BackgroundRespect for confidentiality is important to safeguard the well-being of patients and ensure the confidence of society in the doctor-patient relationship. The aim of our study is to examine real situations in which there has been a breach of confidentiality, by means of direct observation in clinical practice.MethodsBy means of direct observation, our study examines real situations in which there has been a breach of confidentiality in a tertiary hospital. To observe and collect data on these situations, we recruited students enrolled in the Medical Degree Program at the University of Cordoba. The observers recorded their entries on standardized templates during clinical internships in different departments: Internal Medicine; Gynecology and Obstetrics; Pediatrics; Emergency Medicine; General and Digestive Surgery; Maxillofacial Surgery; Plastic Surgery; Orthopedics and Traumatology; Digestive; Dermatology; Rheumatology; Mental Health; Nephrology; Pneumology; Neurology; and Ophthalmology.ResultsFollowing 7138 days and 33157 h of observation, we found an estimated Frequency Index of one breach per 62.5 h. As regards the typology of the observed breaches, the most frequent (54,6 %) were related to the consultation and/or disclosure of clinical and/or personal data to medical personnel not involved in the patient’s clinical care, as well as people external to the hospital. As regards their severity, severe breaches were the most frequent, accounting for 46.7 % of all incidents. Most of the reported incidents were observed in public areas (37.9 %), such as corridors, elevators, the cafeteria, stairs, and locker rooms.ConclusionsIn addition to aspects related to hospital organization or infrastructure, we have shown that all healthcare personnel are involved in confidentiality breaches, especially physicians. While most are committed unintentionally, a non-negligible number are severe, repeated breaches (9.5 %), thus suggesting a certain carelessness, perhaps through ignorance about certain behaviors that can jeopardize patient confidentiality.Electronic supplementary materialThe online version of this article (doi:10.1186/s12910-016-0136-y) contains supplementary material, which is available to authorized users.

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Las emergencias de salud pública, como la que estamos viviendo con la pandemia originada por el coronavirus SARS-CoV-2, han originado trágicas limitaciones de recursos que impidan salvar vidas. Provocando tensiones en la atención sanitaria centrada en el paciente como eje del sistema en condiciones normales y la misma atención sanitaria en situaciones de emergencia originadas en la COVID-19. En esta revisión abordamos algunos de los problemas asistenciales, organizativos y éticos que este escenario ha provocado en la atención primaria como: cancelación de actividades programadas, escasa atención domiciliaria y seguimiento de pacientes ancianos, enfermos crónicos e inmovilizados; desabastecimiento de EPIs y la exposición al riesgo de los profesionales sanitarios, y finalmente los problemas asociados a la telemedicina y atención telefónica a los pacientes.

In-custody deaths are typically investigated by a medical examiner or coroner (ME/C) and include those that occur while in the custody of the police or in a government detention facility (e.g., prison). The potential manners of death are natural, homicide, suicide, accident, therapeutic complication, and undetermined. Once the cause of death is determined, the manner of death is certified based upon the cause and the circumstances of death. Deaths in custody may be challenging due to the potential for death at the hand of another (e.g., inmate, corrections officer, or law enforcement agent) or due to neglect. When a government takes a person's liberty, they have a duty to ensure safe and adequate housing, food, and medical care. Failure of a responsible party to exercise proper care of a person in-custody, may affect the manner of death. Since in-custody deaths at the hand of a government agent can be challenging to certify, we will focus on these manners of death including those associated with excited delirium (ED). Although manners are easily and consistently applied in most deaths, there are nuances in some instances which may result in jurisdictional variations in the determination of the manner of death. We will discuss these variations as the determination made by the ME/C is an opinion based upon his/her particular training, experience, and judgment.

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