



































Bangladesh Journal of Bioethics 2014; 5(3):1-5 

 1 

Practice of Informed Consent, Confidentiality and Privacy by Physicians at a 

Tertiary Care Teaching Hospital  

 

 Zoheb Rafique 
1
, Urooj Bhatti 

2 

 

1 Lecturer, Department of Biochemistry, Liaquat University of Medical & Health Sciences (LUMHS), 

Jamshoro, Pakistan 

2 Lecturer, Department of Physiology, Liaquat University of Medical & Health Sciences (LUMHS), 

Jamshoro, Pakistan 

Email: dr_zohaib@hotmail.com 

 

 

Abstract: Objective: The aim of this paper was to assess the practice of medical ethics by the 

physicians at a public sector hospital in jamshoro Sindh. Material and methods: This survey was 

conducted at four medical units of tertiary care hospital at jamshoro in the month of august 2014. 

Participants were randomly selected from patients aged over 18 years. A structured questionnaire was 

designed and the participants were asked about their demographic profile and their physician’s practice 

regarding informed consent, maintaining confidentiality, privacy and other treatment formalities. Written 

consent was taken from all the participants before interview. Results: A total of 100 patients were 

randomly selected for this study. The majority of patients reported that informed consent was taken from 

them. The patients also responded that privacy and confidentiality is maintained during their treatment. 

However, many patients agreed that they were not properly informed about the laboratory findings, role of 

proposed drugs and also side effects of drugs. Conclusion: There is marked improvement in the practice 

of medical ethics by physicians of this tertiary care hospital. However, awareness workshops should be 

conducted to update and improve the knowledge of medical ethics among physicians. This will surely help 

them translate the knowledge into practice. 

 

Key words: informed consent, confidentiality, privacy 

 

Introduction: In the rapidly changing system of health care, many different factors have affected and 

changed the perception about how health care is practiced today. The rights of patient are also affected. 

Patient rights have now become the center of attention in practice of medicine. Today, concerns about 

patients’ choice and the respect for their preferences, values and the access to medical care are getting 

more complex. The Patients’ expectations are becoming higher and now they always want every thing 

best. They want active participation in decision making and proposed treatments or procedures and the 

other alternatives available
1
. Information regarding designed surgical or medical intervention should be 

presented to patients before starting any procedure or treatment. In addition to this, the risks of treatment 

mailto:dr_zohaib@hotmail.com


Bangladesh Journal of Bioethics 2014; 5(3):1-5 

 2 

as well as benefits should also be explained to the patient, so that patient can make a decision regarding 

what he/she demands. It is recognized as an essential measure, to ensure the preservation of patient 

rights. The requirement for obtaining informed consent is established in every decision making situation in 

clinical practice. Fully informed patient is able to participate in decisions regarding his/her health care
2
. 

Along with informed consent, respect for confidentiality and privacy is also included in responsibility of 

doctors/physicians throughout history. Very recently though attention has been centered on these 

principles with the formal introduction in modern codes of medical ethics. The concepts of confidentiality 

and privacy are closely related. Confidentiality is a narrow term referring to informational privacy and also 

to the responsibility not to disclose any information about patients without prior permission from the 

patient. Privacy is a broad term including informational privacy, physical privacy, protection of the personal 

identity and ability to make informed choices without interference. Confidentiality and Privacy are basic 

rights of patients and they also serve to nurture a frank, trustful and open relationship with 

doctor/physician, thus improving patient care
3
. Numerous studies have shown that doctors in routine 

medical practice don’t consider it necessary to take proper consent after providing the patients with 

thorough information.  Similarly despite the fact that respect for confidentiality and privacy has been a 

responsibility of physicians/doctors throughout history, it is noted that doctors often neglect the aspect of 

medical ethics. However, despite the fact that regulatory body for medicine in our country, the Pakistan 

Medical and Dental Council commonly known as (PMDC), has formulated code of ethics for doctors, no 

major steps have been taken in order to ensure its implementation. Recently, there has been a significant 

change in the thinking of the patients, mainly because of greater influence of ICT (Information 

Communication Technology, primarily of electronic media and the internet). Thus, due to the increasing 

awareness, now patients demand full information about treatment options, treatment plans and also 

possible complications and these aspects were not practiced in the past
4
. In this paper the patient’s 

perceptions regarding practice of physicians in a tertiary care teaching hospital was discussed.  

 

Material and Methods: To assess the perception of patients in the medicine wards regarding practice 

of medical ethics by the physicians, a survey was conducted at Liaquat University of Medical and Health 

Sciences (LUMHS) Hospital Jamshoro in the month of august 2014. A structured questionnaire was 

designed and the patients were then interviewed. A total of 100 patients were randomly selected in four 

medical units. The patients were taken above the age of 18 years, so that they can understand and give 

consent themselves. Written consent was taken at the time of interview. The questionnaire consisted of 

eight (08) questions and it took 15 minutes to complete the interview and fill the questionnaire. 

 

Results: A total number of 100 patients participated in this study. Our study population included 59 male 

patients and 41 female patients. The demographic data of patients is shown in Table 1 and Table 2 shows 

the patient’s responses to the questionnaire. 

