Module 13 - Managing Stress

I am so stressed out is a common statement heard in offices and homes.

What causes stress? Is there good and bad stress? How can I deal with the
conflict in the office? I have a difficult boss, how can I learn to work with him?
How can we communicate better with difficult patients? How should we work
with patients to help them get well? How do I deal with the difficult fellow
employee who manages to ruin a perfectly good day because of her attitude
and smart remarks? All of these things and more cause us stress in the office.
Stress Defined
Stress is tension. Our bodys reaction to stress may include increased heart
rate, tense muscles, increased blood pressure, and sweating. Stressed
individuals may seem confused, irritable, or unable to concentrate. We
sometimes have these symptoms even in situations that cause good stress,
such as getting married or having a baby. Stress also can be caused by
negative events such as divorce or death. In addition, certain stressful situations
affect individuals differently. For example, a job interview can be stressful for
one person but a challenge for another. Learning new computer software can
be stressful for one individual but an opportunity for another.
Common Misconceptions About Stress
There is a lot of talk about stress, and there are some common misconceptions
that are important to understand. The first misconception is that we always
know when we are under stress. Often we become so accustomed to stress
that we are unaware of it. The second misconception about stress is that it
affects only those individuals who live high-pressure lives. Stress may affect
anyone at any level. You dont have to be in a high-level job to experience
stress. Third, it is a misconception to believe that the only way to lower stress is
to change your situation or take medication. Much of our stress is based on how
we perceive the world, so if we change our perception, we may be able to
change our stress levels. Related to that misconception is the idea that stress is
caused by events that happen to us. It isnt the events in and of themselves; it is
how we view the events. The last misconception is that our emotional reactions
have a life of their own and cannot be controlled. We are able to change our
behaviour and our emotional reactions by changing how we think. Our world is
stressful, but we are able to reduce our stress levels.
Causes of Stress
There are big stressors and little stressors. Big stressors are those life-changing
events that we dont deal with every day. Little stressors are those day-to-day
problems that usually affect us for only a short period.
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Big stressors may affect us for a long time, whereas little stressors are those
daily annoyances that sometimes get out of control and lead to inappropriate
behaviour. Some stressors we can control; others are out of our control. Stress
levels are different for everyone. Some people seem to take everything in stride
and not get stressed, while others react to every little annoyance in life as if it
were a major problem.
Stress at Work
Job stress is defined as the harmful physical and emotional responses that
occur when the requirements of the job do not match the capabilities,
resources, or needs of the workers. It is important not to confuse job challenges
with job stress. Challenges on the job motivate us, and when we meet the
challenge, we feel satisfied. When people say a little bit of stress is good for
you, they are probably referring to the challenges of the job. But when the
challenge turns into job demands that cannot be met, satisfaction may turn into
stress. As an example, dealing with difficult patients is a challenge.
Continuously not having enough staff to answer the phones and deal with the
patients may cause job stress.
The government reports that 40% of workers reported that their job was very or
extremely stressful. Twenty-five percent of those surveyed thought their job was
the number one stressor in their lives. It is often hard to distinguish when
personal stress is adding to or may even be causing additional stress on the
job. For example, if an employee is dealing with any of the stressors we
mentioned, the person may not perform well on the job or may react more
strongly to those conditions on the job that normally are challenges, not
stressors.

Module 13 - Job Conditions That

Lead to Stress
What are the major conditions that lead to stress in the workplace? The nature
of the business of health care makes stress an everyday occurrence. Dealing
with people who are sick is often difficult. Stress levels increase when the job
conditions are such that it is impossible to do a good job all the time. Figure
12.3 outlines some examples of what conditions you might see in the medical
office that may create high levels of stress. You probably can make your own list
of conditions that apply in your office.
It is important to remember that continued bad stress affects our health. There
is evidence to suggest that health care expenditures are nearly 50% greater for
workers who report high levels of stress. Over the years, many studies have
looked at the relationship between job stress and health. Early signs of stress
include mood and sleep disturbances, upset stomach, and headaches as well
as disturbed relationships with family and friends. These are all quick to develop
and easy to recognize and to treat.
The long-term effects of job stress are harder to determine. Many chronic
diseases take a long time to develop and may be influenced by other factors
than stress. However, evidence is building that stress plays an important role in
several types of chronic health problems. Psychological disorders,
cardiovascular disease, and musculoskeletal disorders are the most common.

