So much for keeping secrets: the importance of considering patients' perspectives on maintaining confidentiality

Little data are available from patients' perspectives regarding the mainten ance of confidentiality by care providers. Such data may be useful in deter mining the importance of confidentiality to patients and in developing appr opriate policies and procedures regarding confidentiality. Three focus grou ps were conducted with support groups of rural HIV-positive patients. Text was coded inductively and analyzed with software designed for qualitative a nalysis. Participants perceived breaches of confidentiality in hospitals, c linics and health departments that occurred by word of mouth, computers, fa csimile and written materials. Patients included sharing stigmatizing medic al information among medical providers without prior consent as a breach. T hey made decisions about where to seek care based on the degree of professi onalism of medical staff (which included respecting confidentiality), clini c location or the level of security of the organization's computer network since they believed that computers increase information access. Finally, pa rticipants believed that medical personnel should be taught the importance of maintaining confidentiality and that those who violated confidentiality should be punished. Patients would like confidentiality policies that requi re providers to: (1) explain procedures for sharing information, (2) reques t patients' specific consent for access to their medical records, even amon g other providers, and (3) punish those who breach confidentiality.