Medical What?

Ministerial Meandering

Medical what?

“Oh - I can’t tell you that - it’s confidential,” said a nurse.  I was simply trying to locate a parishioner in the local General Hospital - not asking her how my neighbour’s sex-change operation had gone.    Unfortunately, this seems to be the default response to almost any question you ask - of almost any health care worker these days.

I recall a day long past, when I, as a young locum doctor in my teaching hospital, had been given the task of telling the family about the prognosis of the father, who had been admitted to the pulmonary ward with metastatic lung cancer.  At that stage of my career, it was not my place to question decisions made by my senior colleagues, so I prepared myself to speak to his daughter and son-in-law, and tell them that dad had only months to live - if that.  The patient’s permission had not been sought, as far as I knew, but it was still felt that someone in the family ought to know, so that appropriate preparations might be made.  Being so junior in the pecking order, I was not allowed any private space to hold this delicate conversation - even the ward sister would not allow me ten minutes in her office.  So I had to meet these two on the landing outside the lifts (elevators).

This was the first time I had been tasked with breaking bad news, and I had no instruction or role model to follow.  And of course, I blew it - big style.

I introduced myself (which was a plus, because most doctors these days don’t even bother to do that), and then opened with, “I suppose you realize that your father is dying?”  They didn’t.  What I hadn’t been told was that they had been given a lie when dad was originally admitted, saying that he had some ‘arthritis’ in his shoulder, and of course, he still had his cough from his ‘bronchitis.’

The truth was that he had advanced lung cancer, and the pain in his shoulder was from bony secondaries.  That news almost produced a collapse in the daughter, and certainly produced an instant and vitriolic verbal attack on me from the daughter’s husband.  Quite justified, I would say.  But I felt like I had been set up.  I tried to retrieve the situation by saying, “Let’s start again then.  Tell me what you have been told.”  At this point they told me the utter rubbish about arthritis and bronchitis.

Obviously, these situations should never happen, and I vowed at that moment never to leave the most junior member of the team to pass bad news to patients or their relatives.  In fact, when I became a consultant, I took courses on the topic, and used to specifically train my junior staff in how to perform this most difficult of tasks; usually by direct observation of my example.

However, in this country now, there seems to be a conspiracy of silence.  Probably based on ignorance and lack of communication, but silence nonetheless.

As a pastor and retired surgeon, I feel it would not be unreasonable to share at least some medical details of the patient’s condition with me, especially when they have given permission.  Even if this is not allowed, I think it unreasonable to even withhold information on the patient’s location or future possible discharge.

On three occasions in the last week this basic information has been denied  to me on the basis of ‘confidentiality.’  And despite my wearing a hospital staff badge delineating me as one of the Spiritual Care Team.  I did mange to find out that one patient had been transferred from ICU to a certain ward, but when I went to that ward, he was not to be found.  Not only did they not tell me if he had been discharged, transferred to another ward - or to a care home - or to the mortuary; they would not even confirm that he had ever been on the ward.  How, in heaven’s name, is that confidential?  These are not even medical details.

I fear that we have clearly slipped from any vestige of ‘medical-in-confidence’, to ‘medical incompetence.’

Philip+