The Cervical Screening Programme (CSP), although not without its problems, has been successful in reducing the incidence of, and mortality from, invasive cervical cancer.1 It is notable that this success has been achieved without the loss of confidentiality of the private medical records of participating women.

With a view to improving the evaluation of the Programme, open access to the private medical records of all women on the CSP has been granted. This access is not limited to the records of the 150–200 women who develop invasive cervical cancer each year, and has no safeguards.

In my opinion, this unfettered access is not only unnecessary but also wrong.

Open access to the private medical records of women means a loss of confidentiality of the doctor-patient relationship. Furthermore, confidentiality is essential for patients to have trust in their doctor, and trust is essential for patients to receive appropriate care.

When caring for a patient, a doctor has access to a patient’s body and personal details, and the patient willingly allows this invasion of privacy. The information is given in trust that it will be used solely for the purposes of obtaining an appropriate diagnosis and treatment. To respect the privacy of this information is to respect the patients themselves, and accordingly to justify the trust that is placed in the doctor.

Any use of this information, other than that for which the patient has authorised, represents an invasion of the privacy of the patient, and a breach of the trust that made the patient willing to consult the doctor in the first place.2 Allowing the CSP evaluators open access to this information represents a betrayal of this basic trust that a patient places in her doctor.

If a patient does not have faith that the information she hands over will be kept confidential, then she may withhold information—this in turn may lead to her receiving an incorrect diagnosis and inappropriate treatment. With this new Act in place, women will no longer be able to confide in confidence; there is now the fear of ‘Big Mother’ watching them and monitoring them.

Contrary to the reassurances of the CSP, there are no safeguards to this access. There is no way a doctor can cover up (or withhold) any information deemed unnecessary to the CSP evaluators, and (until they have looked through everything) there is no way the evaluators can work out what is necessary for their evaluation process. In practice, the evaluators have the ability to waltz into a private medical clinic, demand a woman’s notes, and sit down to peruse them at their leisure. Confidentiality is like pregnancy—you cannot have just a little bit of it; it is all or nothing.

When the CSP was first introduced, women were promised absolute confidentiality of their medical records—but, down the track, we find this promise has been broken. How can we expect people to have faith in a health system that breaks promises and overrides individual rights?

Anyway, who stands to benefit from this policy change? Certainly not individual women who can opt off the Programme—and yet continue to have regularly cervical smears, recall and appropriate treatment. Not women as a whole, either because there may well be a backlash against the Programme as a result of this Act. By showing a complete lack of regard for the doctor–patient relationship, and a lack of respect for the individual rights of women, the CSP risks losing cooperation of women and their smear takers, which in turn may lead to the eventual downfall of the Screening Programme. The effectiveness of the CSP, depends on increasing the number of women participating in the Programme and on improving the evaluation of the Programme.

Evaluation of the Programme could be improved if it was done regularly using pre-existing evaluation strategies. If women were contacted for consent close to the time of their smear being taken, then they would not have died or disappeared without trace as claimed.

Failing to obtain consent before accessing the medical records of women betrays a complete lack of respect for the individuals concerned, and treats women as sources of useful information rather than as individuals worthy of respect. It is also showing a complete lack of regard for the value of the therapeutic doctor-patient relationship. No wonder people are turning away in their droves from traditional medicine towards alternative healthcare when we treat them in this way.

Academics driving the way forward in healthcare, with the emphasis on evidence-based medicine and showing little regard for the individual, are, in my opinion, largely to blame.