Quiet life

Doctors are inundated with secrets, with each day bringing a new batch.2 What starts as a simple history often leads to the patient divulging highly personal information about their illness, life, and family. These may be stories concerning issues such as marital breakdown, illnesses, and deaths in the family; or a hidden family; or admissions about drug use, sexual abuse, a long held dream, or an undisclosed HIV status. Patients are willing to divulge highly personal information, and the extent to which they cooperate can sometimes be mind boggling.3 Indeed, one of the greatest shocks in our lives as medical students is the sudden realisation that a patient will tell us everything and almost do anything at our behest.

Imagine that you are clerking a patient with a suspected sexually transmitted infection. You will have to ask a number of questions, including the timing of last intercourse, previous sexual contacts and partners, contraceptive method, sexual practices and orientation, duration of relationship, and even last weekend's big night out. And sure enough, most patients answer with little or no discomfort. But the advice that became Spiderman's guiding principle, “With great power comes great responsibility,” applies to the doctor. “Shut your trap,” the strong interjection rings through. “You can ask what you want but better keep quiet about it.”2 This business of maintaining confidences has been described as “our most important spiritual activity.”2 Doctors must learn how to keep secrets so that they can keep quiet about the stories they hear every day in their working lives.

Confidentiality of …