Secrets in primary care: a qualitative exploration and conceptual model.

OBJECTIVE: Secrets and issues of confidentiality are critical concerns in doctor-patient communication and fundamental aspects of every medical encounter. Nevertheless, the nature, content, prevalence, impact, and consequences of secrets in medicine have largely been unexplored. This study investigates the role of secrets in primary care. It describes the intuitive strategies used by primary care physicians to cope with secrets, provides a categorization system, and suggests a conceptual model.

DESIGN: Focus groups of primary care physicians were the principal data collection method employed. Transcripts from 8 focus groups were analyzed using an "immersion-crystallization" framework involving cycles of concentrated textual review of data. Insights from this iterative process and from the literature were employed in the construction of contextual types, content categories, processes, and models.

PARTICIPANTS: Sixty-one family physicians and general practitioners in Israel with a wide variety of seniority, ethnic, religious, and immigration backgrounds.

SETTING: Locations in the north, south, and center of Israel.

RESULTS: Analysis revealed insights about definitions, prevalence, process, and content of secrets in primary care. The main content findings centered on categories of secrets such as propensity to secrecy, toxicity of secrets, and the special nature of secrets in family medicine. The main process findings regarded the life cycle of secrets and doctors' coping strategies. Based on our findings and a review of the literature, a conceptual model of secrets in primary care is proposed.

CONCLUSIONS: The importance and impact of secrets are significant part of daily medical practice. Further research is needed to enhance physicians' effective and ethical handling of secrets and secrecy in practice.