Life is full of choices and secrets. The life of a doctor is unique. Having the knowledge, skill and expertise to keep an individual alive or prolong that life is a blessing. In the course of practicing, you learn that certain information about your patient must be kept a secret, regardless of how unpalatable they may be. Many of the things a patient tells you must never leave the consulting room. It is common knowledge that many happy families have secrets littered around which if exposed changes and affects how relatives relate to one another. Many family ties are broken beyond repair because when these secrets come out in the open, there are elements of doubts, disappointments and distrust. Depending on the content, there may be no way back. Questions are asked and we wonder what else is being hidden from us?

Few years ago, I got out of medical school. During the induction ceremony, we were excited to join a group of men and women who could affect lives. It finally became clear to us that our actions or inactions could determine the outcome of a disease and go a long way in determining whether an individual got worse or better.  In the midst of all that euphoria and excitement, right in front of our families, relatives, friends and teachers, we were asked to read the Physician’s Oath. With our hands raised and broad smiles on our faces, we recited with pride in our voice:

·         I solemnly pledge to consecrate my life to the service of humanity;

·         I will give to my teachers the respect and gratitude that is their due;

·         I will practice my profession with conscience and dignity;

·         The health of my patient will be my first consideration;

·         I will respect the secrets that are confided in me, even after the patient has died;

·         I will maintain by all means in my power, the honour and the noble traditions of the medical profession;

·         My colleagues will be my sisters and brothers;

·         I will not permit consideration of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;

·         I will maintain the utmost respect for human life;

·         I will not use my medical knowledge to violate human rights and civil liberties, even under threat;

·         I make these promises solemnly, freely and upon my honour.

It was quite possible that many of us never really understood the implication of every word and sentence of the oath. We were just too happy to receive the provisional license to practice medicine; our reward for all the physical, mental and emotional stress we had endured while in medical school. I sat down a few days later and thought about that line “I will respect the secrets that are confided in me, even after the patient has died”. The details were clear and precise. The implication was a patient had the right to confide in a doctor and also add that he or she didn’t want anyone, regardless of how close he or she was to that person, to become aware of what had just been discussed in the course of the consultation. I will offer two imaginary scenarios.

Amanda is getting set for her wedding to Dave. The arrangement for the wedding was in full swing and everyone was looking forward to the big day. Dave had insisted there was going to be no sexual relationship until after they had been joined in holy matrimony. He wanted it to be special. However, for almost a year, Amanda had been feeling ill. Symptoms included a recurrent and stubborn cough, fever and unexplained weight loss amongst other symptoms that had become untreatable. He advised Amanda to see his cousin, Amanda, in clinic. Then she walks into the clinic, not as family but as a patient. Then all necessary laboratory investigations are carried out and there seems to be some problems, which luckily can be solved. HIV screening is also done and then there is an even bigger problem. She is HIV POSITIVE. She is told of the result and she is in shock and weeps uncontrollably. When she becomes relatively calm, she looks at her doctor and says, “You must not tell him. If you do, he will leave me. I can’t let that happen”. It must be pointed out that this conversation isn’t an informal chat. She is speaking with a doctor in a hospital. As the Physician’s Oath clearly states, she is entitled to a right to confidentiality. The doctor is in a fix. It is a difficult choice, his patient or his cousin? The oath is quite clear. He can say absolutely nothing unless she wants him to. In countries where litigations are strong and common, he can lose his license if he discloses without the consent of his patient. Later that day, his cousin wants to know how his fiancée is doing and the outcome of the laboratory investigations. The doctor offers him solutions to other minor problems, leaving the HIV aspect, and reassured him that all was well. Unfortunately, he can only advise Amanda to try to disclose to Dave. It’s difficult; he lives with the guilt, knowing that he has kept such vital information away from his poor cousin. Would he have reacted or acted differently if he was his sibling? And would you?

Jennifer has been married for about three years now. However, she has been unable to get pregnant following this union. What her husband is unaware of is that the last time his sweet Jenny saw had her menstrual flow was two years before the wedding (about five years ago). She has somehow managed to deceive him for three years and he actually thinks his wife always has a normal cycle. Five years ago, Jenny had an induced abortion after she got pregnant for a guy she had met at a club. Attempts to find the mystery man when she found out about the pregnancy proved abortive. She had the pregnancy terminated by an auxiliary nurse at a local pharmacy store close to the university she attended then. She had an incomplete abortion with other complications. This was finally taken care of in a proper health facility. But, not everything returned to normal. The damage had been done. While her husband keeps the faith, believing that God’s time is the best, believing in the infinite mercy of God, there is a problem he may never find out. Jennifer is at the Obstetrics and gynaecology clinic to see a doctor because she is under enormous pressure from her mother-in-law and her husband’s siblings to deliver a child. She needs a solution to this dilemma. She tells the doctor the truth and accepts that the problem would certainly be from her. She is however scared of her husband’s reaction if he finds out and insists that this conversation doesn’t get out of the room. She is instead focused on looking for solutions.

The consequences of revealing a patient’s secrets to a relative or friend could be devastating. Families could be broken and friendships lost in the process. This could be ties and bond which have been built over many years. Don’t forget, those we reveal secrets to may be incapable of keeping these sacred details to themselves. They are never settled until they tell a friend who in turn tells another friend. And a chain of communication with connections at different levels is started. Many patients could become victims of stigmatization due to their health status. That should never happen. But you live with the guilt. You know that by keeping these secrets to yourself, you expose innocent people to even greater danger in the future. Unfortunately, they may remain oblivious of the health details of their loved ones for the rest of their lives.

Finally, the job entails you say nothing. Patient can only be advised to disclose such details to their loved ones so that they too can seek help where necessary. They however cannot be forced to reveal these sensitive details if they do not wish to do so. The final decision ultimately rest with the patient. If they vehemently refuse, then for the doctor it’s a case of ‘’hear all evil but most importantly say nothing’’.    

 

Have a good day.

Uche H. Okafor.