Professional secrecy: knowledge of medical students and physicians

Lütz, Kevin Timm; Carvalho, Diego de; Bonamigo, Elcio Luiz

doi:10.1590/1983-80422019273331

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RESEARCH • Rev. Bioét. 27 (3) • Jul-Sep 2019 • https://doi.org/10.1590/1983-80422019273331 copy

Professional secrecy: knowledge of medical students and physicians

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Professional secrecy is the basis of trust in the doctor-patient relationship. This is a cross-sectional, quantitative study aiming to describe the knowledge of medical students and physicians about secrecy. Participants included 100 students who had not studied Ethics (Group 1), 113 that had studied Ethics (Group 2) and 127 regional physicians (Group 3), totaling 340 participants. Group 2, composed of students who had taken two Ethics subjects, had more right answers in 9 of the 16 questions, seven with statistical significance, surpassing Group 3, composed of physicians, which had more correct answers in 3 questions, without significance, and Group 1 with more correct answers in two questions, both significant. It is concluded that teaching contributed to increase knowledge about professional secrecy during medical school and that it is necessary to find ways to emphasize the knowledge of this subject among professionals. Aprovação CEP-Unoesc/Hust 1.799.732

Confidentiality; Ethics, medical; Physician-patient relations; Physicians; Students, medical

Description of the fact related to professional secrecy: legal duty	Gab	Correct answers per group			p

		Group 1 (n=100)	Group 2 (n=113)	Group 3 (n=127)
1. 25-year-old woman self-induces abortion. During the hospital treatment of the uterine bleeding resulting from the act, she said that she was responsible for it. Should health care professionals who report the fact to the public authority?	No	58% (58)	83.2% (94)	73.2% (93)	0.0003
2. Lucid 16-year-old teenager self-induced abortion. During hospital care of the uterine bleeding resulting from the act, she said that she caused it herself. Because she is a minor, should health professionals who attend her report this to the public authority?	No	29% (29)	61.1% (69)	48% (61)	0.0002
3. A judge, during testimony, asks the physician if the patient self-induced abortion. During the treatment, the woman told the physician that she had done so, and the hospital staff reported her to the police, although the patient did not allow anyone to expose this information. Is the physician obliged to disclose it because it is a statement before the judge?	No	38% (38)	70.8% (80)	57.5% (73)	<0.0001
5. A patient legally denounces a physician who broke confidentiality about his/her HIV positive status to unauthorized persons. Can the physician be arrested for this fact?	Yes	58% (58)	54% (61)	37% (47)	0.0031
8. After consulting with her 16-year-old daughter, the mother asks the physician to confirm that the teenager is a virgin. The daughter asked for secrecy. Because it is a minor, can/should the physician reveal the information?	No	87% (87)	95.6% (108)	88.2% (112)	0.0624
9. When the patient arrives at the hospital with a knife or firearm injury, should the attending health professionals notify the public authority?	Yes	88% (88)	71.7% (81)	81.1% (103)	0.0211
13. Underage patient is treated for suspected abuse. Should health professionals inform the public authority?	Yes	97% (97)	95.6% (108)	97.6% (124)	0.6495
14. An 87-year-old woman is seen at a geriatric outpatient clinic. There are limb abrasions and trunk hematomas. The patient denies having suffered falls. As there is a consistent suspicion of maltreatment, should the physician notify the public authority?	Yes	94% (94)	94.7% (107)	96.9% (123)	0.5453
15. A gynecologist who performs complementary examinations for the Unified Health System (SUS) observes a gross error examination request from a professional in the “Mais médicos” program and discloses an identifiable copy of the request to his WhatsApp group. Did the physician breach confidentiality?	Yes	97% (97)	85.8% (97)	92.1% (117)	0.0133

Description of the fact related to professional secrecy: Just cause	Gab	Correct answers per group			p

		Group 1 n=100	Group 2 n=113	Group 3 n=127
4. A patient tells the health professional that he/she omits any sexual partners that he/she lives with HIV and does not want to change this behavior. Should the practitioner disclose the fact to the public authority and, if possible, to the persons involved?	Sim	63% (100)	73.5% (83)	63% (80)	0.1801
6. The physician notes that the bus driver has low vision acuity (outside the allowed parameters). Should they breach confidentiality by informing the company of this fact against the employee’s wishes?	Sim	72% (72)	85.8% (97)	78% (99)	0.0432
7. A patient tells the psychiatrist that he is going to kill his ex-girlfriend in the coming days. Should the physician break confidentiality and immediately report it to the public authority?	Sim	84% (84)	97.3% (110)	81.9% (104)	0.0004
10. It is suspected that the patient will get worse if, at that moment, the diagnosis of his/her serious illness is revealed to him. Should the physician report the diagnosis anyway?	Não	62% (62)	62.8% (71)	63% (80)	0.9970
11. Patient confides to the psychiatrist that he/she is depressed for causing accident deaths in the past, but was not discovered because he/she fled and does not want to be revealed. After the consultation, should the professional communicate the fact to the public authority?	Não	73% (73)	85.8% (97)	78.7% (100)	0.0491
12. A man reports to the physician that he has committed murder in the past and another person is imprisoned in his place. Is it for the physician to inform the public authority of the fact?	Sim	53% (53)	46% (52)	52.8% (67)	0.4551
16. A 27-year-old bricklayer, married, with three healthy children, attends the infectious disease outpatient clinic with complaints of weight loss and oral candidiasis. HIV serology is performed, with a positive result. The patient does not intend to disclose this fact to his wife since he has extramarital affairs and does not want her to know about it, as she would abandon him. Should the physician reveal the fact to the patient’s wife?	Sim	45% (45)	73.5% (83)	61.4% (78)	0.0001

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[1] Correspondência. Elcio Luiz Bonamigo – Rua Treze de Maio, 314, sala 21 CEP 89600-000. Joaçaba/SC, Brasil. Kevin Timm Lütz – Graduando – kevin.lutz@unoesc.edu.br Diego de Carvalho – Doutor – diego.carvalho@unoesc.edu.br Elcio Luiz Bonamigo – Doutor – elcio.bonamigo@unoesc.edu.br