Figure 12.3 Job Conditions That Lead to Stress

Stressful working conditions as a part of the job can lead to lower productivity
and lower profitability. NIOSH reports that stressful working conditions are
associated with increased absenteeism, tardiness, and intentions by workers to
quit. Additionally, some studies suggest that organizations that are considered
healthy organizations have a better bottom line.
What Is a Healthy Organization?
It is one that has low rates of illness, injury, and disability in its workers and is
also competitive in the marketplace. Research done indicates that there are
several organizational characteristics associated with healthy workplaces and
high levels of productivity. Figure 12.4 lists those characteristics.

It is important to remember that everyone in the organization will have a slightly

different viewpoint about the four characteristics shown in Figure 12.4. No
organization is perfect. For example, you may see yourself as the hardestworking employee in the practice. You may be stressed because you dont
believe you have been recognized for your performance. However, your
definition of working hard and the organizations perception of hard work may
differ. If others in the organization are being recognized for work performance
and you arent, you might want to reassess your definition of appropriate work
performance. When everyone around you is getting promoted and you are not,
you need to review your overall performance with your supervisor. You must
also look at long-term performance. Improving your performance over just a few
months probably wont result in a promotion or pay increase.
Many organizations possess several but not all of the characteristics of a
healthy organization. In small offices, the opportunities for career development
may be limited by the size of the organization. Small, healthy workplaces focus
on recognizing performance and demonstrating how much they value the
individual worker. In larger healthy organizations, you will see more
opportunities for career development, but perhaps the larger organization may
not always recognize employees for strong work performance.

Figure 12.4 Characteristics of a Healthy Workplace

Much of this is also about perception. What you see as recognition,
opportunities, and management actions that support organizational values may
differ from how others view these actions.
What Should Organizations Do to Reduce Stress?
Because stress is different for each individual, organizations need to look at the
total environment to ensure that everything possible is being done to reduce job
stress in general. It is not possible to create a work environment without stress,
but employers should take responsibility for preventing as much job-related
stress as possible. Working toward reducing the stress in an organization may
in and of itself cause some additional stress to begin with. Figure 12.5 lists
ideas to help the organization change to help reduce job stress.
Getting an organization to seriously look at its stress problems is not easy.
There are no standardized manuals that, if followed, will lead to stress
reduction. Before implementing a major stress reduction program, it is important
to determine if the stress may be resolved by a simple solution. For example, if
one workflow process is the source of stress, work toward fixing the workflow
process. However, if the practice is experiencing low productivity, a high
turnover of employees, absenteeism, and patient complaints, it is time to look at
identifying the causes of the stress and possible solutions.
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Figure12.5 Reducing Job Stress in the Organization

A three-step approach is suggested, as shown in Figure 12.6, to help identify
the problems. To be successful, every organization should first begin to build
general awareness about the causes, costs, and control of job stress. Top
management commitment is essential to any stress prevention program, and
input should come from all employees. Employees should be involved in all
phases of the program. If the stress is causing high levels of lost productivity,
the organization should consider hiring a professional that is trained in stress
reduction programs.
We spend a great deal of time at our workplace. We cant always have the
perfect job, with little stress, so learning how to manage our stress is important
for our overall success and well-being.

