ABSTRACT
Introduction: The objective of this study was to explore which are the limits to confidentiality that 31 psychiatrists, from Santiago (Chile) and Medellín (Colombia), consider as appropriate when dealing with information on sexual orientation in psychiatric practice. Methods: A questionnaire containing twenty assertions was applied to explore agreement with them. A scale ranging from 1 (no agreement at all) to 5 (complete agreement) was used. Results: There was agreement on the need of inquiring sexual orientation during the psychiatric encounter. There was no agreement, however, on the appropriateness of registering this information in the medical record, irrespective of the sexual orientation of the patient. History of sexual abuse of children or disabled people was considered as a valid waiver of this duty of confidentiality when answering a judicial request. On the contrary, the requirements of information coming from insurance companies were not considered as valid reasons for breaching confidentiality. Psychiatrists do not agree with disclosing their sexual orientation to patients. Conclusion: Psychiatrists agree in a number of situations in which sexual orientation of patients should be either disclosed or kept confidential.
Introducción: El objetivo de este estudio fue conocer cuáles son los límites que 31 psiquiatras de Santiago (Chile) y Medellín (Colombia) consideran en la confidencialidad de la orientación sexual de los pacientes, durante la atención psiquiátrica. Métodos: Se empleó una encuesta anónima con veinte afirmaciones y cinco opciones de respuesta según el grado de acuerdo. Se hizo el análisis comparativo de las medianas para los grados de acuerdo. Resultados: Los participantes estiman pertinente indagar por la orientación sexual durante la consulta pero no registrarla en la ficha clínica, independientemente de que sea homosexual, bisexual o heterosexual. El abuso sexual de menores de edad o personas con discapacidad mental o física es un límite que permite la ruptura de la confidencialidad, ante una solicitud legal. Por el contrario, se encontró rechazo al registro de la orientación sexual en licencias médicas o certificados médicos para compañías de seguro o de salud, en otras situaciones clínicas planteadas se conservó esta tendencia a la conservación confidencial. Los psiquiatras no estuvieron de acuerdo con revelar su propia orientación sexual a los pacientes. Conclusiones: Existen límites tanto para la conservación como para la revelación de la información confidencial de la orientación sexual, con grados similares de acuerdo entre los psiquiatras.
Subject(s)
Humans , Psychiatry , Sexual Behavior , Confidentiality , Sexuality , Medical Records , DisclosureABSTRACT
Background : Patients are becoming increasingly active in their relationship with medical professionals. Their relationship with medical students needing to learn clinical skills, may be specially problematic if patients are not willing to accept their involvement in the medical team. Aim: To examine patient's perceptions of their relation with medical students and their agreement to let students be part of the treating team. Material and Methods: Qualitative study using taped semi-structured interviews addressed to inpatients from one public and one private hospital in Chile. Results: Both groups of patients acknowledged that students dedicated more time to them, but they expressed their preference to limit student's participation to clinical history taking and physical examination. They also expected them to be observers rather than actors. Patients from the private hospital emphasized that only one student per instructor should participate in their care. Patients from the public hospital were more compliant about student's participation. The right to refuse students' involvement in their care was clearly known by all patients from the private system and by most patients from the public hospital. Conclusions: Patients in Chilean public and private hospitals were in general positive regarding student's participation in their care. Students' clinical practice ought to strictly respect patients's rights, and patients should be considered volunteers who generously agree to cooperate with the education of medical students.