of anxiety. "My cousin was told he wasn't suitable after he mentioned anxiety. I've worked ten years for this. I can't lose it over something that finished a decade ago." Underneath, she is embarrassed that she was ever that low.
●Expectations: She expects the entry to be removed today. Only if the doctor explores the declaration does she admit the plan: "If it isn't on my records, then I suppose I could just tick no. They'd never know, would they?"

If Asked: Medical History and Medications

Gating note: Thandiwe answers each of these plainly when the doctor asks about it.

●Other health problems: "Nothing. I had my appendix out as a teenager. Otherwise I'm healthy."
●Medicines: "None at all. Not even the pill. I have a coil."
●Allergies: "None."
●Alcohol, drugs, smoking: "I'll have a glass of wine at the weekend. I've never smoked and I don't take drugs."
●Anxiety, panic, trauma, sleep problems: "No. Just the stress of the application, which is normal."
●Family history: "My mum has been on antidepressants and she's fine. Nothing else."
●Whether the record is wrong: "No, it's all true. I did have it. I just don't want it there. I wouldn't say anything in it is wrong."
●What the record says: "I haven't seen it. I don't know whether it says active or finished. I just assumed it's there for ever."

Social History and Lifestyle Impact

●Work: Housing officer at the council for eight years. She likes her job but has always wanted something more active and with purpose. She would take a pay cut to join the police.
●Home: Lives with her partner, who is fully supportive. Her sister Zodwa told her to ring the surgery and "just ask them to wipe it".
●Running: She runs 10 kilometres most weekends and has entered a half marathon. She has already passed the fitness test for the recruitment process.
●Finances: She has not told her employer. If the offer were withdrawn she would be devastated, but she would stay in her current job.
●Availability: She can speak now. She has about 20 minutes before a meeting and says so only if asked.

If Asked: Associated Symptoms

Gating note: Thandiwe answers each of these briefly when the doctor asks.

●Low mood, loss of interest, energy: "No. I'm the opposite at the moment, if anything. I'm buzzing about the job."
●Sleep and appetite: "Normal. I've been waking early once or twice with the application on my mind, but that's all."
●Worry, panic, racing thoughts: "I worry about the form, nothing else."
●Suicidal thoughts or self harm now: "No. I'd tell you if I did."
●Hopelessness: "No. I've got plans. That's what makes me so keen to protect them."

Responses to Management (The Negotiation Phase)

●If the doctor says the entry cannot be deleted: Reaction: Defensive and a little thrown. "But it's my data. I thought under GDPR I could ask for it to be erased. Why can't you just delete it? It was ten years ago."
●If the doctor explains the record is kept for her care and that rectification only applies to inaccurate entries: Reaction: Slowly accepting. "So it's only if something's wrong, and it isn't wrong, it's just old. So I can't make you delete it. Is there anything I can do about it at all?"
●If the doctor asks about the declaration or raises honesty: Reaction: Embarrassed, then honest. "I did think I could just tick no if it wasn't on my record. Is that really such a big deal? Who would ever know?" She is relieved, not angry, when the doctor explains the risks of a false answer. "I suppose I'd be starting my career on a lie. I hadn't thought of it like that."
●If the doctor explains that the force can only get a report with her signed consent, and she can see it first: Reaction: Interested. "So they can't just look at my records? And I can read what you write before they get it? Can I ask you to change it if I don't agree?" She wants to know how long she has and whether she can refuse.
●If the doctor offers to update the problem to show it ended ten years ago, and to describe in any report that she has been well and off treatment since: Reaction: Visibly relieved. "That's actually what I wanted, really. For it to say it's over rather than still active. Would you really put that I've been well for ten years?"
●If the doctor is asked, or offers, whether this will stop her joining: Reaction: Anxious. "Do you think they'll turn me down? Is one episode from ten years ago going to count against me?" She accepts that the doctor cannot promise the answer and wants to know what she can do to prepare.

Mark Scheme

Domain 1: Data Gathering and Diagnosis

0 / 16 indicators checked+0−0

Positive (0/8)

Negative (0/8)

Domain 2: Clinical Management and Medical Complexity

0 / 22 indicators checked+0−0

Positive (0/11)

Negative (0/11)

Domain 3: Relating to Others

0 / 14 indicators checked+0−0

Positive (0/7)

Negative (0/7)

Clinical Learning Points

The Core Dilemma and the Model Plan

●Thandiwe is a well 35 year old who had one treated episode of depression ten years ago. She has a conditional offer to join the police and a health declaration to complete, and she wants the entry deleted so it cannot "come up". The station tests probity and records: refusing to erase accurate entries, explaining her real data rights, and handling consent for employer reports.
●The model plan has six parts. Decline to delete or conceal an accurate record, with reasons she can follow. Explain what she can do instead. Make the record accurate by showing the problem as resolved. Explain that the force has no direct access and that any report needs her written consent. Advise her to answer the declaration truthfully. Offer an accurate, balanced report that says the episode was single, treated, resolved and has not recurred.
●Acceptable alternatives: updating the problem list during the call or immediately afterwards, offering her a copy of her record so she can see what it says, asking her to put any formal request in writing, or involving the practice manager or data protection officer for the formal process. A brief check of her current mood is expected, but starting treatment or arranging a mental health referral is not.

