Knowledge, Attitudes, and Awareness of Croatian Dentists Concerning Patients’ Confidentiality and Privacy Vice Budimir, D.M.D.; Gordana Cerjan-Letica, Ph.D.; Jozo Budimir, D.M.D.; Darko Macan, D.M.D., D.D.S., Ph.D. Abstract: Confidentiality and privacy have always been a vital part of the health care provider-patient relationship. The aim of this study was to identify and analyze the knowledge, attitudes, and awareness of dentists in Croatia concerning patients’ confidentiality and privacy and to determine the degree to which they were protecting patients’ confidentiality and privacy in everyday practice. Survey data were collected from seventy of the approximately 4,000 dentists in Croatia who had been randomly selected using the registry of the Croatian Chamber of Dental Medicine. Our strategy for data collection included visits to the dental offices and clinics. The data showed that dentists displayed a lack of awareness and had a poor attitude toward respecting patients’ rights to confidentiality and privacy. This study indicated the need to educate dentists about their responsibilities and legal obligations. Dr. Vice Budimir is Resident in Orthodontics and Postgraduate Student in General Dental Practice, School of Dental Medicine, University of Zagreb, Croatia; Dr. Cerjan-Letica is Professor of Sociology, School of Dental Medicine, University of Zagreb, Croatia; Dr. Jozo Budimir is Resident in Oral Surgery and Postgraduate Student in General Dental Practice, School of Dental Medicine, University of Zagreb, Croatia; and Dr. Macan is Professor of Oral Surgery, Department of Oral and Maxillofacial Surgery, University Hospital Dubrava, School of Dental Medicine, University of Zagreb, Croatia. Direct correspondence and requests for reprints to Prof. Dr. Darko Macan, Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University of Zagreb, Av. G. Suska 6, 10000 Zagreb, Croatia;
[email protected]. Keywords: patient-dentist relationship, patient trust, dental ethics, privacy, confidentiality, professionalism, Croatia Submitted for publication 6/11/11; accepted 4/13/12
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he confidentiality and privacy of patient data are very important parts of the physicianpatient relationship1 and are fundamental principles of biomedical ethics.2 Throughout their history, medical and dental professionals have been obligated to the patient to follow the principles regulated by medical and dental professional codes in all societies and cultures.2,3 As an expert on privacy law, Allen4 distinguished three major uses of the term “privacy”: physical privacy, informational privacy, and decisional privacy. Physical privacy refers to freedom from contact with others or exposure of one’s body to others, while privacy of information is related to the prevention of the disclosure of personal information. Decisional privacy is defined as the personal right to make decisions and act on those decisions without interference from others or the state.4 All of these types of privacy are crucial in patient-doctor relationships. Patients grant caregivers access to their bodies for medical examination and treatment, but they also expect caregivers to protect them from any unnecessary or embarrassing bodily contact or exposure. Caregivers obtain sensitive
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personal information from patients to understand their medical or dental problems, and such information is considered confidential, indicating that those who possess the information have a responsibility to protect it from disclosure to others who are not entitled to this information. Confidentiality is the right of an individual to have personal, identifiable medical information kept private.5 It can also be defined as the promise or duty to protect informational privacy.6 Among health professionals, confidentiality comprises all information to which they have access through clinical interviews, physical examinations, patient care, lab or radiological results, or clinical consultations with other professionals involved in the treatment.7,8 In short, confidentiality is the basis for trust.6 Accurate knowledge of a patient’s medical problems is essential for providing safe and appropriate dental treatment.9 It is imperative that caregivers acknowledge that all information that can be used to identify a patient is considered confidential.10 This study examined the ways that dentists understand and manage privacy and confidentiality in Croatia. In Croatia, as in most countries of the
Journal of Dental Education ■ Volume 77, Number 3
world, dentists are legally obligated to respect their patients’ rights to privacy and confidentiality, but in everyday practice, patients are sometimes denied these rights.11 At the final stage of their undergraduate dental education, during the graduation ceremony, graduating students take an oath of professional confidentiality, a special type of secrecy for a member of the dental profession. This oath can also be interpreted as promised secrecy to protect patients’ privacy.12,13 However, in Croatia, dentists are not fully informed about their professional confidentiality and their legal obligations toward patients during their undergraduate education. The students attend lectures about ethics in dentistry. However, legal obligations are not mentioned. This problem is not only found in Croatia, but is a challenge in other countries around the world.10,11,14 This issue raises the question of whether dentists know how to apply patients’ rights to privacy and confidentiality in everyday practice. We conducted a study to assess the knowledge, attitudes, and awareness of Croatian dentists concerning patients’ confidentiality and privacy.
alternatives of which one was correct. The second part of the survey consisted of seven questions about dentists’ attitudes toward patients’ rights to privacy and confidentiality. These questions asked the dentists to describe the frequency with which they had violated professional confidentiality in various situations on a five-point answer scale (0=never, 1=almost never, 2=sometimes, 3=often, 4=almost always). In order to determine the retest-reliability of this instrument, twenty randomly selected dentists were asked to complete the same questionnaire again two months after they had first completed it. The statistical analyses for this pilot study were performed with SPSS (Version 10.0). A significance level of p