Figure 12.6 Stress Prevention Plan for Organizations

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Module 13 - Managing and

Preventing Stress at the Personal
Level
There is a difference between preventing stress and managing stress. Although
we may say we would love a life free of stress, we would probably be very
bored. A stress-free life probably means you are dead! However, there are
some stressors we may be able to prevent or avoid. Other stressors are
unavoidable and will require us to manage our response to the stressful
situation.
At the beginning of the chapter, we identified the big and little stressors in life.
Sometimes more than one big stressor is a part of our life, and often a lot of
little stressors can become a big stressor for us. How do we know when we are
so stressed that it may be affecting our health? How do we determine if we are
able to prevent the stress or if we must manage it? First, lets look at the
symptoms of stress.
Stress Symptoms
Our body gives us some physical clues. Some of the physical warning signs
include sweaty palms or body sweat (that is not due to warm air temperature),
tense muscles, chronic tiredness, nervous stomach, headaches, heartburn, and
weight gain or loss. Many of us are emotional eaters, and we either eat too
much or not enough when we are stressed beyond normal limits.
Second, we react emotionally when we are stressed. We are irritable,
sometimes confused, we become angry quicker, we cant concentrate, we cant
sleep, we are always anxious, we worry about every little thing, and we may
have frequent mood swings.
Last, there may be behavioural warning signs. We overreact to little things, we
act on impulse, we change jobs frequently, we call in sick when we really arent,
and we might begin using drugs or alcohol. Some people begin to withdraw
from others and feel agitated a lot.
To determine if your stress levels are possibly affecting your health, you need to
first assess your current stressors. There are three categories: major life
changes, ongoing problems, and accidental problems or hassles. Again, it is the
big stressors and the little stressors. Most of the major life changes and ongoing
problems are big stressors. The accidental problems and hassles are little
stressors. Make a list of those events that cause stress in your life. The list will
help you identify what you can change or eliminate and what you must accept.
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For those stressors that you must accept, you will need to determine how to
cope with them.
Identify how you currently cope with stress. Are you using healthy or unhealthy
coping techniques? For example, are you exercising (healthy) or are you
drinking alcohol more frequently (unhealthy)? Are you procrastinating
(unhealthy) or attempting to balance your work and personal life (healthy)? Are
you taking breaks (healthy) or working through lunch (unhealthy)? Do you feel
sorry for yourself (unhealthy) or are you using positive thoughts (healthy)? If you
find that you are using more unhealthy techniques to reduce stress than healthy
techniques, it is time for reassessment.
Stress is a highly personalized problem, so the resolutions are also highly
personalized. Some people analyze the situation and take action to deal directly
with the issues. Others are more emotionally oriented and prefer to talk it out or
use other social supports to work through the stressful period. A third coping
style is to use distractions to keep your mind off the situations that are causing
the stress. All of us may use all of these styles, depending on the situation. The
key is to remember that you will need to modify your behaviour to reduce the
stress levels.
Preventing Stress
Some generalized techniques have been found to help prevent the physical,
emotional, and behavioural reactions to stress. Figure 12.7 provides you with
some of those techniques. They wont always work, but these ideas will help
prevent negative stress that may cause health problems. In some cases,
avoiding stress is the best solution. However, we do not always have the luxury
of avoiding the causes of stress. We must then work on how to manage the
stress.

Figure 12.7 Stress Prevention Tips

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Limiting our caffeine and alcohol intake, as well as eating vitamin Crich foods,
proteins, and complex carbohydrates, will help in stress reduction. You will
improve your health in general if you stay away from caffeine and sugar. Many
people eat more when stressed, and often it is the kind of food that is not good
for healthy lifestyles.
There is little evidence that smoking reduces stress. Much of the research
suggests that smokers are more stressed than nonsmokers, and some studies
have shown that individuals report feeling less stressed after they have quit
smoking. There is a lot of evidence that smoking is bad for us in general, so
smoking is not a good choice for a variety of reasons.

Module 13 - Managing Stress

So, how do we deal with stressful situationsthose situations that we cannot
make go away or reduce? Our ability to manage our stress so that we dont
overreact on a continuous basis is important for a healthy lifestyle.

Figure 12.8 identifies some tips for managing stress. Recognize when you will
have stress, and work on managing yourself in the stressful situation. When you
are stressed at work, try to concentrate on the positive aspects of your job. Go
into situations positively, rethinking your negative thoughts. For example,
instead of thinking or saying I will never get this done in time, think or say I
will be as prepared as I can be and get as much done as I can. Reducing
stress requires that you believe in yourself. It also requires that you rethink how
9

