Residents' decisions to breach confidentiality

This study assessed variables involved in physician decisions to breach confidentiality in cases of patients' self-reported past crimes. Seventy internal medicine residents completed a questionnaire containing case vignettes of patients' self-reports of crimes; likelihood of informing the police was ascertained. Results were analyzed according to the type and cost of the crime, previous criminal record, patient characteristics, and intent of the patient to commit future crimes. Results also were analyzed by postgraduate year of the resident. Patient characteristics of race and socioeconomic status had no effect on the decision (p less than 0.122 and p 0.182), although age did (p less than 0.001). Reports of past violence (p less than 0.001), previous criminal record (p less than 0.001) and high-cost crime (p less than 0.007) increased the likelihood of breaching confidentiality. Future intent affected the decision (p less than 0.005), but less than reports of past violence. No differences were seen among postgraduate years of respondents (p less than 0.873). Residents base decisions to breach confidentiality on factors other than the future intent of specific violence. This finding has legal and ethical implications.