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September 21, 2005
Confidence
I was at my wife's hospital today when I ran into a classmate from college, Mike. Crazy the odds, eh? Not really an old friend, but we took a couple classes together. We'll probably never cross paths again. I told him my whole situation while I was waiting for my wife to get her paperwork for a the hospital discount rate to a local gym. He's now an administrator at the hospital, I think he's in charge of medical records? His office is next door to the huge room o' filing cabinets. They're not really filing cabinets. They're huge vertically revolving shelves of files that go all the way to the ceiling. His wife is an Aggie, which is why they're here now. Anyway, he started telling me how his dad owned his own business in Galveston and he was actually hoping they would evacuate so his dad could come up here to a free clinic because he doesn't have health insurance and he hasn't gone to the doctor even though he's been bleeding from the rectum for a year.
Well that's not good.
He's been doing research and found this clinic and he's trying to figure out about what to do about getting insurance. His dad only admitted it to him after it had been going on for a while, and I got the sense he was only telling me because I'm a medical student and he knows me a little bit, but also knows we may never see each other again. Since it's a relatively small community I know some of the doctors at A&M that work at this other hospital and suggested a couple he could talk to. He agreed half-heartedly. I think he feels embarassed about bringing it up to these doctors who he considers to be coworkers. One, a surgeon, even walked past and he declined to approach him.
Fastforward to me sitting at home, I mean, my parents' house, talking to my wife about it. I happen to know that surgeon's number. That guy that walked past. I've been to dinner with him and his wife. In fact, my wife has their home number. How long will Mike perseverate on this before his dad dies of rectal cancer? Maybe it's something else. But it's been a year. What's to think he'll change and do something about it now, just because he talked to me? But he told me about this in confidence, right? At least he was probably acting on the assumption that I'd disappear, right? And what if I did call this surgeon? What would he, a doctor, think of me so loosely talking about this information? That's not demonstrating a very good ability to keep a secret now is it? I mean, these two know each other at work. There might be odd glances at the water fountain.
What the hell am I thinking?! Somebody has got a serious medical problem and I'm worried about uncomfortable social nuances?! I called. The doctor was a bit surprised that this had gone on so long, but, in all, took the news in stride. He said he would try to bump in to Mike and try to bring it up naturally. He said he has found he gets further faster that way, rather than raising the alarm immediately. Good clinical point there.
Nevertheless, I'm forced to ask myself: did I betray Mike's confidence? Was there a confidence to be betrayed? If so, was my betrayal justified?
Posted by Niels Olson at September 21, 2005 10:40 PM
Comments
I, like you, am a 1st year (older) student, so I haven't taken medical ethics or have any relevant experience making first-hand clinical decisions, but my gut instinct says that if you perceived that your friend told you only because he thought you were a med student and thought you'd shed light on things for him, then there was an implicit trust -- however weak -- that should not be taken lightly. I don't know the particulars of the exchange not having been there, so I'm not going to pass judgement and say that you did or did not break the confidence.
I know your desire to help is sincere, but you can't try to cure/help everyone you come across with a problem (or in this case, with a family member with a problem!) or you'll burn out. The father has a known medical problem with obvious symptoms (which could be nothing more than chronic hemmorhoids (are there any other changes, such as weight loss, etc?), but it takes a special kind of stubborness to ignore rectal bleeding for so long) and a son *in the medical field* who also has inherited that special gift for denial/avoidance/etc. Even with radical intervention on your part, there is little evidence to support a thorough follow-through with a treatment regimen should it prove to be cancer.
I do respect your genuine desire to help. It's more laudable to try to help to much, making a few mistakes along the way, than to care too little, methinks.
Posted by: Enrico at September 22, 2005 1:57 AM
Don't fret. I doubt you did something unethical. I can't believe that the conversation you had with the former classmate represented any professional relationship, even knowing that you are a medical student, which, by itself,should encourage confidentiality. If the casual conversation was as you described and the classmate did not request confidentiality, then I don't think that confidentiality is an absolute default duty on your part. Your classmate obviously had an emotional problem to personally bring up his father's symptoms to a "co-worker" despite recognizing the importance to get professional consultation for his father. By your action, you provided the notification of a resource without having the classmate, himself, initiate the process. Whatever, his father turns out to have and whatever your further contact with the classmate, I think you performed a beneficent act for both the father and your classmate. I doubt that your classmate will think otherwise. Anyway, that is my opinion. ..Maurice.
Posted by: Maurice Bernstein, M.D. at September 23, 2005 12:10 AM
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