you view the situation. It requires that you begin to modify your behavior. You
need to be aware of your physiological and emotional reactions to stress, as
well as recognizing what you can change. It is important to use healthy coping
skills all the time. Using them will help you be ready for the times when you are
feeling overwhelmed.
How we perceive stressful events and how we react to them determine the
impact on our health. If we always respond in a negative way to stress, we are
likely to see our health and happiness suffer. We may also lose our job and our
family relationships if we dont learn to deal with the stress. The reality is that
attitude is everything when it comes to preventing and managing stress.
There is a fine line between feeling stressed out but functioning and being
burned out and in need of professional help. The term burnout was first used in
1974 by Herbert Freudenberger. He described burnout as the collapse,
exhaustion or extreme fatigue resulting from an excessive demand of energy,
strength or resources. Burnout is a psychological condition brought about by
unrelieved stress that results in exhaustion, lower resistance to illness,
increased pessimism, and possible depression. The important word in the
definition is unrelieved. We all face stress, but when there is no relief from the
sources of the stress, we may have burnout and need professional help.
How can we tell if we just have high stress levels or we are burned out? If we
are asking the question, it is best to seek professional help. Some experts
suggest that the symptoms of burnout may become so much a part of your life
that you may think you have a physical problem and not recognize the
psychological problem.
Stress is a widely used term and is often misunderstood. There are
misconceptions about stress and whether it is good or bad for us. A certain
degree of stress probably is helpful in maintaining good mental and physical
health. Organizations can learn to be proactive in preventing and managing
stress. Individuals can reduce their stress levels by using a wide variety of
techniques. The physical and mental well-being of the employees can
contribute to a positive bottom line for the medical office. The key to reducing
stress is to be ready to accept a possible change in your perceptions about the
situation at hand. A positive attitude creates a stronger workplace and healthier
lifestyle.

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Module 13 - RADIOLOGY /X-RAY

DEPARTMENT
The radiology department is concerned largely with investigative procedures.
Radiologists utilize an array of imaging technologies (such as ultrasound,
computed tomography (CT), nuclear medicine, positron emission tomography
(PET) and magnetic resonance imaging (MRI) to diagnose or treat diseases.
Interventional radiology is the performance of (usually minimally invasive)
medical procedures with the guidance of imaging technologies. The acquisition
of medical imaging is usually carried out by the radiographer or radiologic
technologist.
The main duties of the secretary in this department are typing the reports of xrays, ultrasounds and other examinations. The secretary will need fast audio
typing skills and a good knowledge of anatomical terminology. From my
experience of working as a temp in two large London hospitals, the secretarys
work is divided between typing reports from audiotape and typing from direct
dictation in the hot reporting room (sometimes conversely known as the igloo
because of the large white viewing panels around the walls). In the reporting
room the secretary sits at the computer in the darkened room next to the
radiologist who views the x-ray films on the light box and dictates his or her
findings for her to type and print out as he goes along. Familiarity with medical
terms is especially necessary here as are speed and accuracy.
There are normally about five or six consultant radiologists in a large hospital as
well as several registrars. All carry out complicated investigations and reporting
and the workload is heavy. There may be several part-time secretaries as well
as a senior full-time secretary. Reports have to be sent out to consultants,
wards and to GPs. There is little contact with patients and contact is mostly with
radiologists, radiographers and reception staff. Many telephone calls are from
GPs and hospital staff enquiring about results.
Commonly used imaging modalities include plain radiography, computed
tomography (CT), magnetic resonance imaging (MRI), ultrasound, and nuclear
imaging techniques. Each of these modalities has strengths and limitations
which dictate its use in diagnosis.

Glossary of terms used in radiology

Abdomen: The belly, that part of the body that contains all of the structures
between the chest and the pelvis . The abdomen is separated anatomically from
the chest by the diaphragm, the powerful muscle spanning the body cavity
below the lungs.
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Abscess: A local accumulation of pus anywhere in the body.

