Challenges of Confidentiality in Clinical Settings: Compilation of an Ethical Guideline
AbstractAbstract Background: Respecting patients confidentiality and privacy are considered as the patients’ rights. Confidentiality is the key virtue for trust building in physician-patient relationship. While law considers confidentiality as absolute except for legal situations, despite efforts to maintaining confidentiality, sometimes breaching confidentiality is unavoidable but not necessarily unethical. There is no Iranian unified ethical guideline to define clear approaches to patient confidentiality in clinical setting. To keep all medical data confidential it is necessary to identify the scope of the problem. In this study, we aimed at identifying the scope of the problem. Methods: This study was conducted in three phases including literature review, qualitative study (semi-structured interview) and focus group discussion. The literature review provided a framework for the second phase. Results: The content analysis of the interviews presented 3 main themes indicating problems in maintaining confidentiality in clinical setting including management issues, organizational ethics and physician-patient relationship. Conclusion: Based on the results a draft guideline in confidentiality in clinical setting was prepared and finalized in focus groups discussions.
General Medical Council [GMC] (2017). Confidentiality: good practice in handling patient. Available at https://www.gmc-uk.org/-/media/documents/confidentiality-good-practice-in-handling-patient-information---english-0417_pdf-70080105.pdf
Mechanic D, Meyer S (2000). Concepts of trust among patients with serious illness. Soc Sci Med, 51(5): 657-68.
Flynn HA, Marcus SM, Kerber K, Alessi N (2003). Patients concerns about and per-ceptions of electronic psychiatric records. Psychiatr Serv, 54(11): 1539-41.
Sankar P, Moran S, Merz JF, Jones NL (2003). Patient perspectives of medical confidentiality: a review of the literature. J Gen Inter Med, 18(8): 659-69.
Maddick AF, Laurent S (2012). Consent, competence and confidentiality for chil-dren and young people: case problems from osteopathic practice. Intern J Osteo-pathic Med, 15(3), 111-19.
Beltran-Aroca CM, Girela-Lopez E, Colla-zo-Chao E et al (2016). Confidentiality breaches in clinical practice: what hap-pens in hospitals? BMC Med Ethics, 17(1): 52.
Elger BS (2009). Violations of medical con-fidentiality opinions of primary care phy-sicians. Br J Gen Pract, 59(567): e344-52.
TysonP (2011). The Hippocratic oath today. www.pbs.org/wgbh/nova/body/hippocratic-oath-today.html
U.S. Department of Health & Human Ser-vices (2009). Summary of the HIPAA Pri-vacy Rule. Available at https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html
Jonsen AR, Siegler M, Winslade WJ (2010). Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine. 7th ed. McGraw-Hill. New York, USA.
Tobin BM, Leeder SR, Somerville ER (2002). Community versus individual benefit. Med J Aust, 176(6): 279-80.
Agyapong VI, Kirrane R, Bangaru R (2009). Medical confidentiality versus disclosure: ethical and legal dilemmas. J Forensic Leg Med, 16(2): 93-6.
American Medical Association [AMA] (2011). The AMA Code of Medical Eth-ics’ opinions on confidentiality of patient information. http://virtualmentor.ama-assn.org/2011/07/coet1-1107.html
General Medical Council [GMC] (2013). Confidentiality: protecting and providing information.Availablea thttp://www.gmcuk.org/guidance/ethical_guidance/confidentiality_53_56_disclosures_to_protect_others.asp
British Medical Association [BMA] (2011). Confidentiality and disclosure of health information. https://www.bma.org.uk/-/media/files/pdfs/practical%20advice%20at%20work/ethics/confidentialitytoolkit_full.pdf?la=en
Conseil National de L'Ordre des Médecins (2013). French code of medical ethics. Confidentiality, Ar-ticle 4. Available at https://www.conseil-nation-al.medecin.fr/sites/default/files/code_de_deontologie_version_anglaise_1.pdf
Guedj M, Sastre MT, Mullet E, Sorum PC (2009). Is it acceptable for a psychiatrist to break confidentiality to prevent spous-al violence? Intern J Law Psychiatr, 32(2): 108-14.
Tarasoff V. Regents of the University of California (1976).
Berlin ED, Bravender T (2009). Confidenti-ality, consent and caring for the adoles-cent patient. Curr Opin Pediatr, 21(4): 450-6.
Spear S, English A (2007). Protecting confi-dentiality to safeguard adolescents’ health: finding common ground. Contraception, 76(2): 73-6.
Lehrer JA, Pantell R, Tebb K, Shafer MA (2007). Forgone health care among U.S. adolescents: associations between risk characteristics and confidentiality con-cern. J Adolesc Health, 40(3): 218-26.
Ford CA, Millstein SG, Halpern-Felsher BL, Irwin CE Jr (1997). Influence of physi-cian confidentiality assurances on adoles-cents’ willingness to disclose information and seek future health care. A random-ized controlled trial. JAMA, 278(12): 1029-34.
Klein JD, Wilson KM, McNulty M, Kapphahn C, Collins KS (1999). Access to medical care for ado-lescents: results from the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls. J Adolesc Health, 25(2): 120-30.
Duncan RE, Vandeleur M, Derks A, Sawyer S (2011). Confidentiality with adolescents in the medical setting: what do parents think? J Adolesc Health, 49(4): 428-30.
McKee MD, ÓSullivan LF, Weber CM (2006). Perspectives on confidential care for adolescent girls. Ann Fam Med, 4(6): 519-26.
Gilbert AL, Rickert VI, Aalsma MC (2014). Clinical conversations about health: the impact of confidentiality in preventive adolescent care. J Adolesc Health, 55(5): 672-7.
Lawrence RE, Rasinski KA, Yoon JD, Curlin FA (2011). Adolescents, contra-ception and confidentiality: a national survey of obstetrician-gynecologists. Con-traception, 84(3), 259-65.
Deneyer M, Devroey D, De Groot E, Buyl R, Clybouw C, Vandenplas Y (2011). In-formative privacy and confidentiality for adolescents: the attitude of the Flemish paediatrician anno 2010. Eur J Pediatr, 170(9): 1159-63.
Sethi N, Lane G, Newton S et al (2014). Disaster easily averted? Data confidential-ity and the hospital desktop computer. In-tern J Med Inform, 83(5): 385-91.