Intended for healthcare professionals

Letters

Family secrets

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7119.1380b (Published 22 November 1997) Cite this as: BMJ 1997;315:1380

Patients have right to privacy and confidentiality

  1. Susan Bewley, Director of obstetrics1
  1. a Women's Services Directorate, St Thomas's Hospital, London SE1 7EH
  2. b Department of Anaesthesia and Intensive Care, Aberdeen Royal Hospitals NHS Trust, Aberdeen AB25 2ZB

    Editor—In Hilary Aitken's filler article the author writes about the occasion when she learnt to interview patients after asking visitors to leave.1 At the end of the piece Roger Robinson states that the BMJ thinks that patients should decide themselves who should be present at the doctor-patient interview. This may represent an idealistic view of a group of non-practising doctors with an overdeveloped sense of political correctness relating to patient autonomy. Confidentiality is a cornerstone of the doctor-patient relationship, and, even unwittingly, friends and relatives can inhibit the consultation. Patients do not know in advance what doctors are going to ask them and may not wish to disclose sensitive topics (such as previous sexually transmitted diseases, abortions, and alcohol use) or even ostensibly trivial information (such as the author's example of the wearing of dentures). Although the doctor is a powerful authority figure, patients are influenced by their relatives and may feel pressurised to disguise or withhold information or to take certain treatment options afterwards. Most notably we see this with victims of domestic violence whose partners never leave them unaccompanied. Indeed, the reaction when visitors are asked to leave “as a routine” can itself be informative. It is always possible to invite people back when summarising a consultation or to invite the wider family in later. I agree with Aitken, and not the BMJ, that adult consultations should always be conducted on a one to one basis in private. Patients have a right to privacy and confidentiality, and doctors must work to ensure this.

    References

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    Most patients speak more freely when on their own

    1. Alan Barnett, Specialist registrar in anaesthesiab,
    2. Steve Stott, Consultant anaesthetistb
    1. a Women's Services Directorate, St Thomas's Hospital, London SE1 7EH
    2. b Department of Anaesthesia and Intensive Care, Aberdeen Royal Hospitals NHS Trust, Aberdeen AB25 2ZB

      Editor—The wishes of patients are paramount, and as doctors we must do our best to comply with them. We can only offer advice, backed up with evidence and experience to help them make up their minds.

      The preoperative anaesthetic visit creates a unique doctor-patient relationship. There are only a few minutes to introduce ourselves, establish rapport, and gain the complete trust of the patient. Any factor that interferes with this process can only be to the disadvantage of both the patient and the anaesthetist.

      Family values and interpersonal relationships vary greatly from one person to the next. Some people do need the presence and support of a close friend or relative, but we believe that most patients speak much more freely when on their own. Responsibility for whether relatives stay or go should not be placed on the patient. It is unfair to expect people, already in a state of anxiety and stress, to risk offending their friends or relatives by asking them to leave.

      We agree with Hilary Aitken that relatives should be asked to leave before the interview.1 After all, they may easily be invited back to participate once rapport has been established. This is not an all encompassing rule, and clinicians with the necessary psychosocial and discretionary skills should be able to recognise those patients who need support and will feel more comfortable in the presence of a familiar person. Patients wishes' are paramount, but occasionally doctors know best.

      References

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