Physicians' strategies for safeguarding confidentiality: the influence of community and practice characteristics

Confidentiality is an issue of particular importance in rural communities where it seems everyone knows everyone else. Privacy may be compromised when professional relationships are interwoven with personal ones. We conducted a study to determine the influence of practice characteristics on safeguarding confidentiality.

A survey was mailed to all family and general practice physicians in Kansas. Differences in confidentiality strategies were studied to determine if they were related to characteristics of the respondents and their practice environments.

A total of 510 physicians (55%) responded to the survey. Only in practices in which more than 5% of the patients were personal acquaintances was a strategy for preserving confidentiality affected: of seven specific strategies, only one, speaking with office personnel about confidentiality, was statistically associated with this practice characteristic.

Physicians practicing in smaller communities and areas with more extensive social interconnectedness may need to address the issue of privileged communication to a greater extent. If other options are exhausted, physicians may need to send patients with particular needs for confidentiality outside their communities to obtain care.