Dr. Monica’s Corner: Doctor-Patient Confidentiality & the Medic’s Responsibility

We all have aspects of our lives that we prefer to keep hidden. Events that have happened to us in childhood, activities (incongruent with our character) that we have participated in or things we simply do not want to share with our friends or family.
Being a doctor is almost like being a catholic priest where people find it comforting to be able to share these stories without fear of judgement and are offered forgiveness.

Some of our secrets can make us unwell and sharing them is helpful; who can you trust? Discussing the full gist can certainly aid diagnosis.

In my many years of working as a medic, I have heard too many of these secrets to mention. Some of my colleagues say I get more than my fair share of these sometimes very shocking life stories. I like to think that people feel comfortable to disclose to me and know that it will stay CONFIDENTIAL.

The most frequently occurring are stories of childhood abuse, domestic violence and sexuality/sexual exploits.
These tend to have long term effects on the physical, mental and spiritual health of most patients and we need to start talking seriously about them.

One story that strikes me is of Mr Bamijoko (Not Real Name). He walked in to the consultation room looking like the world had collapsed on his shoulders. “How can I help you today” I asked. ”I am so low Dr” He started to cry. Nothing embarrassing about seeing a 55yr old man cry particularly when you’re caught in the web he has found himself in.

The story was, Mr Bamijoko (NRN), a well-respected University lecturer has been caught by his wife for being unfaithful and he is distraught. Not just because he has been caught but also because he is still very much “in love” with the other woman and will be a repeat offender. He has told his longsuffering wife that he is no longer seeing her, however according to Dr Maury, that was a …!

You may be tempted to say, serves him right. However, his story is; he studied all his life, married quite late, Christian values, hardly sowed any wild oats.
He married a fellow lecturer, had a baby and things changed, as you would expect. He then has a series of minor emotional affairs, which he worked through with his wife.

Then comes a new female lecturer in his department, attractive, single, maternal and listens to him drone on and on about his subject.
He “falls in love” with her. After a few months, the affair is blown open and his wife is very upset. She decides to move out of their home to her parents’ and gives him an ultimatum to choose between his new flame or her.

He ruminates on this for a while, managing to spend time with the other woman on the side. After a while, he decides he misses his wife and child and went to plead with his Mrs to come back home amidst promises of never seeing his girlfriend again.

Wife is now back home and he is still completely drawn to the other woman hence his attendance on the day. He is tearful and low and exhibiting all the symptoms of depression.

Mrs Bamijoko (NRN) wants a full STI check (sexually transmitted infections) and is waiting to know her fate while Oga is still lovesick. I offer him a listening ear, counselling support and the check madam wants.

While he can be supported to face his reality and be as honest as he can, I will not be judging his final decision.
He will not be judged, that is not a health professional’s role. My role is to keep all his secrets safe. I may run into him in church, the supermarket or elsewhere, it doesn’t matter. No one will ever hear it from me.

There are occasions when a doctor cannot keep a secret. If the patient is deemed to be a risk to the public, then the appropriate authorities will be notified immediately. There are many examples of those (story for another day)

In the West, patient confidentiality is key and patients can freely come forward to get early diagnosis and treatment. Everyone who has access to clinical records is signed up to confidentiality. In Nigeria however, fear, lack of information and low patient confidence is ruining lives.

Whatever your secrets are, if they are making you ill or you simply want to talk about them, go to your doctor, clarify the confidentiality clause and get spilling!