Do we maintain an adequate level of individual privacy and confidentiality for our patients during their stay in hospital?
A study of 364 patients attending an urban, university based emergency department (ED) reported in the Emergency Medicine Journal has found that privacy is a strong predictor of overall patient satisfaction with their treatment.

From ancient times, respect for patient privacy and ensuring patient confidentiality have been regarded as a fundamental obligation of healthcare providers, and are now a cornerstone of contemporary medical practice.
For patients in the emergency department (ED), appropriate privacy and confidentiality are especially critical if a good physician–patient relationship is to be established.
The ED setting is unique compared with ordinary wards in the hospital; the spaces for patients are usually overcrowded or undersized, and patients are often placed in close proximity to each other, family members, healthcare providers, other staff and the working station. ED patients may have some sensitive problems, for example, drug overuse, domestic violence, sexual assaults, sexually transmitted diseases and sociopsychiatric conditions, etc. Accordingly, severely ill or trauma patients, who may not be capable of protecting their own privacy and confidentiality, can only depend on their healthcare providers to ensure their privacy and confidentiality. This demands ED healthcare providers to be particularly sensitive to issues concerning privacy and confidentiality.

Factors contributing to feelings of inadequate privacy amongst the patients surveyed included:

  • Patients managed in close proximity to other patients and separated by only a curtain.
  • Concerns over frequent interruptions by other staff and ‘irrelevant persons’ during examination, or curtains being drawn back during staff movements, exposing the patient.
  • Reluctance to be examined in a crowded environment; including female patients unhappy to be examined by male staff even when female staff were present.
  • Patients managed in corridors due to overcrowding of the ED experienced little or no privacy or confidentiality.
  • Staff talking to each other through the curtains and across patient care areas (often passing patient information in raised voices).
  • Patients remaining in the ED for longer periods of time experienced more frequent privacy incidents.
    Just another reason to banish the scourge of access block and ED overcrowding.

Poor perceptions in personal privacy were found to effect the disclosure of personal information, and lead to a deep dissatisfaction with the level of individual care.

Patients are often required to discuss matters including family history, psychiatric history, domestic violence, sexual assaults etc. Communication with elderly or hearing impaired may require communication in a raised voice to be heard.
And in my own experience, language differences between patient and doctor can occasionally lead to less than skillful interactions with respect to confidentiality.

Results from this study highlight the importance of designing ED’s with an environment conducive to maintaining privacy and confidentiality during patient interactions and interventions. For example, the use of rooms with walls and doors to provide a more secure environment as well as minimizing noises and smells.

Less expensive  to fix, the EMJ study also found the most important factor in patients perceptions of privacy was simply a lack of vigilance, and insensitivity amongst staff.

Here is an example of what can go very wrong when you become a little privacy complacent: curtain call
And here is a reminder for us all to engage our brains before putting our mouths into gear: loose lips

Factors predicting patients’ perception of privacy and satisfaction for emergency care [Emerg Med Jdoi:10.1136/emj.2010.093807]

One Response to “patient privacy.”

  1. The curtain thing is very interesting. Having worked in critical care areas for the majority of my working life, I was taught from early on that closed curtains are like a closed door and should be treated as such. As for the whole vaginal exam thing (Curtain call), I was lucky enough to be looked after by a registrar in the ED who very simply got me to lay with my head the foot of the bed to avoid that awkward curtain call. Must have been effective as it was 12 years ago and I have remembered that treatment….

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