BMJ  2003;327:1024-1025 (1 November), doi:10.1136/bmj.327.7422.1024

Paper

Privacy of patients' information in hospital lifts: observational study

¹ St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, Canada M5B 1W8, ² Department of Medicine, St Michael's Hospital, University of Toronto, ³ Departments of Surgery and Health Policy, Management and Evaluation, St Michael's Hospital, University of Toronto

Introduction

Respect for the confidentiality of patients' information is a basic principle of ethical and effective medical practice. It ensures individual patients' privacy, and, more broadly, it upholds public perception of the quality of the healthcare system and its professionals. Observational studies have shown that breaches of patients' confidentiality by healthcare professionals occurred in 3%-7% of lift rides in hospitals.^{1 2}

Even though most healthcare professionals know the limits of confidentiality well, they have trouble applying them to their behaviour, particularly in hospital lifts where discussions of patients' information may be overheard.³ To decrease the risk of compromising patients' confidentiality in public spaces in hospitals, we investigated the number and nature of comments that compromise patient confidentiality in hospital lifts and the reactions of colleagues who witnessed these comments.

Participants, methods, and results

We instructed medical students in the information privacy policy of St Michael's Hospital, a tertiary care centre in Toronto, Canada. They recorded the date, time, duration, and location of every journey they took in a public lift at St Michael's Hospital during regular hours for two weeks in November 2002.

These observers excluded journeys where only their own healthcare team was present because no healthcare professional, patient, or visitor was present to witness a compromise of patient confidentiality. Observers, who were identifiable as medical students, recorded all breaches of patients' confidentiality by hospital staff and any reactions by witnesses to these comments.

Hospital caregivers made 18 comments deemed to compromise a patient's confidentiality on 13 out of 113 lift journeys (observers overheard multiple comments on some journeys). Doctors made the most comments (11), then allied health professionals (6), and then nurses (1). Most comments referred to patients by their initials or reason for admission, but names were used four times.

Reactions attempting to minimise breaches of patients' confidentiality happened only twice. Both times medical students naive to the existence of our study politely asked that the conversation be continued in another location. The students' interventions were successful.

Comment

Patient confidentiality was compromised on more than one in ten lift journeys, strengthening the evidence that public lapses in patient confidentiality are widespread.^{1 2} Most comments disguised patient identity, which shows awareness of the need for discretion in public spaces and the motivation to uphold it. But clarification of what constitutes a breach in patient confidentiality is needed.

The small number of reactions (to less than a tenth of comments) shows that other healthcare workers in elevators are either reticent or lack awareness. The silence of witnesses may even perpetuate the problem; on several occasions, breaches in confidentiality started conversations that further compromised patients' privacy.

Breaches of a patient's confidentiality compromise ethical health care and undermine patients' confidence in caregivers. Healthcare institutions must provide effective training to minimise these breaches. We hope that providers here and in all healthcare institutions will heed the call to improve discretion for the patients who entrust us with their care.

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We thank our observers, all medical students at the University of Toronto at the time we did the study: Melissa Albin, Sonia Butalia, Patrick Cervini, Jared Peck, and Gregory Silverman.

Contributors: JMAB conceived of the study. All authors designed the study, interpreted the data, and revised the paper. SNV analysed the data and drafted the paper. CMB and JMAB approved the final draft. JMAB is guarantor.

Funding: No additional funding.

Competing interests: None declared.

Ethical approval: Research ethics board, St Michael's Hospital.

References

1. Ubel PA, Zell MM, Miller DJ, Fischer GS, Peters-Stefani D, Arnold RM. Elevator talk: observational study of inappropriate comments in a public space. Am J Med 1995;99: 190-4.[CrossRef][ISI][Medline]
2. Hasman A, Hansen NR, Lassen A, Rabol R, Holm S. [What do people talk about in Danish hospital elevators?] Ugeskr Laeger 1997;159: 6819-21. (In Danish.)[Medline]
3. Grady C, Jacob J, Romano C. Confidentiality: a survey in a research hospital. J Clin Ethics 1991;2: 25-30, discussion 30-4.[Medline]

(Accepted August 5, 2003)

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Breach of patients’ confidentiality and Data Protection Act 1998 can be legally prosecuted

Humayon Pervez
bmj.com, 1 Nov 2003 [Full text]

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