Aneurysm: A localized widening (dilatation) of an artery, vein, or the heart. At
the area of an aneurysm , there is typically a bulge and the wall is weakened
and may rupture.
Aorta: The largest artery in the body, the aorta arises from the left ventricle of
the heart, goes up (ascends) a little ways, bends over (arches), then goes down
(descends) through the chest and through the abdomen to where ends by
dividing into two arteries called the common iliac arteries that go to the legs.
Aortic aneurysm: An out pouching (a local widening) of the largest artery in the
body, the aorta, involving that vessel in its course above the diaphragm
(thoracic aortic aneurysm) or, more commonly, below the diaphragm abdominal aortic aneurysm.
Cardiomegaly: Enlargement of the heart. Cardiomegaly is a descriptive term
that is used to refer to the physical finding of an enlarged heart and is not a
disease itself.
Congestive heart failure: Inability of the heart to keep up with the demands on
it and, specifically, failure of the heart to pump blood with normal efficiency.
Effusion: Too much fluid, an outpouring of fluid.
Emphysema: A lung condition featuring an abnormal accumulation of air in the
lung's many tiny air sacs, a tissue called alveoli.
Enlarged heart: Enlargement of the heart. Also referred to medically as
cardiomegaly.
Hernia: A general term referring to a protrusion of a tissue through the wall of
the cavity in which it is normally contained.
Hiatal: Pertaining to an hiatus, an opening.
Hiatal hernia: An anatomical abnormality in which part of the stomach
protrudes up through the diaphragm into the chest
Humerus: The long bone in the arm which extends from the shoulder to the
elbow.
Nodule: A small solid collection of tissue, a nodule is palpable (can be felt).
Pleural: Pertaining to the pleura, the thin covering that protects the lungs. The
term "pleural" is pronounced like "plural" (but does not have plural meanings).
Pleural effusion: Excess fluid between the two membranes that envelop the
lungs. These membranes are called the visceral and parietal pleurae. The

12

visceral pleura wraps around the lung while the parietal pleura lines the inner
chest wall.
Pneumonia: Inflammation of one or both lungs with consolidation.
Pneumothorax: Free air in the chest outside the lung.
Pulmonary: Having to do with the lungs
Pulmonary oedema: Fluid in the lungs
Radiograph: A film with an image of body tissues that was produced when the
body was placed adjacent to the film while radiating with X-rays.
Sarcoidosis: A disease of unknown origin that causes small lumps
(granulomas) due to chronic inflammation to develop in a great range of body
tissues.
Shortness of breath: Difficulty in breathing . Medically referred to as dyspnoea
. Shortness of breath can be caused by respiratory (breathing passages and
lungs ) or circulatory ( heart and blood vessels) conditions.
Trachea: A tube-like portion of the breathing or "respiratory" tract that connects
the "voice box" (larynx) with the bronchial parts of the lungs.
Tuberculosis : A highly contagious infection caused by the bacterium called
Mycobacterium tuberculosis. Abbreviated TB.
Vertebrae: The preferred plural of vertebra

13

Module 13 - RADIOTHERAPY
Radiotherapy, also called radiation oncology, is the medical use of ionizing
radiation as part of cancer treatment to control malignant cells (not to be
confused with radiology, the use of radiation in medical imaging and diagnosis).
Radiotherapy may be used for curative or adjuvant treatment. It is used as
palliative treatment (where cure is not possible and the aim is for local disease
control or symptomatic relief) or as therapeutic treatment (where the therapy
has survival benefit and it can be curative).
Total body irradiation (TBI) is a radiotherapy technique used to prepare the body
to receive a bone marrow transplant. Radiotherapy has several applications in
non-malignant conditions, such as the treatment of trigeminal neuralgia, severe
thyroid eye disease, pterygium, pigmented villonodular synovitis, prevention of
keloid scar growth, and prevention of heterotopic ossification. The use of
radiotherapy in non-malignant conditions is limited partly by worries about the
risk of radiation-induced cancers.
Radiotherapy is used for the treatment of malignant cancer, and may used as a
primary or adjuvant modality. It is also common to combine radiotherapy with
surgery, chemotherapy, hormone therapy or some mixture of the three. Most
common cancer types can be treated with radiotherapy in some way. The
precise treatment intent (curative, adjuvant, neoadjuvant, therapeutic, or
palliative) will depend on the tumour type, location, and stage, as well as the
general health of the patient.
Radiation therapy is commonly applied to the cancerous tumour. The radiation
fields may also include the draining lymph nodes if they are clinically or
radiologically involved with tumour, or if there is thought to be a risk of
subclinical malignant spread. It is necessary to include a margin of normal
tissue around the tumour to allow for uncertainties in daily set-up and internal
tumour motion. These uncertainties can be caused by internal movement (for
example, respiration and bladder filling) and movement of external skin marks
relative to the tumour position.
To spare normal tissues (such as skin or organs which radiation must pass
through in order to treat the tumour), shaped radiation beams are aimed from
several angles of exposure to intersect at the tumour, providing a much larger
absorbed dose there than in the surrounding, healthy tissue.
Brachytherapy, in which a radiation source is placed inside or next to the area
requiring treatment, is another form of radiation therapy that minimizes
exposure to healthy tissue during procedures to treat cancers of the breast,
prostate and other organs.
One of the major limitations of radiotherapy is that the cells of solid tumours
become deficient in oxygen. Solid tumours can outgrow their blood supply,
14

