ABSTRACT

The confidentiality promise is technically complex, politically uncertain and scientifically ill-defined to address multiple patients' needs. This is because patients' confidentiality provides diverse perspectives which are yet to meet thorough academic examination. Therefore, the purpose of the study was to assess circumstances that may constrain healthcare workers from keeping the confidentiality promise. The study's objectives were to assess the impact of knowledge level of healthcare providers concerning patient confidentiality, the current trends in keeping the confidentiality of patients and assessing circumstances healthcare workers may be constrained from keeping the confidentiality promise. The study sought to achieve its purpose by adopting a quantitative approach with the cross-sectional explanatory design to gather data through a survey questionnaire using 141 respondents. The respondents included healthcare providers (nurses, medical officers, health specialists and surgeons) of University of Uyo Teaching Hospital, Nigeria. The data was analysed using correlation and simple linear regression via the application of SPSS. The results show that knowledge of public reporting, reporting child maltreatment and knowledge of patients' threats to third parties significantly predicted patient confidentiality. However, knowledge of criminally inflicted injuries, even though positive, did not significantly predict patient confidentiality. The findings suggest that social media does not support patient confidentiality; thus an increase in social media activity is associated with a decrease in patient confidentiality. In-service training, knowledge of patient de-identification and the use of an electronic medical record system are current trends or practices at the facility. The results imply that some circumstances may constrain healthcare providers from keeping the confidentiality promise, hence breaches. The study recommends that healthcare providers should be educated on the use of social media and breach of confidentiality.

CHAPTER ONE

INTRODUCTION

1.0 Introduction

In this chapter, the researcher discusses the background of the study, problem statement, the objectives of the study and hypotheses. In addition, the significance of the study, definitions of key terms and the chapter organization are discussed.

1.1 Background of the Study

The origins of professional confidentiality date back to Hippocrates, who stated, “Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.” This oath remains a widely cited anchor point in contemporary discussions of the moral burden physicians carry in protecting patient information, and continues to be treated as the historical starting point for the principle of medical confidentiality (Archibong et al., 2025). From those ancient times, confidentiality and privacy for healthcare providers have become both a legal and an ethical obligation, and are today treated as one of the values that flow from the broader ethical principle of patient autonomy alongside beneficence, non-maleficence and justice (Varkey, 2021). Confidentiality remains a central pillar of the physician-patient relationship, since a patient's willingness to disclose sensitive information, and the strength of the therapeutic alliance more broadly, depends heavily on the assurance that such information will be protected from unauthorised disclosure (Stern & Rustad, 2022). Confidentiality, and whatever it stood for, was largely disregarded in the past. Historical analyses of the flow of patient information show that before the introduction of formal record-keeping obligations for health professionals in the early twentieth century, confidentiality functioned mainly as an informal social norm attached to oral exchanges between a patient and a single caregiver, and that patients with stigmatised or communicable conditions historically had very limited protection from public exposure or identification (Wadmann, Hartlev, & Hoeyer, 2022).

It was only gradually, from the nineteenth century onward, that confidentiality became recognised as a formal element of medical ethics and law, as an increasing number of jurisdictions embedded professional secrecy into criminal and civil codes and imposed sanctions on practitioners who disclosed patient information without justification (Wadmann et al., 2022). In 1803, Thomas Percival established the first modern code of Western medical ethics, which states, “Patients should be interrogated concerning their complaint in a tone of voice which cannot be overheard.” The American Medical Association's (AMA) original Code of Medical Ethics, adopted in 1847, was a revision of Percival's work and formally included the principle of confidentiality. The current version of the AMA's Principles of Medical Ethics continues to hold that a physician shall respect the rights of patients, colleagues and other health professionals, and shall safeguard patient confidences within the constraints of the law, subject to a narrow and well-defined set of exceptions such as legal compulsion, just cause, or the patient's own written consent (Zarpellon, Bianchi, Fürst, & Nunes, 2025). In Nigeria specifically, professional secrecy and medical confidentiality are similarly recognised within the framework of health legislation and professional regulatory codes that govern practitioner conduct, although enforcement and public understanding of these protections remain uneven (Otor, 2024). Regulatory and accreditation bodies also hold that patients have a right, within the law, to personal and informational privacy. Modern healthcare practice continues to recognise the importance of confidentiality as one of the four cardinal principles guiding clinical decision-making, and it remains embedded in oaths, professional codes of conduct and the academic curricula used to train healthcare workers (Varkey, 2021). Most of these codes commonly hold that confidentiality may be breached only when required by law, when in the public interest, or when necessary to prevent harm to others.

