Confidentiality in Caribbean health care - abstract

ABSTRACT

The AIDS epidemic has brought into sharp focus the ancient ethic of confidentiality of medical information. This report is part of a larger study commissioned by the Caribbean Community Secretariat on ethical and legal issues pertaining to the HIV/AIDS epidemic. Twenty-one persons in leadership posts were interviewed; these included Chief Medical Officers of 9 Ministries of Health, holders of top positions in 9 Non-governmental Organisations, including UWI's Faculties of Medical Sciences and Law, trade unions, professional organisations and 3 top Barbadian Civil Servants. The number of years' service by the respondents was 9.38 (SD 6.32). They were unanimous in their view that breaches of confidentiality by health care workers warranted disciplinary action by the relevant professional council, although 4 (19.0 percent) suggested more lenient approaches in certain cases. Despite this, 15 (71.4 percent) said that medical records should be complete and accurate, with all confidential information recorded, and that records should be more professionally managed. Sixteen respondents (76.2 percent) said that third parties, including insurance companies, immigration departments, CMOs' offices, etc., would be guilty of an offence in law if a patient's confidential matters were leaked by them. Most respondents thought that the duty to warn the spouse of an HIV-infected patient of the risk of infection was a very difficult issue. Eleven (52.4 percent) said the doctor should, if necessary, break a patient's confidentiality and warn his/her spose. In small Caribbean societies confidentiality is very important. If people feel that their private affairs will be divulged, they will stay away from health care workers, compromising their care and threatening public safety. It is recommended that the issue of confidentiality be given more attention in CME and in medical practice in the Caribbean (AU)