causing a low-oxygen state known as hypoxia. Oxygen is a potent

radiosensitiser, increasing the effectiveness of a given dose of radiation by
forming DNA-damaging free radicals. Tumour cells in a hypoxic environment
may be as much as 2 to 3 times more resistant to radiation damage than those
in a normal oxygen environment. Much research has been devoted to
overcoming this problem including the use of high pressure oxygen tanks, blood
substitutes that carry increased oxygen, hypoxic cell radiosensitisers such as
misonidazole and metronidazole, and hypoxic cytotoxins, such as tirapazamine.
There is also interest in the fact that high-LET (linear energy transfer) particles
such as carbon or neon ions may have an antitumour effect which is less
dependent of tumour oxygen because these particles act mostly via direct
damage.
Dose
The amount of radiation used in radiation therapy is measured in gray (Gy), and
varies depending on the type and stage of cancer being treated. For curative
cases, the typical dose for a solid epithelial tumour ranges from 60 to 80 Gy,
while lymphomas are treated with 20 to 40 Gy.
Preventative (adjuvant) doses are typically around 45 - 60 Gy in 1.8 - 2 Gy
fractions (for Breast, Head, and Neck cancers.) Many other factors are
considered by radiation oncologists when selecting a dose, including whether
the patient is receiving chemotherapy, patient comorbidities, whether radiation
therapy is being administered before or after surgery, and the degree of
success of surgery.
Delivery parameters of a prescribed dose are determined during treatment
planning (part of dosimetry). Treatment planning is generally performed on
dedicated computers using specialized treatment planning software. Depending
on the radiation delivery method, several angles or sources may be used to
sum to the total necessary dose. The planner will try to design a plan that
delivers a uniform prescription dose to the tumour and minimizes dose to
surrounding healthy problems.
Fractionation
The total dose is fractionated (spread out over time) for several important
reasons. Fractionation allows normal cells time to recover, while tumour cells
are generally less efficient in repair between fractions. Fractionation also allows
tumour cells that were in a relatively radio-resistant phase of the cell cycle
during one treatment to cycle into a sensitive phase of the cycle before the next
fraction is given. Similarly, tumour cells that were chronically or acutely hypoxic
(and therefore more radio resistant) may reoxygenate between fractions,
improving the tumour cell kill. Fractionation regimes are individualised between
different radiotherapy centres and even between individual doctors. In North
America, Australia, and Europe, the typical fractionation schedule for adults is
1.8 to 2 Gy per day, five days a week. In some cancer types, prolongation of the
fraction schedule over too long can allow for the tumour to begin repopulating,
and for these tumour types, including head-and-neck and cervical squamous
15

cell cancers, radiation treatment is preferably completed within a certain amount

of time. For children, a typical fraction size may be 1.5 to 1.8 Gy per day, as
smaller fraction sizes are associated with reduced incidence and severity of
late-onset side effects in normal problems.
In some cases, two fractions per day are used near the end of a course of
treatment. This schedule, known as a concomitant boost regimen or
hyperfractionation, is used on tumours that regenerate more quickly when they
are smaller. In particular, tumours in the head-and-neck demonstrate this
behavior.
One of the best-known alternative fractionation schedules is Continuous
Hyperfractionated Accelerated Radiotherapy (CHART). CHART, used to treat
lung cancer, consists of three smaller fractions per day. Although reasonably
successful, CHART can be a strain on radiation therapy departments.
Another increasingly well-known alternative fractionation schedule, used to treat
breast cancer, is called Accelerated Partial Breast Irradiation (APBI). APBI can
be performed with either brachytherapy or with external beam radiation. APBI
normally involves two high-dose fractions per day for five days, compared to
whole breast irradiation, in which a single, smaller fraction is given five times a
week over a six-to-seven-week period.
Implants can be fractionated over minutes or hours, or they can be permanent
seeds which slowly deliver radiation until they become inactive.
Glossary of terms (volver a este punto)