 



Bangladesh Journal of Bioethics 2014; 5(3):1-5 

 3 

Table: 1   Demographic Profile 

Sex               No of Patients 

Male                 59 

Female             41 

 

 

Table: 2 Shows the perception of patients regarding physicians practices 

Statement                                                                                                     Responses 

                                                                                                              (1) Yes     (2) No    (3) Don’t Know 

1. Informed consent taken                                                             (1)  85     (2)  15      (3)    0 

2. Confidentiality of the patients assured                                      (1)  94      (2)  05      (3)  01   

3. Privacy of the patient maintained                                              (1)  92      (2)  08      (3)    0 

4. Patients are informed about the diagnosis                                (1)  90      (2 ) 10      (3)    0     

5. Patients are informed about the reason for investigations        (1)  79      (2)  21      (3)    0 

6. Physicians have discussed with the patient the relevant  

       laboratory findings                                                                     (1) 66       (2)  34      (3)    0  

7. Physicians have explained the role of the proposed drugs       (1) 28        (2)  72      (3)    0 

8. Physicians have explained the side effects of the  

      proposed drugs                                                                           (1)10         (2) 90       (3)   0 

 

 

Discussion: This study was designed to assess the practice of informed consent, confidentiality, privacy 

and other treatment modalities by physicians at a tertiary care hospital. In our study 85 % of the patients 

were of the view that informed consent was taken from them. We asked about taking informed consent 

during general physical examination, history taking and routine procedures. This percentage is very good 

because of the reason that we have teaching hospital and now bioethics is being taught at undergraduate 

as well as postgraduate level, so physicians are familiar with informed consent, its components and 

requirements. We also looked at physician’s practice of maintaining and assuring privacy and 

confidentiality. In our study we found that 94 % of the patient agreed that confidentiality was assured and 

maintained during their treatment and only 6 % of the patient either disagreed or not sure about their 

confidentiality. When we asked about the maintenance of privacy, 92 % of the patients were of the view 

that privacy was maintained during their examination, treatment and routine procedures and only 8 % of 

the patients negated this statement. Our study data is better then other studies conducted in Pakistan 

indicting that physicians are aware of the actual practice of medical ethics. In one question we asked the 

patients about the information regarding the diagnosis, 90 percent of the patient agreed that they were 

informed about the diagnosis or the disease they are suffering, while 10 % patients disagreed and were 

not told about their diagnosis. 79 % of the patients were of the view that they were informed about the 



Bangladesh Journal of Bioethics 2014; 5(3):1-5 

 4 

reason for investigation/laboratory reports and 21 % disagreed and were having view that they were not 

informed about the reason for having different laboratory reports, blood tests, urine tests and other 

investigations etc. When asked about the discussion of relevant laboratory findings, only 66 % of the 

patient agreed and 34 % of the patients disagreed with the statement. In our last two questions we asked 

the patients about the role of the drugs given to them by the physicians and also the side effects of those 

drugs. We found that only 28% of the patients agreed that they were explained in detail the role of the 

drugs given to them, means why that particular drug is given and for how much time and at what time the 

patents have to take those drugs and 72 percent of the patient disagreed. Only 10 % of the patient agreed 

that they were explained the side effects of the drugs which they were taking and 90 percent disagreed 

and told us that they were not briefed about the side effects of the treatment they took. When we 

discussed these issues in detail with some patients and also with some residents/physicians working in 

medicine wards, we found some interesting answers. Doctors say that majority of patients are illiterate, so 

it is of no use to tell them about the laboratory findings and drug side effects in detail. Some physicians 

were of the view that patients and their relatives are only interested to see patient get well soon and they 

are not interested how and why. Patients were having view that doctors are over burdened. Some patients 

say doctors are less interested and some physician’s say that patients are not educated much and they 

don’t understand even the basic things some time, so therefore they don’t discuss things in detail. 

Residents say they have less house officers and senior doctors and consultants don’t give much time and 

some patients say that doctors are sincere with their duty. Informed consent enjoys unassailable position 

in both research and clinical situations as safeguard of patients’ rights. The involvement of the patient in 

decision making process is much easier when there is direct link/communication with the individual. The 

Pakistani milieu carries challenges to this process because important decision making is very often done 

by the family members or in some cases it is left entirely to the attending physician. This also raises some 

ethical dilemmas for the physicians who may not feel comfortable with the communication which excludes 

the patient or in accepting the paternalistic decision making role
5
. This study has one potential limitation 

that this study was conducted in one single hospital and its results cannot be generalized for all 

government/public sector units/hospitals in Pakistan. 

 

Conclusion: The results of our study suggest that physicians at teaching hospitals may have improved 

their practice of medical ethics. However, due to the fact that data was collected only at one tertiary 

care/teaching hospital, we can’t comment on ethical practices of the physicians from private healthcare 

sector and other public sector hospitals. Nonetheless, to encourage the ethical practice, steps should be 

taken in highlighting the importance of basic principles of medical ethics: informed consent, confidentiality 

and privacy. Furthermore, awareness campaign should be conducted for the physicians to improve their 

knowledge of the ethical principles. 

 

 



Bangladesh Journal of Bioethics 2014; 5(3):1-5 

 5 

References: 

1. Farida M, Habib and Hind Sulaiman Al Siber. Assessment of Awareness and Source of Information 

of Patients’ Rights: a Cross sectional Survey in Riyadh Saudi Arabia. American Journal of Research 

Communication. 2013; 1(2):1-9. 

2. Faisal Ghani Siddiqui, Jan Mohammad Shaikh, Mohammad Munir Memon. An Audit of Informed 

Consent in Surgical Patients at a University Hospital. J Ayub Med Coll Abbottabad. 2010; 22(1). 

3. Ayesha Humayun Et Al. Patients' perception and actual practice of informed consent, privacy and 

confidentiality in general medical outpatient departments of two tertiary care hospitals of Lahore. BMC 

Medical Ethics. 2008; 9:14. 

4. Waris Qidwai Et Al. Informed consent, privacy and confidentiality practiced by doctors of a tertiary 

care hospital in a developing country. Indian Journal of Medical Ethics. 2013; 9(1). 

5. A M Jafarey, A Farooqui. Informed consent in the Pakistani milieu: the physician’s perspective. J Med 

Ethics. 2005; 31:93–96. 

 

Conflict of Interest:  There is no conflict of interest. 

 




