Violations of medical confidentiality: opinions of primary care physicians

Background

Physicians should be able to distinguish situations where they need to protect confidentiality from those where they could be obligated to reveal information. Data are scarce concerning physician''s attitudes in daily situations where violations of confidentiality are avoidable. Physicians should be aware of situations where patients are identifiable.

Aim

To solicit participation of primary care physicians in a teaching intervention and to explore participants'' opinions on violations of confidentiality.

Design of study

A questionnaire presented seven vignettes describing avoidable violations of confidentiality (for example, without patient consent a physician mentions a politician''s illness their spouse). Participants answered on a scale of 0–3 (0 = no violation and 3 = serious violation). All contacted physicians were invited to a teaching session during which the study results were discussed.

Method

Three-hundred and seventy-eight members of the Association of Physicians in Geneva (community physicians) working in primary care medicine, and 130 GPs and internists working at the University Hospital of Geneva (hospital physicians) took part. Physicians'' answers were compared to responses from Swiss, UK, and other European law professors, and from 311 medical and law students in Geneva.

Results

Between 4% (case 6) and 57% (case 2), of physicians thought that no violation occurred. Law professors attributed the scores to each case as 3, 3, 2, 3, 2, 3, 3; the means of physicians were: 1.9, 1.4, 0.7, 1.4 (hospital physicians)/1.9 (community physicians), 0.4, 1.6, 2.6. In most cases, physicians'' and students'' answers were similar. A significantly higher percentage of community physicians than hospital physicians and students thought that a physician violates confidentiality if they provide the list of their patients to the police for the investigation of the theft of a purse in the waiting room.

Conclusion

Physicians need to be fully aware of their obligations towards patient confidentiality. Avoidable breaches of confidentiality occur when colleagues and authorities (such as police and those in a judicial context) ask for information.     

千科理相通 万法理可鉴

现代科学技术革命的基本特征揭示＂千科理相通,万法理可鉴＂;系统原理验证了＂千科理相通,万法理可鉴＂;现代科学认知方法要求＂千科理相通,万法理可鉴＂。这一命题适用于包括中医药在内的各个领域自身研究以及和其他科学之间的联系上,是辨证的科学的思维方式,在实践中具有重要的指导意义。     

A researcher's journey for clarity: clarifying liability and indemnity issues when carers take on a role in medicines management

A client attending a depot clinic in a mental health setting requested that her husband be enabled to give her injection. This request was followed up in a practice development project. Following the success of the project, the local National Health Service (NHS) Mental Health Trust supported a research project to explore the issues raised further. The Local Research Ethics Committee raised a question around carer liability. This question led to a 2-year liaison with the NHS Litigation Authority, the local NHS Trust's legal team, Royal College of Nursing and others. The journey clarified that liability for a carer was covered under the Third Party Liability Scheme, where the carer came under the umbrella of being an 'authorised voluntary worker'. While the experience delayed the research project, it was a significant learning opportunity in the NHS ethical approval system.     

Can a Video Curriculum on the Social Determinants of Health Affect Residents' Practice and Families' Perceptions of Care?

IntroductionScreening and management of the social determinants of health (SDH) are critical for child health promotion. We sought to evaluate the impact of a facilitated video curriculum on resident SDH screening competence, parental perceptions of resident practice, resident-initiated referrals to a medical–legal partnership (MLP), and formula distribution to food-insecure families.MethodsThis was a pre–post study with concurrent control performed at a large pediatric residency program. Second- and third-year residents were assigned to control and intervention groups on the basis of their continuity clinic day. The curriculum included videotaped vignettes of screening for SDH and a “day in the life” series of families describing the impact of intervention on their lives. Residents completed self-assessments on screening competence and resource knowledge. After a well-child encounter, families (3 per resident) assessed their level of trust and respect for the resident and the number of SDHs screened for. MLP referral rates and formula distribution were compared.ResultsThe intervention group's self-assessed competence in screening for housing, benefits, and educational concerns was significantly higher compared to controls (each P ≤ .05). Parents' rating of trust and respect was high and did not differ between groups. Screening for each SDH was higher in the intervention group with domestic violence (odds ratio 2.16, 95% confidence interval 1.01–4.63) and depression (odds ratio 2.63, 95% confidence interval 1.15–5.99), reaching statistical significance. MLP referral rates increased (P = .06), and formula distribution (P = .02) reached statistical significance in the intervention group.ConclusionsThis SDH video curriculum improved resident self-assessed screening competence, parental perception of screening, and both MLP referrals and formula distribution.     

医疗纠纷裁决法治化的思考

从机构设置、裁决程序、责任制度、裁决与诉讼的关系等角度就完善我国工生行政部门裁决医疗纠纷活动的法律制度进行探讨,指出,应实现医疗事故技术鉴定与法医鉴定统一化,设置裁决医疗纠纷的专门机构,以增强医疗纠纷裁决的独立性;改进医疗纠纷裁决的程序,建立备案审查制度;建立以卫生行政部门为被告的行政诉讼制度;裁决医疗纠纷应公开化。     

医事法律人才培养中实践性法学教学模式之探究

教学模式是人才培养模式中的关键。传统的法学教育模式有其合理性但存在诸多弊端,应大力进行改革与创新。医事法律极具实践性,唯有创建一个体系化的实践性教学模式,才能最终培养出适合于时代需要的高素质医事法律人才。     

砂仁药材及其饮片的质量分析

目的：对国内市售砂仁质量进行评价分析,为药品监管和质量标准提高提供科学依据。方法：依据法定标准对样品进行全面检验;采用性状和DNA条形码相结合对样品进行真伪评价,以此结果进一步对正品和伪品的挥发油总量和乙酸龙脑酯含量进行相关性分析。结果：按照法定标准抽检的样品,不符合规定项目为性状、乙酸龙脑酯含量测定,以近缘物种冒充砂仁的情况较为突出。结论：国内市售砂仁质量有待提高,可通过质量标准提高,增加专属性较强且可量化评判的性状特征、DNA条形码鉴别等方法进行质量控制。     

医疗纠纷中电子病历应用的相关问题思考

医疗纠纷已经成为社会的一个热点问题,而针对医疗文书在医疗纠纷诉讼中的重要作用,在了解我国电子病历应用和立法现状的基础上,对数据电文构成的病历的合法性进行探讨,并根据电子病历能够替代纸病历,同时在医疗纠纷中具有法律效力。     

试论思想道德修养与法律基础课程教学中德与法融合的实现路径

在思想道德修养与法律基础课程教学中实现法律与道德的融合,面临一些现实的制约因素.对教材中的道德与法律的双重解读不能面面俱到,要抓住重点章节,同时注重典型案例的选取,以案例教学为中心,架起德与法融合的桥梁.小悦悦和药家鑫两则案例的双重分析,为德与法的融合路径提供了良好的范本.道德的追求并非空洞的说教,更是一种理性的思考.只有结合实例的双重分析,才能不断增进理性和成熟心智,这才是德与法融合的精神实质和内涵所在.