Don't become a doctor #16 - I've got a secret

Confidentiality is a legal requirement in medicine. There are only a few relationships where your conversations are protected by law: your spouse, your priest, your lawyer, and your doctor. We are entrusted with private information, and we have to protect it.

There are exceptions, instances where for the welfare of another person or the general public, we must disclose information, but otherwise, we are bound by professional duty and law to keep our information secret. Generally, this prohibition covers medical illnesses, medications, frailties, personal identifiers.

But that's just the tip of the iceberg. Patients have told me things, dark and secret things, long hidden, told to no one on the face of this earth but me. I have heard stories of rape and incest, physical and emotional abuse, spousal arguments, infidelity, greed, maliciousness and cruelty. I have had a husband and wife come in separately for STD screenings. I have had wives come in with injuries from their husbands. I have had patients tell me about being sexually abused as children.

When someone tells you a secret like these, you will not know how to feel. There will be anger and outrage, pity and sadness, compassion and anxiety. And as a doctor, you will want to fix the problem. But that is not what has been asked of you. You were asked to keep a secret, and that is all.

If you cannot live beneath the burden of all these secrets, then maybe medicine is not for you. But it is these secrets that make medicine into an art.


As as aside, if there is one thing that I hate, it is the abuse of children, and if it were possible to hate one particular form of child abuse more than others, it is child sexual abuse. Morality aside, the health consequences are staggering: insomnia, PTSD, eating disorders, sex disorders, anxiety, depression, substance abuse, anger and impulse control issues, headaches, chronic pain, fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, asthma, obesity have all shown higher rates in victims of child sexual abuse.

7 comments:

cardiactamponade said...

Great post, as usual ifinding. Happy new year!

Anonymous said...

I just started reading your blog and I decided to start from the beginning. I did read all of the "Don't become a doctor" series and that's how I discovered this but then I started from the bottom. Those first posts reeeeeeaaally get to me. i feel like i'm going through a lot of the same stuff now. can i ask you, where did you go for medical school?

incidental findings said...

Wouldn't be very anonymous if I told you that.

Anonymous said...

ohhh i see. i'm okay with that :) do you think you can comment on how important a person's choice on med schools can be? based on where you ended up going, how important do you think medical school rankings are? it's just AMAZING reading your story! so far i'm on 2005! haha

Anonymous said...

@Anonymous: here's a paper on the validity of these rankings. http://journals.lww.com/academicmedicine/Fulltext/2001/10000/America_s_Best_Medical_Schools__A_Critique_of_the.5.aspx

incidental findings said...

I think the philosophy of a medical school and their fit with your own ideals is really important, more than other factors. LCME dictates that >90% of the MD curriculum is essentially the same, so it's all about delivery.

Anonymous said...

Hey,
How do you precisely remember all the different stories and who experienced what if you have so many patients everyday?