Prevent Doctors From Speaking to a Family Member
Law, ethics, and medicine
Balancing confidentiality and the information provided to families of patients in primary care
Abstract
Background: Medical confidentiality underpins the doctor–patient relationship and ensures privacy and then that intimate data can be exchanged to improve, preserve, and protect the health of the patient. The right to information applies to the patient alone, and, only if expressly desired, can it exist extended to family members. However, it must exist remembered that one of the primary tenets of family medicine is precisely that patient care occurs ideally within the context of the family. At that place may be, then, sure occasions when difficulties will arise every bit to the extent of the information provided to family members.
Objectives: This study aimed to draw family doctors' attitudes to confidentiality and providing patient information to relatives likewise as their justifications for sharing information.
Method: A descriptive postal questionnaire was self-administered by family unit doctors.
Results: Of 227 doctors, 95.ane% provided information to a patient's family unit and over a third (35%) disclosed information to others without prior patient consent.
Conclusions: The findings reveal that family doctors should pay more than attention to their patients' rights to information, privacy, and confidentiality, and reflect very advisedly on the fine remainder between this and the occasional need for the support and collaboration of family members in delivery of care. Accent should exist placed on ethics and legal issues during undergraduate instruction and in-service training of doctors.
- confidentiality
- chief care
- professional-family relations
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- confidentiality
- primary care
- professional-family relations
The medico–patient human relationship is the primary focus of ideals in medicine. It is both a personal and a professional relationship founded on trust, confidence, dignity, and mutual respect.one Medical confidentiality protects this human relationship and ensures privacy so that intimate information tin exist exchanged to improve, preserve, and protect the patient's wellness.2 Except in certain circumstances, a patient must specifically give consent for disclosure of information about their health care earlier a treating doctor is at liberty to hash out that information with anyone, including the patient's family.3 This doctor–patient relationship is particularly of import in primary care.
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A defining feature of family medicine is the development of a sustained relationship between patients and doctors over long periods of fourth dimension.four Family doctors are involved with people before they become ill and they also wait subsequently chronically and terminally sick patients. Patients who seek the service of main care professionals have families, are subject field to a series of socioeconomic conditions, and go through a diversity of experiences and conflicting situations over time. The doctor'south noesis of the patient'due south environment helps professional decision making when the demand arises.
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1 of the primary tenets of family medicine is precisely that patients should exist ideally cared for within the context of the family unit,5 then that there are numerous occasions when data is exchanged with family members.
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The family doctor is non only the md of a given patient but likewise, probably, of other members of the family unit.6
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Family unit members may ofttimes exist present during a consultation.vii, 8
All these circumstances may give rise to several problems of business organisation that make the physician–patient relationship in primary care more complex and include the worry or questions asked most a patient's wellness by family members and the ethical dilemmas involving confidentiality and privacy.9
The objective of the present study was to describe attitudes of family doctors towards confidentiality, providing information to relatives, and their justification for whatsoever sharing of information.
METHODS
Type of study
We conducted a cross-exclusive survey. The upstanding research committee of the regional wellness authority canonical the study.
Study population
The size of the sample every bit initially calculated was 385 with population proportion = 0.5, precision of five%, and confidence level 95%. However, our final sample consisted of 227 family doctors, representing a response rate of 59%. Of the 72 primary healthcare centres in the province of Murcia, Espana, 56 (77.seven%) responded.
Source and drove of data
The data were obtained by means of a self-administered, validated questionnaire. The bodily questions were formulated in a brain-storming session involving seven family doctors and three university teachers, all recognised experts in the field. To bank check the internal consistency and thus to validate the questionnaire, it was administered to a further 30 family doctors, who were asked for their comments and suggestions as to how information technology could be improved. Cronbach'south α test was applied to the results (α = 0.87).
