Ford C A, Millstein S G
Department of Pediatrics, University of California at San Francisco, USA.
Arch Pediatr Adolesc Med. 1997 May;151(5):505-9. doi: 10.1001/archpedi.1997.02170420075013.
To investigate physicians' practices in assuring confidentiality to adolescent patients.
Mail survey.
California.
Seven hundred eighty-six board-certified physicians in family practice, internal medicine, obstetrics and gynecology, or pediatrics (response rate, 65%).
Physicians were asked the percentage of adolescent patients (15 to 18 years old) with whom they discuss confidentiality during routine visits and the content of their assurances of confidentiality. A clinical vignette assessed physicians' knowledge of legal guidelines for confidential treatment of adolescents.
Physicians reported discussing confidentiality with 53% (on average) of their adolescent patients. Eleven percent of physicians did not discuss confidentiality with any adolescent patients. Hierarchical linear regression used to control for other physician demographic and practice factors showed that female physicians were more likely to discuss confidentiality than were male physicians (R2 change = 0.03, P < .001). There was also an association between specialty and discussing confidentiality (R2 change = .04, P < .001); obstetricians and gynecologists were more likely to discuss confidentiality than were other primary care physicians (beta = .21, P < .001). Among physicians who discussed confidentiality, 64% assured unconditional confidentiality and 36% assured conditional confidentiality. When asked about legal guidelines for managing a 15-year-old patient with a sexually transmitted disease, 63% of physicians responded correctly, 5% responded incorrectly, and 31% were unsure of management guidelines.
Physicians do not consistently discuss confidentiality with their adolescent patients. Most of the physicians who discuss confidentiality, with adolescents assure unconditional confidentiality, which is inconsistent with professional guidelines or the legal limitations of confidentiality.
调查医生在确保青少年患者隐私方面的做法。
邮寄调查。
加利福尼亚州。
786名家庭医学、内科、妇产科或儿科的董事会认证医生（回复率为65%）。
询问医生在常规就诊时与青少年患者（15至18岁）讨论隐私的比例以及他们对隐私保证的内容。一个临床案例评估了医生对青少年隐私治疗法律指南的了解。
医生报告称，平均与53%的青少年患者讨论过隐私问题。11%的医生从未与任何青少年患者讨论过隐私问题。用于控制其他医生人口统计学和执业因素的分层线性回归显示，女医生比男医生更有可能讨论隐私问题（R2变化 = 0.03，P < .001）。专业与讨论隐私之间也存在关联（R2变化 = .04，P < .001）；妇产科医生比其他初级保健医生更有可能讨论隐私问题（β = .21，P < .001）。在讨论过隐私问题的医生中，64%保证无条件隐私，36%保证有条件隐私。当被问及管理一名患有性传播疾病的15岁患者的法律指南时，63%的医生回答正确，5%回答错误，31%不确定管理指南。
医生并非始终与青少年患者讨论隐私问题。大多数与青少年讨论隐私问题的医生保证无条件隐私，这与专业指南或隐私的法律限制不一致。
