Privacy and dual loyalties in occupational health practice.

This survey set out to explore occupational health professionals' courses of action with respect to privacy in a situation of dual loyalty between employees and employers. A postal questionnaire was sent to randomly selected potential respondents. The overall response rate was 64%: 140 nurses and 94 physicians returned the questionnaire. Eight imaginary cases involving an ethical dilemma of privacy were presented to the respondents. Six different courses of action were constructed within the set alternatives proposed. The study indicated that privacy as an absolute value is not in the interest of either employees or employers. It also showed that, where dual loyalty is concerned, the most valid course of action in dealing with sensitive subjects such as drug and work community problems, sexual harassment and sick leave is to rely on tripartite co-operation. If they maintain their professional independence and impartiality, health professionals are well placed to succeed in this challenging task; if not, there are bound to be severe violations of privacy.

Sensitivity towards patient needs in the occupational health consultation.

BACKGROUND: Many employers in Finland provide not only preventive health care but also primary care for their employees. This puts occupational health professionals (OHPs) in a dual role, which in turn raises questions about patient privacy. AIM: To investigate occupational health nurses' (n = 140) and physicians' (n = 94) perceptions of privacy in caring relationships. METHODS: A self-administered questionnaire was sent to 183 occupational health (OH) physicians and 183 OH nurses. Descriptive statistics and frequency tables were used to characterize the variables. The differences between nurses and physicians were determined with Pearson's chi-square tests and Fisher's exact tests. RESULTS: Both nurses and physicians felt that physical, social, psychological and informational privacy was important in the OH setting. The duration of work experience did affect perceptions of privacy. One-third of respondents considered it good practice to take a full medical history from prospective employees as part of the pre-employment assessment. Over half of the OHPs found the currently valid requirements concerning patients' information privacy too strict in that they may in certain cases complicate the provision of care and treatment. CONCLUSIONS: Tact and sensitivity are paramount when dealing with patient privacy. The aim of privacy, however, should not be to conceal information, but rather to prevent any harmful disclosure.

Privacy in occupational health practice: promoting and impeding factors.

AIM: This article describes the views of occupational health professionals, employees, and employers on factors that are thought to promote and impede privacy in occupational health practice. METHODS: The data were collected through theme interviews with 44 subjects and were analysed by content analysis. RESULTS: Both promoting and impeding factors organized around two content areas: "caregiving" (patient-caregiver relationship) and "tripartite cooperation" (cooperation between occupational health professionals, employees, and employer). The content areas illustrated the two different roles Finnish occupational health professionals have toward their two groups of clients: employees and employers. "Adequate behaviour" (respect, good communication, presence) and "Adequate knowledge base" (instinct, work experience, ethical thinking, knowledge of legislation) promoted privacy in caring relationship, whereas "Inadequate behaviour" (untrustworthy, busy, distant, "friend") impeded its realization. In tripartite cooperation, the promoting factors had to do with "Common good" (impartiality, regular contacts, community spirit, fair play) and "Individual good" (informed consent, advocacy). The main category, "Confusions in loyalties", emerged from three subcategories (confusions in confidentiality, confusions in duties, and confusions in roles) illustrating the impeding factors in tripartite cooperation. CONCLUSIONS: Questions of privacy are crystallized in occupational health professionals' diverse duties and roles towards employees and employers. In occupational health practice, privacy cannot be seen only as a privilege of employees, but must also be viewed as an instrumental value serving the interests of employers and whole work community. Confusions in loyalties need more discussion and research before privacy can be optimally realized. Lapses in confidentiality should never happen.

Understanding privacy in occupational health services.

The aim of this study was to gain a deeper understanding of privacy in occupational health services. Data were collected through in-depth theme interviews with occupational health professionals (n = 15), employees (n = 15) and employers (n = 14). Our findings indicate that privacy, in this context, is a complex and multilayered concept, and that companies as well as individual employees have their own core secrets. Co-operation between the three groups proved challenging: occupational health professionals have to consider carefully in which situations and how much they are entitled to release private information on individual employees for the benefit of the whole company. Privacy is thus not an absolute right of an individual, but involves the idea of sharing responsibility. The findings open up useful new perspectives on ethical questions of privacy and on the development of occupational health practices.