The kickoff part of the questionnaire consisted of 15 items to define the socio-professional characteristics of the sample (see tabular array one). To evaluate the information provided by the doctor to families of patients we chose the following questions and possible answers:
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Table ane
Socio-professional person characteristics of the study sample
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Practise you provide information to patients' families?
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Yes
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No
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When providing information to patient'due south families, do you:
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Ask the patient get-go
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Practice and then without asking the patient first
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Only do and so in the example of minors
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What course does such information take?
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Oral
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Written
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Both oral and written
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What blazon of information do you provide to family unit members?
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Complementary to that offered to the patient
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The same information
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None
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To define the amount of information doctors consider it necessary to requite family unit members we used the 3 statements given in table ii (which shows the extent to which the doctors agreed with each, as determined by a Likert scale of ane–four; four = highest degree of agreement). The reasons for offering data to family members were explored past the 5 statements given in fig one (which shows the extent to which doctors agreed with each on a Likert scale). We used 1 item to assess the importance given to confidentiality in dissimilar health issues determined by a Likert calibration of 1–five (5 = the about importance).
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Table 2
The amount of data relatives should be given: opinion of family doctors
The questionnaires were mailed to 385 of 554 practising family doctors in the province of Murcia, called in a stratified random mode. They were asked to fill in the questionnaires on a voluntary and anonymous basis before returning them to the authors.
Statistical analysis
The SPSS 11.0 package was used for statistical analysis of the information using simple distribution of frequencies, clan betwixt variables (Pearson'southward χtwo test), and the Kruskal–Wallis test for intergroup comparison.
RESULTS
Socio-professional person characteristics
The socio-professional characteristics of the sample are summarised in table i. Of the professionals who completed the questionnaires well-nigh were aged 36–55 years (84.six%); the number of men comprising the sample was double that of women (64.3% 5 35.7%, respectively) and most were married (78.9%). As regards the length of service, the largest group (52.4%) was formed past those who had been in exercise for 11–20 years, followed by those who had been in practice for 21–30 years (26%). At the time of filling in the questionnaire, thirty% had been in their nowadays postal service for less than three years and 26% between iii and 5 years. Those in their present mail service for more than 15 years were represented by the lowest percentage (11%) of replies. Almost doctors (52.four%) worked in practices in towns of 5000–xv 000 inhabitants.
The doctors' professional training had involved an internship specialising in family unit and community medicine (49.viii%), specialisation through unlike courses (30.4%), or transfer from other specialties (19.eight%). Most doctors (92.one%) were exclusively employed in the public sector. The number of patients on each dr.'southward listing varied from 1901 to 2100 for 32.6%, whereas 20.3% had fewer than 1500 patients. In the main (35.seven%), the family doctors saw 41–l patients per day. Approximately one-half the doctors practised in health centres that served as authorities accredited centres for training family unit doctors, and lxx.9% dedicated four to six hours per day to seeing patients.
Providing information to relatives
In the nowadays study 95.i% of family doctors provided information to a patient'southward family unit: 55.9% only did and so after asking the patient for permission but 35.3% did not call back this formality was necessary, and 8.8% said that they simply informed the family if the patient was a minor (less than xviii years of age). The information was provided orally by 89%, and the rest provided both oral and written information. The type of information offered to families was complementary to that offered to the patient (52.4%) or the same (42.7%), and only four.9% did not offer information to family unit members.
The extent to which doctors agreed with the reasons provided in the survey for offer information to the family is depicted in fig 1, and the amount of data doctors consider family members need is shown in tabular array 2.
Table iii presents a contour of the family unit doctors who did non consider it necessary to ask their patients' permission earlier providing information to family members.
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Tabular array three
Characteristics of family unit doctors who did not consider it necessary to inquire their patients' permission before providing information to family unit members
Evaluation of importance of confidentiality
The means (confidence intervals) of how the family doctors valued confidentiality with respect to different aspects of wellness, as determined by a Likert scale, were as follows: 4.52 (iv.40 to 4.64) for sexuality, 3.98 (3.83 to 4.thirteen) for illegal drugs, 3.76 (iii.61 to three.96) for legal drugs, 3.62 (3.47 to 3.77) for chronic illnesses, iii.59 (3.43 to 3.76) for mental illnesses, 3.55 (three.38 to iii.72) for acute illnesses, and three.28 (3.11 to iii.44) for eating habits.