In the health literature, confidentiality continues to be discussed in relation to patients' rights and is treated as an essential element of the trusting relationship that patients have with their healthcare providers (Zeleke & Chanie, 2022). There is a growing empirical literature affirming that patients expect a right to privacy and expect personal information about them to be held in trust, with adequate security of records and appropriately controlled access to that information (Fyanka & Ekpendu, 2023). Recent reviews of the continued relevance of the Hippocratic Oath also support the view that confidentiality remains essential to the formation of therapeutic relationships between patients and healthcare providers, and, by extension, to the institutions that employ them, in that there is a continuing expectation that professional individuals and organisations will maintain the confidentiality of patient information (Archibong et al., 2025).

1.2 Problem Statement

The maintenance of confidentiality is both a legal and an ethical duty of all healthcare workers (Zeleke & Chanie, 2022). Empirical work on patient trust reiterates that indiscriminate disclosure of patient confidences can humiliate patients, undermine trust, and seriously imperil patients' relationships with their doctors and other caregivers (Stern & Rustad, 2022). Patients expect that healthcare providers will honour the implied duty of confidentiality and fulfil their obligation as patient advocates. Moral arguments for confidentiality are commonly rooted in the competing frameworks of utilitarian and deontological ethics: the former justifies confidentiality chiefly by its beneficial consequences for trust and help-seeking behaviour, while the latter frames it as a duty owed to the patient regardless of the outcome it produces (Varkey, 2021; Tseng & Wang, 2021).

Breaching confidentiality may be thought to weaken society's faith in the greater institution of medicine and healthcare (Stern & Rustad, 2022). The resultant distrust threatens the provision of the detailed and accurate information necessary for correct diagnosis and treatment. Thus, the possible long-term erosion of patient openness continues to militate strongly against breaches of confidentiality (Zeleke & Chanie, 2022). Contemporary bioethical reviews of medical confidentiality recognise certain exceptions to the general rule of confidentiality, including disclosure compelled by law, disclosure in the public interest, and disclosure necessary to protect an identifiable third party from serious harm — for instance, where a patient discloses an intention to harm another person, or where a healthcare worker becomes aware of suspected child maltreatment or a criminally inflicted injury (Zarpellon et al., 2025; Conlon, Raeburn, & Wand, 2021; Sagalowsky et al., 2021). It is for this reason that this study intends to find out under what circumstances healthcare workers are constrained from keeping the confidentiality promise.

1.3 Objectives of the Study

The study seeks to assess the role of confidentiality as an essential aspect in patients' information in the hospital and under what circumstances healthcare workers may be constrained from keeping the confidentiality promise. The specific objectives include the following;

Objectives:

i. To assess the knowledge level of healthcare providers on confidentiality at University of Uyo Teaching Hospital in Nigeria.

ii. To study the current trends in the practice of confidentiality at University of Uyo Teaching Hospital in Nigeria.

iii. To find out under what circumstances healthcare providers may be constrained from keeping the confidentiality promise at University of Uyo Teaching Hospital in Nigeria.

1.4 Significance of the Study

The findings of this study are important for government policymakers, health institutions and researchers. The study is relevant in these areas due to the fact that it provides insight into staff perception of patient confidentiality; it identifies the prevailing trends in patient confidentiality practice in the study area, which can be applicable to many health facilities in Nigeria and Africa at large. The findings further provide useful information for government and policymakers to formulate national and institutional policies on the storage and disclosure of patient information. This will help to curtail the indiscriminate disclosure of patient information either in the news, in print, or over social media.

