Patients' perception and actual practice of informed consent, privacy and confidentiality in general medical outpatient departments of two tertiary care hospitals of Lahore
Tóm tắt
The principles of informed consent, confidentiality and privacy are often neglected during patient care in developing countries. We assessed the degree to which doctors in Lahore adhere to these principles during outpatient consultations.
The study was conducted at medical out-patient departments (OPDs) of two tertiary care hospitals (one public and one private hospital) of Lahore, selected using multi-stage sampling. 93 patients were selected from each hospital. Doctors' adherence to the principles of informed consent, privacy and confidentiality was observed through client flow analysis performed by trained personnel. Overall patient perception was also assessed regarding these practices and was compared with the assessment made by our data collectors.
Some degree of informed consent was obtained from only 9.7% patients in the public hospital and 47.8% in the private hospital. 81.4% of patients in the public hospital and 88.4% in the private hospital were accorded at least some degree of privacy. Complete informational confidentiality was maintained only in 10.8% and 35.5% of cases in public & private hospitals respectively. Informed consent and confidentiality were better practiced in the private compared to the public hospital (two-sample t-test > 2, p value < 0.05). There was marked disparity between the patients' perspective of these ethical practices and the assessment of our trained data collectors.
Observance of medical ethics is inadequate in hospitals of Lahore. Doctors should be imparted formal training in medical ethics and national legislation on medical ethics is needed. Patients should be made aware of their rights to medical ethics.
Từ khóa
Tài liệu tham khảo
McCullough LB, Chervenak FA: Informed consent. Clin Perinatol. 2007, 34: 275-85. 10.1016/j.clp.2007.03.005.
Mahmood K: Informed consent and medical ethics. Ann King Edward Med Coll. 2005, 11: 247-9.
Mallardi V: The origin of informed consent. Acta Otorhinolaryngol. 2005, 25: 312-327.
Nasilowsky W: Patient's consent to treatment with reference to the development of medical ethics. Wiad Lek. 2007, 60: 198-200.
del Carmen MG, Joffe S: Informed consent for medical treatment and research: a review. Oncologist. 2005, 10: 636-41. 10.1634/theoncologist.10-8-636.
Moskop JC, Marco CA, Larkin GL: From hippocrates to HIPAA: privacy and confidentiality in emergency medicine: Part I. Conceptual, moral and legal foundations. Ann Emerg Med. 2005, 45: 53-9. 10.1016/j.annemergmed.2004.08.008.
Geiderman JM, Moskop JC, Derse AR: Privacy and confidentiality in emergency medicine: obligations and challenges. Emerg Med Clin North Am. 2006, 24: 633-56. 10.1016/j.emc.2006.05.005.
Sankar P, Mora S, Merz JF, Jones NL: Patient perspectives of medical confidentiality: a review of the literature. J Gen Intern Med. 2003, 18: 659-69. 10.1046/j.1525-1497.2003.20823.x.
Bhurgri H, Qidwai W: Awareness of the process of informed consent among family practice patients in Karachi. J Pak Med Assoc. 2004, 54: 398-401.
Shiraz B, Shamim MS, Shamim MS, Ahmed A: Medical ethics in surgical wards: knowledge, attitude and practice of surgical team members in Karachi. Indian J Med Ethics. 2005, 2: 94-6.
Jafarey A: Informed consent: views from Karachi. East Mediterr Health J. 2006, 12: S50-5.
Jafarey AM, Farooqui A: Informed consent in the Pakistani milieu: the physician's perspective. J Med Ethics. 2005, 31: 93-96. 10.1136/jme.2002.002220.
Moazam F: Family, patient and physician in medical decision making: a Pakistani perspective. Hastings Cent Rep. 2000, 6: 28-37.
Khan RI: Informed consent and some of its problems in Pakistan. J Pak Med Assoc. 2008, 58: 82-4.
Qidwai W, Qureshi H, Azam SI, Ali SS, Ayub S: Perception of bioethics among general practitioners in Karachi. Pak J Med Sci. 2002, 18: 221-6.
Cockcroft A, Omer K: Baseline Community Based User Survey – Bangladesh Hospital Improvement Initiative. Revised Report. 2003
Paterick TJ, Carson GV, Allen MC, Paterick TE: Medical informed consent: general considerations for physicians. Mayo Clin Proc. 2008, 83: 313-9.