Why an Accurate Record Is Not Deleted on Request

●The record exists for continuity and safety. A future clinician prescribing, assessing mood or reviewing a relapse needs to know about past depression and its treatment. Good medical practice (GMC, 2024) requires formal records, including patients' records, to be clear, accurate, contemporaneous and legible (records section).
●Removing a true entry because it is inconvenient would make the record misleading. A doctor who agreed would be acting dishonestly, because Good medical practice also requires information you communicate as a medical professional to be accurate, not false or misleading, and not to leave out relevant information deliberately (honesty section).
●The same principle covers softer versions of the request, such as "just make it say something vaguer" or "don't mention it if they ask". Neither is an acceptable compromise.

What the Data Protection Rights Actually Give Her

●Erasure. The ICO explains that the right to erasure applies only in defined circumstances, and it does not apply to special category data such as health data where keeping it is necessary for medical diagnosis, the provision of health care, or the assessment of working capacity, when handled by or under a professional with a duty of secrecy. A GP record falls squarely within this. She cannot demand its deletion.
●Rectification. She can ask for inaccurate or incomplete data to be corrected. A diagnosis she disliked is not inaccurate. The ICO notes that where something is later found to be wrong, the record should usually show both the original entry and the correction, which keeps an accurate account of care.
●Disagreement. Where the practice declines a correction, the ICO says that as good practice it should record that the patient challenged the data and why. Patients can therefore ask for their view to be noted. Where an entry is a clinician's opinion, it is hard to call it inaccurate if the record makes clear it is an opinion and whose.
●Process. A request can be made verbally or in writing, the practice should reply within one month (extendable in some circumstances), and an unhappy patient should complain to the practice first and then to the Information Commissioner's Office. The ICO currently notes that its guidance is under review following the Data (Use and Access) Act, so avoid quoting finer detail than you need.

Making the Record Accurate

●Her problem list still shows depression as active with no end date. That is an inaccuracy the practice can fix. Mark the problem as past or resolved with a sensible end date, leaving the original consultation entries as they are. This is a genuine rectification, because an active entry wrongly implies current illness.
●It also helps her. A resolved entry from ten years ago, with a note of full recovery and discharge, reads very differently from an unexplained active diagnosis.
●Do not alter dates, change codes to a milder diagnosis, or remove the consultation notes. Document what was changed, when and why.

Consent and the Access to Medical Reports Act 1988

●The Act covers a medical report prepared for employment or insurance purposes by a doctor who is or has been responsible for the person's clinical care. An employer cannot apply without first notifying the person, and the person must consent (section 3).
●She can say she wants to see the report before it is sent. The doctor must not send it until she has had access, or 21 days have passed without her replying (section 4). Access may be by inspection or a copy, and a reasonable fee may be charged for a copy.
●She can ask in writing for amendments to anything she considers incorrect or misleading. If the doctor will not amend it, she can ask for a statement of her views to be attached. The report cannot be sent without her consent after she has seen it (section 5).
●The doctor must keep a copy for at least six months, and she can see it during that period (section 6). A limited exemption applies where disclosure would risk serious harm or reveal a third party's information (section 7).
●The force does not have access to her record. Explaining this removes much of her anxiety and gives her control.

The Health Declaration and Honesty

●The declaration is hers to complete, not the doctor's. The role of the GP is to say, calmly, that a true answer is the safest course. A false declaration can lead to the offer being withdrawn if it comes to light, and it creates a fresh integrity problem that is worse than a single resolved episode.
●The doctor must not help her conceal anything, and should not confirm "nothing on record" to anyone. Good medical practice (honesty and integrity) requires honesty and integrity, including that information given as a medical professional is accurate and not misleading.
●Raising this does not require accusing her. Many people think of this shortcut when frightened. The way to handle it is to ask what the form says and how she plans to answer, and then explain the risk without blame.

A Fair and Useful Report

●If the force asks for a report and she consents, the doctor should answer the questions asked, accurately and completely on relevant points. Here the favourable facts are true: a single episode, around six months, treated with medication and counselling, discharged well, no relapse or treatment for ten years, and no current symptoms.
●Reports should be proportionate. Include what is relevant to the question, and not unrelated entries. She should see the report first and can ask for amendments.
●Occupational health decide fitness for the role on current evidence, individually. The practice cannot promise the result and should not say a past episode will definitely bar or definitely not bar her. That outcome is unknown, and honest uncertainty is better than false reassurance.
●Check how she is now and ask about thoughts of self harm. Stress about the application can unsettle people, so offer an open door. She does not need treatment.

Common Mistakes in This Station

●Agreeing, even quietly, to remove, hide or soften the entry, or to leave the depression out of a report.
●Refusing without explaining or giving only "it's policy". She hears obstruction and may ask a colleague who says yes.
●Misstating the law by saying she has an absolute right to erasure, or that patients can never have anything corrected.
●Missing the resolved status. The practice can fix the active entry.
●Lecturing her when she reveals the idea of ticking no.
●Implying the employer can read the record, or forgetting she can see and amend the report first.
●Promising she will or will not get the job.
●Skipping the mental state and risk check, or turning a request about records into a depression assessment.
●Leaving no documentation of the request and decision.

Mapped to the RCGP curriculum topic: Continuity and Quality of Care, Safety and Prescribing.

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