Since Hippocrates, privacy has been touted as the 1 cornerstone of healthcare ethics. Confidentiality stems from respect for the autonomy and self-control of information. Respect for patient confidentiality and privacy is considered a patient right. From a deontological point of view, confidentiality is a duty and rests on the ethics of virtue that Islam insists upon; Maintaining data protection and confidentiality is the key virtue for building trust in the doctor-patient relationship. In the field of healthcare, patient information should be kept confidential in professional relations (1). Parsa M. Privacy and confidentiality in the medical field and its various aspects. J Med Ethics Hist. 2009;4:1–14. The challenges of confidentiality in clinical practice Confidentiality itself is rarely questioned. It is accepted by most physicians and patients as one of the main pillars of a trusting relationship between physicians and patients. But a careful examination of what confidentiality is, why it is necessary, and what it means in practice reveals profound and fundamental differences in understanding and expectations.
In the final phase of this study, all categorized challenges guided us in creating draft ethical guidelines for maintaining confidentiality in clinical settings. This guideline consists of 10 articles containing definitions and conceptualizations of confidentiality, the circumstances in which the breach of confidentiality is acceptable, the consequences of the breach of confidentiality, the circumstances in which disclosure of information is acceptable only through the consent of patients, the disclosure of information for the benefit of society, Breach of confidentiality due to legal restrictions, Privacy in children and patients with mental disorders, Privacy in Cyberspace and eHealth, as well as Privacy in Morning Reports and Grand Rounds. In general, the absolute nature of confidentiality is questionable when there are concerns about the safety of the third party or public health (10). In modern medicine, the exchange of data should take place after the patient`s consent, unless otherwise specified in the relevant normative guidelines. In this draft, some exceptions to absolute confidentiality without patient consent were mentioned. Breaches of confidentiality are permitted: (1) upon legally authorized request; 2) if the patient`s well-being so requires; (3) while safeguarding the well-being of society and (4) where it is necessary to protect the third party from major harm or threat. In accordance with this draft, Australian law balances individual benefits against the security of society (11). The Irish Medical Council also specifies the conditions under which exceptions to absolute confidentiality are accepted (12). High-risk behaviour in adolescents is the leading cause of adolescent morbidity and mortality (19). Youth seeking health care and reporting high-risk behaviours, so they may have concerns about confidentiality (21). Fear of violating confidentiality is the main reason teens (22, 23), especially among high-risk teens, don`t seek treatment (21).
Therefore, the provision of confidential health services is necessary for them. While parents recognize the benefits of privacy for teens, they are concerned about supporting their child`s continued risky behavior through confidentiality (24, 25). Parents may be distracted by teen privacy and its importance (26). They would offer confidential contraceptive services to young people without informing their parents (27). Privacy concerns may be a reason for not receiving health care, and tightening confidentiality restrictions can reduce health care use among youth, with adverse health consequences (21). Given the legal context, the use of well-defined procedures and the necessary relationships with youth were necessary to maintain confidentiality and will reduce barriers to youth use of the health system (28). The results of this study provide valuable insights into healthcare professionals` knowledge and attitudes regarding patient privacy in resource-limited countries. There are some limitations to this study. First, it was a cross-sectional survey of an institution; Only health professionals who came during the data collection period were interviewed.
Demirsoy N, Kirimlioglu N. Protecting privacy and confidentiality as patients` rights: the views of doctors and nurses. 2016;27(4):1437–48. Health professionals who dealt with medical ethics (CAR = 2.30, 95% CI [1.42-3.72]) were much more likely to have patient confidentiality than those who had not received training in medical ethics. Healthcare professionals who had direct contact with patients were (AOR = 3.06, 95% CI [1.12-8.34]) times more likely to have a positive attitude towards patient confidentiality than those who did not have direct contact with patients. Healthcare professionals who visited more patients daily (more than 40 and 30-40) had approximately (AOR = 4.38, 95% CI [2.46-7.80]) and (AOR = 1.96, 95% CI [1.12-3.43]) more positive attitudes towards patient confidentiality than those who visited fewer than 30 patients per day. In addition, respondents facing more ethical dilemmas (OR = 3.56, 95% CI [1.23-10.26]) were often more likely to have a positive attitude towards patient confidentiality than those facing less ethical dilemmas. Bivariate and multivariate binary logistic regression analyses were performed to measure the relationship between healthcare professional knowledge and patient confidentiality and independent variables. In bivariate regression, participants` gender, respondents` age, work experience, medical ethics training, number of patients treated, direct patient contact, number of ethical dilemmas, participants` income were the variables of candidates to knowledge of healthcare professionals towards confidentiality for multivariate regression analysis (P < 0.2). With the multivariate regression model of respondents, medical ethics education and the number of ethical dilemmas were significantly associated factors in healthcare professionals` knowledge of patient confidentiality (Table 4). This means that being male (AOR = 1.63, 95% CI [1.03-2.59]) was several times more likely to have good knowledge of patient confidentiality than women after controlling for other factors. Health professionals who received training in medical ethics (AOR = 1.73, 95% CI = [1.11-2.70]) were more likely than their peers to have a good knowledge of patient confidentiality.
Similarly, healthcare professionals with more ethical dilemmas (OR = 3.07, 95% CI [1.07-8.79]) were more likely to have good knowledge than those with fewer ethical dilemmas. All health professionals working in the University of Gondar Specialist Hospital and those available during the study period were the sources and population studied. The study excluded healthcare professionals with less than six months of experience, those who were not found in hospital for various reasons, and those who were on annual leave during the data collection period. Khac Hai N, Lawpoolsri S, Jittamala P, Thi Thu Huong P, Kaewkungwal J. Practices in security and confidentiality of HIV/AIDS patient information: a national survey of HIV ambupatient clinic staff in Vietnam. PLoS ONE. 2017;12(11):e0188160. While there may be instances where the physician is naturally inclined to share information, such as answering a spouse asking questions, the requirements of an exception to confidentiality may not be met.