Whitney SN, McGuire AL, McCullough LB: A typology of shared decision making, informed consent, and simple consent. Ann Intern Med. 2004, 140: 54-9.
Blustein J: Doing what the patient orders: maintaining integrity in the doctor-patient relationship. Bioethics. 1993, 7: 290-314. 10.1111/j.1467-8519.1993.tb00220.x.
The World Medical Association: World Medical Association Declaration of Helsinki: Ethical principles of research involving human subjects. [http://www.wma.net/e/policy/b3.htm]
Yousaf RM, Fauzi ARM, How SH, Rasool AG, Rohana K: Awareness, knowledge and attitude towards informed consent among doctors in two different cultures in Asia: a cross sectional comparative study in Malaysia and Kashmir, India. Singapore Med J. 2007, 48: 559-65.
Miyashita M, Hashimoto S, Kawa M, Shima Y, Kawagoe H, Hase T, Shinjo Y, Suemasu K: Attitudes toward disease and prognosis disclosure and decision making for terminally ill patients in Japan, based on a nationwide random sampling survey of the general population and medical practitioners. Palliat Support Care. 2006, 4: 389-98.
Asai A, Kishino M, Tsuguya F, Sakai M, Yokota M, Nakata K, Sasakabe S, Sawada K, Kaiji F: A report from Japan: choices of Japanese patients in the face of disagreement. Bioethics. 1998, 12: 162-72. 10.1111/1467-8519.00102.
Chan HM: Informed consent Hong Kong style: an instance of moderate familism. J Med Philos. 2004, 29: 195-206. 10.1076/jmep.29.2.195.31508.
Liseckiene I, Liubarskiene Z, Jacobsen R, Valius L, Norup M: Do family practitioners in Lithuania inform their patients about adverse effects of common medications?. J Med Ethics. 2008, 34: 137-40. 10.1136/jme.2006.019448.
Henley L, Benatar SR, Robertson BA, Ensink K: Informed consent–a survey of doctors' practices in South Africa. S Afr Med J. 1995, 85: 1273-8.
Ruhnke GW, Wilson SR, Akamatsu T, Kinoue T, Takashima Y, Goldstein MK, Koenig BA, Hornberger JC, Raffin TA: Ethical decision making and patient autonomy: a comparison of physicians and patients in Japan and the United States. Chest. 2000, 118: 1172-82. 10.1378/chest.118.4.1172.
Pellegrino ED: Intersection of western biomedical ethics and world culture: problematic and possibility. Camb Q Healthc Ethics. 1992, 3: 191-6.
Sypher B, Hall RT, Rosencrance G: Autonomy, informed consent and advance directives: a study of physician attitudes. W V Med J. 2005, 101: 131-3.
Boisaubin EV: Observations of physician, patient and family perceptions of informed consent in Houston, Texas. J Med Philos. 2004, 29: 225-36. 10.1076/jmep.29.2.225.31504.
Amin FM, Jawaid M, Rehman S: An audit of information provided during Preoperative informed consent. Pak J Med Sci. 2006, 22: 10-13.
Imam SZ, Syed SK: Patients' satisfaction and opinions of their experiences during admission in a tertiary care hospital in Pakistan – a cross sectional study. BMC Health Services Research. 2007, 7: 161-10.1186/1472-6963-7-161.
Shrier I, Green S, Solin J: Knowledge of and attitude toward patient confidentiality within three family medicine teaching units. Acad Med. 1998, 73: 710-12. 10.1097/00001888-199806000-00021.
Cleary PD, Edgman-Levitan S: Patients evaluate their hospital care: a national survey. Health Affairs. 1991, 10: 254-67. 10.1377/hlthaff.10.4.254.
Sulmasy DP, Dwyer M, Marx E: Knowledge, confidence, and attitudes regarding medical ethics: how do faculty and housestaff compare?. Acad Med. 1995, 70: 1038-40. 10.1097/00001888-199511000-00024.
Schildmann J, Cushing A, Doyal L, Vollmann J: Informed consent in clinical practice: pre-registration house officers' knowledge, difficulties and the need for postgraduate training. Med Teach. 2005, 27: 649-51. 10.1080/01421590500138747.