Methodological issues in the study of confidentiality: a reinterpretation of findings

Investigations of confidentiality management have been constrained by an inability to obtain direct measures of clinicians' behaviors when deciding whether to breach or safeguard a confidence. Some researchers have used responses to hypothetical case vignettes to derive approximations of how clinicians manage confidences entrusted to them by their patients. However, these studies have focused primarily on total confidentiality scores, without exploring the possibility that subsets of clinical cases might elicit different confidentiality decisions. In this investigation, reanalysis of responses to case vignettes obtained from 436 psychologists, psychiatrists, and internists revealed that on the issue of confidentiality management, these health care providers discriminate among cases involving: Premeditated harm to others, socially irresponsible acts with possible dire consequences to self or others, and minor theft. Of these three categories of cases, those involving social irresponsibility elicited the greatest disagreement among the clinician groups studied.