The findings will help to remove barriers to patient-staff and staff-staff relationships, which will translate into greater utilisation of health services, resulting in improved health outcomes. The findings have further enlightened clinical staff to be mindful when dealing with patient information. In addition, the findings of the study may further create an avenue for further studies to be conducted on patient confidentiality in other parts of the country, to create a ripple effect in respecting patient information in our society.

1.5 The Scope of the Study

The study covered health professionals in direct patient care in a private hospital in Pantang, Accra. The study was limited to clinical staff of the selected hospital and did not cover non-clinical staff or staff from other hospitals. Therefore, generalisation should be done with caution. In view of the fact that the study was to assess patient confidentiality and under what circumstances healthcare workers may be constrained from keeping the confidentiality promise, the study made use of staff who mostly have direct interaction or contact with patients. Other facilities and other categories of staff were not part of the study due to resource and time constraints.

1.6 Operational Definitions

Patient: The person to whom the doctor or health facility owes a duty of care.

Patient information: Data given directly by patients to a healthcare professional. This also includes data generated from other investigations or procedure details of the said patient.

Confidentiality: Confidentiality refers specifically to the handling of information that has been shared between a doctor and a patient.

Privacy: May be the physical sphere within which others may not intrude, freedom of choice for important decisions (autonomy), and privacy as control over personal information.

Disclosure: Giving out patient information.

Healthcare professionals: Professionals trained to provide healthcare services to patients. Includes doctors, nurses, and members of allied health.

REFERENCES

Archibong, E. I., et al. (2025). Hippocratic Oath, principle of confidentiality and the moral burden of physicians. Ibom Medical Journal, 18(3).

Conlon, D., Raeburn, T., & Wand, T. (2021). Decision-making processes of a nurse working in mental health, regarding disclosure of confidential personal health information of a patient assessed as posing a risk. Collegian, 28(3), 261–267. https://doi.org/10.1016/j.colegn.2020.08.010

Fyanka, K., & Ekpendu, C. M. (2023). An assessment of the right to privacy and confidentiality of patients in the context of medical negligence, error and malpractice in Nigeria. African Journal on Law and Human Rights, 7(1).

Otor, I. E. (2024). Medical confidentiality and professional secrecy in Nigeria. Journal of Criminal and Forensic Studies, 6(1).

Sagalowsky, S. T., et al. (2021). Mandatory reporting between legal requirements and personal interpretations: Community healthcare professionals' reporting of child maltreatment. Academic Pediatrics, 21(3), 521–528.

Stern, T. A., & Rustad, J. K. (2022). Developing, losing, and regaining trust in the doctor-patient relationship. Primary Care Companion for CNS Disorders, 24(3).

Tseng, P.-E., & Wang, Y.-H. (2021). Deontological or utilitarian? An eternal ethical dilemma in Outbreak. International Journal of Environmental Research and Public Health, 18(16), 8565. https://doi.org/10.3390/ijerph18168565

Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119

Wadmann, S., Hartlev, M., & Hoeyer, K. (2022). The life and death of confidentiality: A historical analysis of the flows of patient information. BioSocieties, 18(2), 282–307. https://doi.org/10.1057/s41292-021-00269-x

Zarpellon, H. M., Bianchi, F., Fürst, H., & Nunes, R. (2025). Preserving medical confidentiality in Brazilian criminal investigation cases: A narrative review of the principles of bioethics. Clinics, 80, 100740. https://doi.org/10.1016/j.clinsp.2025.100740

Zeleke, T., & Chanie, A. F. (2022). Health professionals' knowledge and attitude towards patient confidentiality and associated factors in a resource-limited setting: A cross-sectional study. BMC Medical Ethics, 23(1).

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