Patients' perception and actual practice of informed consent, privacy and confidentiality in general medical outpatient departments of two tertiary care hospitals of Lahore.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Humayun
Ayesha
A
Department of Community Health Sciences, FMH College of Medicine and Dentistry, Lahore, Pakistan. drayeshah@gmail.com
Fatima
Noor
N
Naqqash
Shahid
S
Hussain
Salwa
S
Rasheed
Almas
A
Imtiaz
Huma
H
Imam
Sardar Zakariya
SZ
D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000592:standards / Q000706:statistics & numerical data; D003219:Confidentiality / Q000941:ethics; D003430:Cross-Sectional Studies; D026690:Ethics, Clinical; D004992:Ethics, Medical; D005260:Female; D019983:Guideline Adherence / Q000941:ethics / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D007258:Informed Consent / Q000941:ethics; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010154:Pakistan; D010361:Patients / Q000523:psychology / Q000706:statistics & numerical data*; D010820:Physicians / Q000941:ethics / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D018907:Privacy; D036301:Qualitative Research; D012938:Social Perception