DISCOVERIES REPORTS (ISSN 2393249X), 2021, volume 4
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CITATION: Murtaza MM, Ali S, Shahbaz W, Elger BS. Doctor-patient confidentiality: a cross-sectional study of opinions among medical students and doctors. Discoveries Reports 2021, 4: e16. DOI: 10.15190/drep.2021.1
Submitted: January 12, 2021; Revised: February 14, 2021; Accepted: February 17, 2021; Published: March 11, 2021;
Doctor-patient confidentiality: a cross-sectional study of opinions among medical students and doctors
Muhammad Murad Murtaza (1), Shehrbano Ali (1,*), Warda Shahbaz (1), Bernice S. Elger (2)
(1) CMH Lahore Medical College, Lahore, Pakistan
(2) Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
* Corresponding author: Shehrbano Ali, CMH Lahore Medical College, Lahore, Pakistan. Email: shehrbanoali@gmail.com; Phone: 00923124950312
Abstract
Background: Confidentiality is a fundamental ethical principle. However, its limitations are not always well known by medical professionals. This may lead to breaches or encourage upholding it even when there is an overriding ethical or legal obligation. The aim of this study is to assess the degree of awareness among doctors and medical students in Pakistan, regarding patient confidentiality and its limitations, and what factors influence this awareness.
Methods: A cross-sectional study was carried out including 379 individuals: 217 medical students and 162 doctors from different areas of Pakistan. They were asked to complete a questionnaire that included different scenarios of violation of patient confidentiality. Participants were asked to mark the degree of violation in every case according to their opinion.
Results: 74.9% of the respondents agreed that mentioning names of patients to spouses is a breach of confidentiality. Fewer respondents considered breaches in cases of sharing the diagnosis of a politician without naming (58%); sharing information with another doctor (64.3%), sharing information with the police following a theft (48.5%), sharing information with a forensic pathologist (39.3%), sharing information with non-medical colleagues (77%). A majority (88.1%) considered it unethical for a computer specialist to take home patient information. Opinions were influenced by the age of medical students, but not of doctors.
Conclusion: Our study showed some awareness about confidentiality and its limitations. However, there is a lot of room for improvement. Knowledge of medical professionals remains stagnant throughout their career despite increase in patient exposure and experience. Thus, there is a need for continuous education of students and doctors alike, which currently does not exist internationally. Not only is it important to inculcate medical ethics as an individual subject in the medical degree, but refresher courses should also be conducted for doctors to ensure that they remain mindful and aware of their obligations regarding confidentiality.
References
1. Mahmood K: Informed consent and medical ethics. Ann King Edward Med Coll 2005, 11:247-9.
2. Humayun A, Fatima N, Naqqash S, Hussain S, Rasheed A, Imtiaz H, et al. Patients' perception and actual practice of informed consent, privacy and confidentiality in general medical outpatient departments of two tertiary care hospitals of Lahore. BMC Med Ethics. 2008;9(1):14.
3. Baird G. Confidentiality: what everyone should know, or, rather, shouldn’t. Br J Gen Pract 2008; 58(547): 131-133.
4. Tremayne-Lloyd T. Confidentiality. Disclosure to a patient’s family. Can Fam Physician 2003; 49:300-1.
5. Sankar P, Mora S, Merz JF, Jones NL: Patient perspectives of medical confidentiality: a review of the literature. J Gen Intern Med 2003, 18: 659-69.
6. Pakistan Medical and Dental Council Code of Ethics 2010. PMDC. Accessed on: January 20, 2020). http://www.pmdc.org.pk/LinkClick.aspx? fileticket=v5WmQYMvhz4%3D&tabid=102&mid=554.
7. Confidentiality. American Medical Association. 2021. Accessed on: February 15, 2021. Available from: https://www.ama-assn.org/delivering-care/ethics/confidentiality.
8. Code of Ethics 2004. Editorially Revised 2006. Revised 2016. AMA. Accessed on: January 20, 2020. http://www.ama.com.au/codeofethics.
9. Mathews B, KennyMC. Mandatory reporting legislation in the United States, Canada, and Australia: a cross-jurisdictional review of key features, differences, and issues. ChildMaltreat 2008; 13(1): 50–63.
10. Gupta M. Mandatory reporting laws and the emergency physician. Ann Emerg Med 2007; 49(3): 369–376.
11. Houry D, Sachs CJ, Feldhaus KM, Linden J. Violence-inflicted injuries: reporting laws in the fifty states. Ann Emerg Med 2002; 39(1): 56–60.
12. Grady C, Jacob J, Romano C. Confidentiality: a survey in a research hospital. J Clin Ethics 1991; 2(1): 25–30; discussion 30–44.
13. Anonymous. Medical confidentiality and the law. BMJ (Clin Res Ed) 1981; 283: 1062.
14. Shrier I, Green S, Solin J, Duarte-Franco E, et al. Knowledge of and attitude toward patient confidentiality within three family medicine teaching units. Acad Med 1998; 73(6): 710–712.
15. Scott K, Dyas JV, Middlemass JB, Siriwardena AN. Confidentiality in the waiting room: an observational study in general practice. Br J Gen Pract 2007; 57(539): 490–493.
16. Lindenthal JJ, Thomas CS. Psychiatrists, the public, and confidentiality. J Nerv Ment Dis 1982; 170(6): 319–323.
17. Rodriguez MA, McLoughlin E, Nah G, Campbell JC. Mandatory reporting of domestic violence injuries to the police: what do emergency department patients think? JAMA 2001; 286(5): 580–583.
18. Elger, B.S. Violations of medical confidentiality: Opinions of primary care physicians. British Journal of General Practice 59(567): e344–e352.
19. Elger BS, Harding TW. Avoidable breaches of confidentiality: a study among students of medicine and of law. Med Educ 2005; 39(3):333–337.
20. Weiss BD. Confidentiality expectations of patients, physicians, and medical students. JAMA 1982; 247(19): 2695–2697.
21. Rodriguez MA, Craig AM, Mooney DR, Bauer HM. Patient attitudes about mandatory reporting of domestic violence. Implications for health care professionals.West J Med 1998; 169(6): 337–341.
22. Zubair, Syed Sohaib & Khan, Mukaram. (2014). Police Violence in Pakistan: Forms and Justifications. Research on Humanities and Social Sciences ISSN (Paper) 2224-5766 ISSN (Online) 2225-0484; 4: 63-68.
