confidentiality or discretion in rural practice

I was recently asked how I was feeling by the medical receptionist when we ran into each other at our cafe. This morning the florist also asked. They didn’t have to do anything to find out I’d been in hospital, the first opened the discharge report, the latter prepared a bouquet.

Sometimes in small communities there are limits to the possibility of protecting confidentiality and the best that can be managed is discretion. I’ve pretty much always lived and worked in rural communities so this is quite comfortable for me, but a number of my professional colleagues choose to live in nearby towns and villages to avoid the complications.

I see confidentiality as a bit of an urban concept and certainly social work arose, both through the English hospital almoners and the US  settlement  houses, in urban settings. It’s much easier to maintain confidentiality when you live on the other side of the tracks to the people your providing a service to.

My own preference, undoubtedly as a result of my personal circumstances, is to live and work in the same community, thus being accountable in a wholistic way. This is best supported by discretion and respect where strict confidentiality isn’t possible.


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