16

Module 13 - Records Management

Practice
This module sets out the minimum periods for which the various records
created within the NHS or by predecessor bodies should be retained, either due
to their ongoing administrative value or as a result of statutory requirement. It
also provides guidance on dealing with records, which have ongoing research
or historical value and should be selected for permanent preservation as
archives and transferred to a Place of Deposit approved by The National
Archives.
The Annex provides information and advice about all records commonly found
within NHS organisations. For ease of use, there are separate schedules
relating to health and corporate (ie non-health) records. The retention schedules
apply to all the records concerned, irrespective of the format (eg paper,
databases, e-mails, X-rays, photographs, CD-ROMs) in which they are created
or held.
Records of the NHS and its predecessor bodies are subject to the Public
Records Act 1958, which imposes a statutory duty of care directly upon all
individuals who have direct responsibility for any such records.
Type of record: lists alphabetically records created as part of a
particular function. The business and corporate records schedule
has grouped together records of major functions commonly found
in NHS organisations.
Minimum retention period: records are required to be kept for a certain
period either because of statutory requirement or because they may be
needed for administrative purposes during this time. If an organisation
decides that it needs to keep records longer than the recommended
minimum period, it can vary the period accordingly and record the
decision and the reasons behind it, on its own retention schedule.
Records which have been selected for permanent preservation by the
relevant place of deposit should normally be transferred there as soon as
they reach the retention period specified and in any case before they
reach 30 years old, unless a longer operational retention period is
specified in this Code, in which case transfer should take place as soon
as possible after this period has been reached. NHS organizations
wishing to keep records more than 30 years old for operational reasons
beyond the minimum period specified in this Code should consult The
National Archives for advice. Note that transfers of selected records to
places of deposit will be covered by Condition 7(1) of Schedule 3 and
s.33 of the Data Protection Act 1998.

17

Derivation: notes the details of legislation and any other references of

relevance to the recommended minimum retention period.
Final action: at the end of the relevant minimum retention period, one or
more of the following actions will apply:
1) Review: records may need to be kept for longer than the
minimum retention period due to ongoing administrative need. As
part of the review, the organisation should have regard to the fifth
principle of the Data Protection Act 1998, which requires that
personal data is not kept longer than is necessary. If it is decided
that the records should be retained for a period longer than the
minimum (provided that this does not total a period of 30 years or
more from creation, in which case see the comments on the
minimum retention period above), the internal retention schedules
will need to be amended accordingly and a further review date set.
Otherwise, one of the following will apply:
2) Transfer/consult a Place of Deposit or The National Archives
(see Archives section below): if the records have no ongoing
administrative value but have or may have long-term historical or
research value, or they have some administrative value but are
more appropriately held as archives. Records with such value
must be transferred to the organisations approved Place of
Deposit. Where the organisation has no existing relationship with a
Place of Deposit, The National Archives should be contacted in the
first instance. Where an organisation is unsure whether records
may have archival value, The National Archives or the Place of
Deposit with which the organisation has an existing working
relationship should be consulted.
3) Destroy: where the records are no longer required to be kept
due to statutory requirement or administrative need and they have
no long-term historical or research value. In the case of health
records, this should be done in consultation with clinicians in the
organisation .
Note: NHS organisations have a legal responsibility to maintain records
safely and securely under Principle 7 of the Data Protection act. Patients
can gain a copy of their record by making a subject access request under
DPA, but should not normally be provided with original record itself (even
if it has reached the end of the recommended retention period and is due
for destruction) unless the permission of the Lord Chancellor has been
obtained in accordance with s.3(6) of Public Records act. More
information on the operation of s.3(6) can be obtained from the National
archives.

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Module 13 - Retention periods

As previously stated, records should not ordinarily be kept for longer than 30
years. The Public Records Act does, however, provide for records, which are
still in current use to be legally retained. Additionally, under separate legislation,
records may be required to be retained for longer than 30 years (eg Control of
Substances Hazardous to Health Regulations). The minimum retention periods
should be calculated from the beginning of the year after the last date on the
record. For example, a file in which the first entry is in February 2001 and the
last in September 2004, and for which the retention period is seven years,
should be kept in its entirety at least until the beginning of 2012.
Each organisation should produce its own retention schedules in the light of its
own internal requirements. Organisations should not apply to any records a
shorter retention period than the minimum set out in these schedules, but there
may be circumstances in which they need to apply a longer retention period.
Any decision to extend must ensure that the retention period does not exceed
30 years unless prior approval has been obtained via The National Archives.
Also, in respect of any records that contain personal data as defined by the
Data Protection Act, consideration should be given to the fifth principle of the
Act, ie that Personal data processed for any purpose or purposes shall not be
kept for longer than is necessary for that purpose or those purposes.

