Trust, Information-Sharing and the Doctor–Patient Relationship: A Multi-Method, Empirical-Ethics Study of New Zealand General Practice

Abstract

Information-sharing in health care presents opportunities for efficient and effective patient care based on the exchange of high quality information, improved decision making, and increased collaboration and coordination of care across the system. However, it also presents concerns around the control of information and maintaining trust in the privacy, confidentiality and security of information. These concerns reflect the difficulty in balancing how to share information in ways that protect the interests of the individual and any overriding interests of the public. This thesis reports on research exploring trust and information-sharing between patients and General Practitioners (GPs) in New Zealand using a multi-method, empirical-ethics approach. This combines a critical realist theoretical perspective with critical applied ethics. The findings from two empirical studies outline expectations that GPs ensure patient privacy and confidentiality, only sharing information as necessary or appropriate. While levels of trust in health professionals and organisations are high, patient knowledge and awareness of the rules and practices around information-sharing are low. Further these matters are not often discussed between GPs and patients, and patients are not concerned by this. Patients showed little concern about information being shared within the health system or with health professionals, but had concerns about the potential implications of third-party sharing. While some actions may disrupt or breach trust there are ways that GPs can seek to rebuild trust with patients. The findings con rm the importance of trust for the GP{patient relationship and suggests that patients' trust GPs to use and share information when necessary and for their benefit. In an ethical analysis based on Beauchamp and Childress' four principles, this thesis suggests that trust is best conceived as a foundational aspect of what it is to interact with patients in a way that fulfils GPs' obligations. This thesis suggests that an orientation towards building and maintaining trusting GP{patient relationships provides a more robust and relationally focused way of balancing conflicting ethical obligations as exist around information-sharing.