The importance given to confidentiality by the professionals surveyed every bit regards certain aspects of health intendance is summarised in fig 2. Sexual matters were considered important or very important by 92.5% of doctors and food related issues were given the least importance (39.vii%).
We found statistically significant differences when evaluating confidentiality in the context of the socio-professional variables used to characterise the family doctors. The greatest caste of confidentiality was given to sexual matters by male (p = 0.007), separated (p = 0.0016) doctors who work in a rural surround (p = 0.001) and who had trained equally family doctors (p = 0.001), with less than 1500 patients on their lists (p = 0.005). Historic period, too, resulted in statistically meaning differences. Those over 55 gave more importance to confidentiality in eating habits (p<0.001), acute illnesses (p<0.001), chronic illnesses (p<0.001), and mental illnesses (p<0.001).
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The family doctors comprising our survey sample are representative of the general state of affairs of the profession in Kingdom of spain. They were mainly men, of middle age, married, and had children. They were at the height of their careers with a wealth of experience, mainly working in semiurban or rural communities and solely for the local health service. Their workload might be considered excessive, every bit judged from the high number of patients on their lists and the big number of patients seen every day. This had a negative upshot on other types of activeness that might also be considered equally within the competence of primary care doctors.ten
A new law in Spain (41/2002) concerned with patients' rights and doctors' obligations in matters of clinical information and documentation, clearly specifies that the possessor of such data is the patient. However, the police also states that people associated with the patient, either by family ties or more informal ones, may also be informed to the extent that the patient wishes. Article 7 of the constabulary, which states that it is a right of every person that the confidential nature of information referring to his or her health be respected and that no-i can accept access to such data without the patient's permission, reinforces the patient's right to privacy. However, information technology is clear from the results of our analysis that almost all family doctors provide information to family members and that over a third (35%) volition disclose information to others without prior consent, implying that a high per centum are breaking the law. Medical information should only be shared with family members with the patient's consent, and ignoring this could issue in a finding of professional misconduct.iii
Family doctors cite basically two reasons for providing family members with information apropos a patient: (a) considering the family members are collaborating in the patient's treatment or (b) considering they are caring for the patient. A small number of doctors justify the provision of information because family unit ties provide certain rights over the patient or because they wish to at-home the anxiety of relatives, since ignorance of such information might cause concern. We are of the stance that family unit or emotional ties do not institute a correct in itself over and above what a patient might decide at a given moment.
The professional profile of the family doctor who does not consider information technology necessary to ask for the patient's permission before disclosing information is typically that of a doctor with more than 20 years' service, aged over 45 with a heavy workload (more than than 2000 patients on their listing and seeing more than than 60 patients/24-hour interval), and dedicating the to the lowest degree time to patients (three to four hours/day), which limits the fourth dimension available per patient. Other characteristics of these doctors are firstly, they are not specialists in family and community medicine but have transferred from other specialties, and secondly, they do non piece of work in centres providing preparation to new doctors, both of which strongly suggest that the ethical and legal aspects of the profession are better covered in family medicine courses. The same doctors generally piece of work in rural practices, where it is much more likely that they too attend to diverse members of the aforementioned family making it easier to share information without giving proper consideration to the matter. Indeed, the reason given for sharing information is precisely that family ties requite a right to receive such information.
