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INTRODUCTION: The right to privacy and the right to confidentiality are elements of great importance which make the core of ethics in biomedicine. These principles also determine the basis for patient-physician relationship, which is crucial for the delivery of high-quality health care in the diagnosis and treatment of patients. Since ancient times, many nations in their cultures have always had medical codes that defined and described doctors’ duties and patients' rights, including the right to privacy and the right to confidentiality. Medicine recognized these rights and they became a part of various medical codes, declarations and resolutions, but their importance was also realized by the law in many societies. Different countries of the world incorporated the patients’ rights in their law and made them a part of the legal regulations.
AIMS OF THE RESEARCH: Most countries in the world, including Croatia, regulate patients' rights by different laws and medical codes. However, in everyday practice dentists sometimes don't respect their legal obligations and deny the patients their rights. According to the literature, there is no relevant scientific data that describes dentists' knowledge, attitudes, and awareness of patients' privacy and confidentiality in the Republic of Croatia. The aim of this study was to explore the dentists' knowledge, attitudes, and awareness of the patients' privacy and confidentiality in Croatia.
PATIENTS AND METHODS: The research protocol has been submitted for a review to the Ethics in Research Committee of the School of Dental Medicine, University of Zagreb, and the study has been approved. The aim of this study was to assess the dentists' knowledge, attitudes, and awareness about professional confidentiality and privacy. In our survey we included 600 dentists, who according to data from the registry of the Croatian Chamber of Dentists, make 15% of the total number of dentists. Our respondents filled out a questionnaire containing queries related to the dental laws and codes of the dental ethics. The questionnaire was consisted of two parts. In the first part dentist answered ten multiple-choice questions regarding their knowledge about the professional privacy and confidentiality, while in the second part we asked them about their attitudes toward the patients’ rights to privacy and confidentiality.
RESULTS: The age of the interviewees ranged from twenty-seven to sixty-six years (mean=44 years). 43,.5% (n=261) of them were male and 56,5 percent (n=339) were female. The interviewees had between one and thirty-nine years of clinical experience (mean=17 years) in the dental practice. Most of the respondents were concessionaires in the network of the public health service who had a contract with the Croatian Institute for Health Insurance (HZZO). 61% of the interviewees own their own practice, while 39% worked as employees. Majority of dentists (91,5%) were general doctors of dental medicine. There was no difference in sex, age, duration of active service, type of practice, employment status and type of work. Prior to completing the questionnaire the interviewees rated their awareness of the privacy and confidentiality. The self-rated awareness score and the summary of information were not significantly correlated. Overall, the correct answer was given by the majority of interviewees for only four statements: the first one which determines the patients’ right, the second one which describes the patient’s right to privacy, the seventh one which determines the legal obligation of revealing dental records and the ninth one which determines classification of violation of professional secrecy. On average, the interviewees answered four questions correctly (interquartile range=3-5), and the number of correct answers among the interviewees ranged from 0 to 9. There was no difference in knowledge among the interviewees with regard to sex, employment status, or type of practice. indicating that the dentists were inaccurate in assessing the degree of their awareness of the patients’ rights to privacy and confidentiality. The interviewees answered to questions about their attitudes toward the patients’ rights to privacy and confidentiality on a five-point answer scale (0=never, 1=almost never, 2=sometimes, 3=often, 4=almost always), which were mostly distributed in the range of 0-2. Dentists frequently breached patients’ confidentiality by commenting their patients to other colleagues, as the dental records were rarely inadequately stored so that unauthorized persons could have an easy access to them.
CONCLUSION: To summarize, our results showed insufficient knowledge, lack of awareness, and poor attitudes of dentists toward the patients’ privacy and confidentiality in Croatia. We conclude that Croatian dentists need better informing about their obligations and patients’ rights. We believe that better education can undoubtedly improve these results. Furthermore, both dental students and dentists should be provided with classes as well as with postgraduate continuing education courses where their ethical and legal obligations would be thought and thoroughly explained.