Invasion of Patient Privacy, Physical and Historical: Are Doctors Unaware?
There has been at least two issues that I have presented on my blog where the responses of the visitors have given me professional and ethical pause. I mean I have been made aware that there are some strong feelings and attitudes that patients carry which has never been previously stressed to me nor, I think, to other physicians. As the example, I have had the discussion of physical modesty of patients in relation to their interaction with their physicians. There were some strong concerns about unprofessional physician behavior in this regard. And the last posting was about physician history taking, specifically about taking a history about firearms in the household. The suggestion was made that some of the questions which physicians feel are important medical questions may not be considered as such by some patients. In this post, I don’t intend to defend the merits of the unhappiness by some patients regarding these issues or the merits of any physician’s rebuttal. What I am concerned about is that this may be just the tip of an iceberg of ignorance of what we physicians know (really don’t know) about how patients feel about our behavior as we treat them. Is this ignorance because we physicians just don’t listen or is it because patients don’t talk to their doctors about it? Whatever the reason, this ignorance on our part is not a healthy condition to lead to the best relationship with the patient. If the patient is unhappy about what the patient feels is the physician’s disregard for their physical modesty or thinks that the doctor is unnecessarily invading the patient’s privacy by asking unnecessary questions or even other issues that I haven’t even mentioned, this can be a obstruction to any attempt at the best of medical care. Also, as a teacher of medical students, I wonder,in this regard, if our medical schools need to emphasize certain issues of patient concern which we have not emphasized in the past. Any thoughts on this subject? ..Maurice.
posted by Maurice Bernstein, M.D. @ 8:47:00 PM
3 comments
3 Comments:
Yet another post that I can't help but comment on ... thank you!
This is one of those questions that I think will draw a different response from each commentor ...
My own personal reaction is that there are several areas that I don't consider to be within the physician's domain ...
Among the things that I may be uncomfortable answering, but which I feel are questions he has a right to ask, are any questions which directly relate to my health - questions about my sexual activities, diet, physical activity, fastidiousness, emotional health, family history, smoking, drugs ... etc. ...
However, questions about seat belts, motorcycle helmets, guns, anything along those lines ... no.
I feel that way for more than one reason:
1) Adults generally understand the risks they take when they choose to drive without seat belts, etc. Being questioned about those choices will not usually cause them to change their behavior, but it might make them resentful - and evasive.
Give adults the slack they need to make their own choices on issues which have not yet affected their health, and are not directly, immediately, related to their health.
2) That sort of question is patronizing - no matter how it's phrased. There's an unspoken assumption in the very question that the physician believes the patient isn't smart enough, responsible enough, to make his own choices. That doesn't help create the candidness necessary for the doctor/patient relationship ... all it creates is resentment and a wide communication gap which may never again be bridged.
3) Where particularly the gun issue is concerned - often the physician himself does not own a gun, and knows practically nothing about owning guns, shooting, or hunting. Questioning someone who might be very involved in guns, smithing, hunting, shooting ... might actually be seen as downright insulting.
Compare this to some fellow who works at Wal-Mart sitting in your exam room, telling you how to conduct his physical ... or how to use one of your medical tools.
Actually, that wouldn't be quite as bad, because although the Wal-Mart clerk would be impertinent, he's at least "on subject" with regards to why he's seeing you. However, when you confront a patient about guns, it's not even "on topic" - you're reaching out of the exam room, and into the privacy of his home, and you're doing so regarding a subject that does not directly relate to his medical health.
For myself, the bottom line is: if it directly relates to my health, then ask away, and I'll do my very best to be forthcoming. But the "do you wear a seat belt?" and "do you own a gun?" questions might make me wonder who I should make my next appointment with.
Moof, this particular post is all about physician ignorance of how the patient sizes up that physician's behavior during the professional interaction. My question to you is: have you talked to your doctor, even in general, about what behaviors in taking a history or performing a physical would make you feel uncomfortable? If the patient doesn't communicate their concerns to the doctor how can the doctor become educated about his/her patient and have a chance to tweak his/her behavior for a better relationship? ..Maurice.
I'm sorry, Dr. Bernstein, I just saw your question, or I would have answered it earlier.
No, I haven't spoken to my own physician in that manner, but I have an unusual problem with nose-to-nose communication ... although I do quite well in writing. When I was still seeing a PCP, I used to write down my questions and concerns, because I knew that I would never get them said otherwise; however the thought of critiquing his interaction with me never entered my mind. I saw that as part of his individuality and training.
Dr. Bernstein, I think that many of us are intimidated by the position, if not always by the individual ... and it's a rare physician who tries to dispel that. Actually, the very profession itself makes communication difficult relationally - it's like a fine balance between detachment and intimacy, and that can be very awkward on both sides: physician and patient.
Post a Comment
<< Home