Lack of confidentiality is a major deterrent to skilful wellness intendance and one of the main reasons that patients are reluctant to divulge information.11 However, information technology is true that many people visit family unit doctors in the company of relatives or friends.v, vi This might seem to be a good idea since (a) the family context serves to illuminate patient disease, illness, and health, (b) family unit members might reveal the source of the illness, (c) discussing illness with friends and relations sometimes helps, (d) the family is probably securely concerned well-nigh the patient'south wellness, and (e) the family probably acts as a care resource and collaborator.5 However, the patients do not know in advance what questions the medico will enquire. In such a situation, patients may not wish to discuss sensitive topics (such every bit sexual habits, abortion, alcohol apply, or usage other drugs) or fifty-fifty ostensibly lilliputian topics,12 since it is known that patients speak much more freely when on their own.13 The doctor must exist careful to avoid potential alienation of patient confidentiality when discussing diagnoses and treatment decisions in the presence of family members.9
In general, doctors seem sufficiently concerned almost the confidentiality of their patients. However, there are differences as regards the relative importance doctors requite to different health related issues. The expanse where confidentiality is well-nigh respected is that of sexuality. It should be remembered that a high percentage of patients seek advice on matters related to sexual wellness, where confidentiality is one the most important factors in choosing the particular branch of the health service.14 By ensuring confidentiality and maintaining professionalism a doctor will create the trusting, comfortable environment necessary for the thorough evaluation of a patient'due south sexual health risks.fifteen, 16
The 2d well-nigh important expanse where doctors respect the need for confidentiality is the consumption of illegal or legal drugs. In the instance of substance abuse, the accent on confidentiality goes across that of full general health care.17 Nutrient habits are regarded by doctors as beingness of the least importance equally far equally confidentiality is concerned.
In general, and so, there is a need to revise and improve procedures for the maintenance of confidentiality in main care.18
Although it is a commonplace in primary care that treating an individual with a illness actually ways treating the family, traditional limitations equally regards the scope of confidentiality sometimes seem to take been pushed likewise far. Perhaps it is time that family unit doctors paid more attending to their patients' rights to privacy. Family unit doctors should inform their patients that express amounts of confidential data may need to be shared with other members of their family, and only that information necessary and relevant to the treatment of the trouble will exist shared.two Doctors should be trained in psychosocial and discretionary skills to enable them to recognise those patients who need support and volition feel more comfy in the presence of a family member in the surgery.12
Our survey shows that sure socio-professional characteristics of family doctors significantly affect the degree of privacy and confidentiality that a patient will receive. We found that sexuality is the nigh respected surface area, although statistically significant differences existed between doctors in this matter—family medicine specialists with a depression workload and working in smaller rural centres respect confidentiality to a greater extent, despite the abovementioned greater likelihood of contact with other family unit members. It seems that, in this matter, they are more aware of the touch that the diffusion of this blazon of information might have.
In Espana, family doctors have a loftier work load and large numbers of patients on their lists. This has led to the formation of both internal and external pressure level groups demanding that at to the lowest degree ten minutes be allowed for each consultation and that doctors should have no more than 1500 patients, thus permitting them to discharge their professional obligations in a better manner.18 It is interesting that the doctors who considered it necessary to seek the patient's permission before providing information to family unit members and those who assigned greater importance to confidentiality in our survey were precisely those with a lighter piece of work load.
Limitations of the study
Since no similar studies are bachelor in the referenced literature for Spain, our findings cannot be compared with elsewhere. In addition, the study was limited to public sector medicine and therefore the findings cannot be extrapolated to private practice.
CONCLUSIONS
Our results suggest that family doctors should pay more attending to their patients' rights to information, privacy, and confidentiality, and that they should reflect very carefully on the fine balance between this and the occasional need for the support and collaboration of family members in offer care. In that location are socio-professional factors likewise (principally excessive workload and previous training) that can exist improved past health service managers and which seem to have a negative effect on patients' rights to privacy. We agree with Shrier et al 11 that accent should be given to ethics and legal problems during undergraduate education and in-service preparation.
Acknowledgments
Nosotros thank Professor D Pérez-Flores for his help in checking the statistical analysis.
REFERENCES
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Source: https://jme.bmj.com/content/31/9/531
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