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When patient confidentiality is breached while treating cancer

Armen Hareyan's picture
The Cancer Experience: Book cover

Going through cancer treatment experience is difficult not only for patients but also for doctors.

In a new book, titled The Cancer Experience: The Doctor, The Patient, The Journey, Dr. Roy Sessions deals with a variety of emotion-related and ethics issues that encompass much of the basis of the cancer treatment experience. The following is an excerpt from the book's 13th chapter, discussing patient confidentiality and special patient circumstances.

The physician who is loose with patient confidences is in violation of a sacred trust. This is true for all medical confidences, but with cancer, it is monumental in importance.

The Oath to which I have eluded is very clear and uncompromising regarding a patient’s right to total privacy; the absoluteness of this commandment is never in doubt. Anyone hearing a doctor chatting about identifiable medical information should be wary of trusting such a marginally ethical individual, who at best has questionable judgment. In these litigious times, loose-lipped professionals will be held accountable for their indiscretions. During World War II when espionage was rampart, posters were hung throughout Great Britain that read, “Loose Lips Sink Ships.” One might apply that same caution to health care professionals, especially physicians. Loose lips can sink careers.

I recall an unhappy story involving a breach of confidentiality and an unfortunate turn of events for a young doctor. When I was in training at Barnes Hospital in St. Louis, a resident in another specialty was fired after a less-than-discrete discussion with another resident while riding on a hospital elevator. He was talking in a low but clear voice about how one of his patient’s alcoholism was complicating his care. It happened that one of the patient’s adult children had just arrived from out of town, and yes, was on that same elevator, at exactly the same time. As it turned out, the patient’s family had been very influential supporters of the medical center, and the ax was swift and powerful. The resident’s error was careless and revealed immaturity at a minimum, but there was no malice of thought. Nevertheless, it was a huge mistake that altered his career substantially. The issue was not the conversation— the discussion was relevant and appropriate to have with a colleague, but it should have been held in strict privacy.

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Patients have a right to expect complete confidentially whatever their medical concern; however, with information pertaining to cancer privacy becomes an obsession with some. Old stigmas endure, and certain patients want to keep the issue confidential. This is especially important in some highprofile patients in which the reason for privacy is obvious. In other patients, however, the obsession with keeping the cancer private might be based on not wanting family members to worry or simply not wishing to constantly be perceived in the shadow of the illness.

During the period in which I practiced at Georgetown University Medical Center in the nation’s capital, I had the opportunity to take care of a number of national leaders, many well known and recognizable. We generally catered to them by not requiring waiting-room delays, instead ushering them into exam rooms upon entry into the office. This was as much for security reasons as it was privacy. In any event, I was seeing a prominent member of the president’s cabinet—the secretary of an important department of government. He came through the waiting area with a bodyguard and was quickly brought into an exam room. I examined him, and we made plans for an operation. Then he was ushered out—all within forty-five minutes. That same night, on network news, it was announced that Secretary “So and So” had visited a Georgetown cancer surgeon that day for an unknown reason. The firestorm began about thirty minutes after the news broadcast, and it started with the leadership of the university. The assumption, of course, had been that we had somehow leaked the information. After checking with the clerical people in my office, all of whom adamantly denied violating this inflexible rule, we started studying the list of other patients who had been in the waiting room that day. A producer for the reporting network was on the patient list, and when I called him and asked the question, he readily admitted that the information had come from him. Even though he apologized, he truly felt that he was only doing his job. I was aggravated by this, but accepted his explanation and reported back to the secretary, who, as it turned out, understood the game far better than I, and all was forgiven. The beltway insider understood the fundamental fact that the newsman reporting that information was different from our having leaked it. In the latter circumstance, it would have been an unforgivable violation of patient confidentiality.

When caring for famous people, there can be great pressure on the doctor from outside sources—news media, gossip columnists, and social acquaintances who somehow are aware that the patient is under medical care. Whatever the source, and no matter how relentless the pressure, the patient’s privacy must be regarded as sacrosanct. On a number of occasions, my wife and children have been surprised to learn from an outside source that a famous person was under my care, but they always understood why they had not heard it from me.

I did violate that confidence one time, many years ago. I had been asked to go to a country in Central America to examine and care for the president of that country. Because there was some concern of an impending coup, he was unable to come to the medical center where I was an attending surgeon. The potential adventure was too much for me to resist, and I flew there in an unmarked plane dispatched by that country’s military. Upon landing, I was whisked off the plane at the end of the runway and taken to the palace, where I examined the president; we made arrangements for surgery to be done that same night. The procedure was done under tight security, with armed guards in the operating room. Fortunately, the problem was easily corrected. Several days later, after making sure my patient was doing well, I left under the same security blanket as before. Back in my home base, I returned to my routine. Two days later a very large man with a crew cut and a dark suit and tie came to my office to ask about my recent visit to that Central American country. He was from the CIA, and he wanted to know what my business with that particular president had been. I stammered and hesitated under the unsmiling stare of a very intimidating guy, and after partially recovering from the revelation that my secret trip had been anything but a secret, I ended up telling him more than I had planned to, and certainly more than I should have. I have always rationalized my breach of that president’s confidentiality by telling myself that since this was not a cancer-related problem my transgression was not as serious as it might have been. I wonder how resolute I would have been in circumstances where cancer was the issue, in which confidentiality would be more important. I am embarrassed to admit that, because I was frightened, I did not “practice what I preached.” I fully confessed all of this to my patient. Not only did he readily forgive me but he was greatly amused and somehow not surprised that the CIA was so interested in him.

Continued: Pitfalls of caring for cancer-afflicted celebrities

Excerpt from: The Cancer Experience: The Doctor, The Patient, The Journey (Ch. 13) Roy B. Sessions, MD
Rowman & Littlefield Publishers, INC ISBN: 978-1-4422-1621