Archives
It is a legal requirement that NHS records which have been selected as
archives should be held in a repository that has been approved for the purpose
by The National Archives. Where an organisation is already in regular contact
with its Place of Deposit, it should consult with it over decisions regarding
selection and transfer of records. Where this is not the case, The National
Archives should be contacted in the first instance.
Some individual hospitals have themselves been appointed as a Place of
Deposit. In practice these have tended to be those larger hospitals that can
commit the resources necessary to provide appropriate conditions of storage
and access, and to place them under the care of a professionally qualified
archivist. However, it is open to any NHS organisation to apply for Place of
Deposit status. The National Archives can provide further advice on this matter,
and further information about the work of archivists in NHS organisations is
available from the Health Archives Group.
Where possible, the schedules identify those records likely to have permanent
research and historical value. Beyond this, some NHS organisations will have
particular and individual reasons, which relate to their own history, for retaining
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particular records as archives. Conversely, it should also be borne in mind that

some records may have a long-term research value outside the NHS
organisation that created them (eg both administrative and clinical records from
a number of different hospitals have been used to study the 1918 influenza
epidemic). The Health Archives Group will advise on the current and potential
research uses of NHS archives, including patient records.

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Module 13 - Minimum retention

period
This retention schedule details a Minimum Retention Period for each type of
health record. Records (whatever the media) may be retained for longer than
the minimum period. However, records should not ordinarily be retained for
more than 30 years. Where a retention period longer than 30 years is required
(eg to be preserved for historical purposes), or for any pre-1948 records, The
National Archives (see note 1 below) should be consulted. Organisations should
remember that records containing personal information are subject to the Data
Protection Act 1998.
The following types of record are covered by this retention schedule (regardless
of the media on which they are held, including paper, electronic, images and
sound, and including all records of NHS patients treated on behalf of the NHS in
the private healthcare sector):
Patient health records (electronic or paper-based, and concerning all
specialties, including GP medical records); records of private patients
seen on NHS premises;
Accident & Emergency, birth and all other registers;
Theatre, minor operations and other related registers;
X-ray and imaging reports, output and images;
Photographs, slides and other images;
Microform (ie microfiche/microfilm);audio and video tapes, cassettes, CDROMs, etc;
E-mails;
Computerised records; and
Scanned documents.
Where an organisation has an existing relationship with an approved Place of
Deposit, it should consult the Place of Deposit in the first instance. Where there
is no pre-existing relationship with a Place of Deposit, organisations should
consult The National Archives.
The coding below denotes the status of the type of record and its retention
period:
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C = a previously existing record type (ie referenced in the previous

retention schedule dated March 2006) but a Change to the retention
period
N =a New record type (either not referenced in the previous retention
schedule or a more explicit description of a record type than previously
published)
S = a previously existing record type, with the Same retention period.

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Module 13 Assignment
Welcome to your Module 13 Assignment.
Please note that all your work for this assignment should be saved in one document and it
should follow the following title requirements:
Medical Secretary_ Module 13_Your Name
Part 1:
Write a 500 word essay on how you prevent and cope with job stress.
Part 2:
From:

Module 13 - Medical Secretary - Minimum retention period

Please select the Type of Health Records that are likely to be found in a GP practice.
The list must include the Type of Health Record and the minimum retention period.

Please read below before submitting your assignment:

1. You must ensure that you have COMPLETED the assignment and all the requirements before
submitting your work.
2. In order to successfully complete your module you are required to achieve a minimum pass
mark of 75%.
3. By submitting your assignment you indicate that you have understood the following statements:
This assignment is my own original work, except where I have appropriately cited the original
source ( References for text or images used )
This assignment has not previously been submitted for assessment in this or any other subject.

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 If it is deemed that my assignment includes unoriginal work that is not referenced, my assignment
will be failed with no option to resubmit.

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