Some years ago, while working in a women’s clinic, I came across a patient who we shall call Mrs A.B. Mrs A.B came to the hospital because she had been trying to get pregnant for many years to no avail. During the history taking process, she was asked about past pregnancies to which she responded that she had never been pregnant. As part of the investigations to check what might be keeping her from getting pregnant, the consultant decided to carry out a hysteroscopy; this is a process where a camera is inserted into the womb to get a better view and potentially treat any abnormalities found. During the procedure, a small piece of a baby’s bone was found embedded in her uterine lining. This was removed successfully and shortly after Mrs A.B was able to spontaneously achieve pregnancy. Imagine if we did not have the medical resources to conduct that investigation. As I think about Mrs A.B’s story, I better appreciate the usefulness of doctor-patient confidentiality.
The truth is, it is not unusual for patients to feel intimidated by their doctors, or to feel some form of embarrassment from their medical histories. This sometimes results in patients not being completely forthcoming about when asked questions by their doctor. Unfortunately, this type of incomplete disclosure can compromise the quality of care provided by the doctor.
As a doctor, I can tell you that your doctor is just like every other person you interact with. They just happened to study and practice medicine. And just like everyone else, your doctor does not know absolutely everything and is also capable of making mistakes. They need you to work with them to get you the best possible medical care. Like, your cooperation can literally save your life.
Unfortunately, sometimes, patients withhold information from their doctors for fear of being judged. Some other reasons why patients may not tell their doctors everything is because they are embarrassed, or they think certain things are too insignificant and do not want to waste the doctors time.
While it may seem reasonable in the moment due to embarrassment/feeling self-consciousness, it is never a good idea to withhold information from your doctor. If anything, you should err on the side of over sharing when it comes to conversations with your doctor. This is because your doctor needs to be able to pick up diagnostic clues from your stories, and any part that is left out might lead to a missed diagnosis. The history taking process can be a tedious one, and answering so many questions can get tiring, but the process is intentionally designed that way in order to pick up the smallest of clues.
It is the duty of the doctor to make sure that the questions are being asked in language that is easy for the patient to understand. If you do not understand a question asked by your doctor, it is better to ask for clarification than to provide a wrong answer. Doctors ask questions about everything from your current symptoms to your past illnesses, to the illnesses experienced by other family members. While some questions may seem unnecessary or unrelated, it is always better to answer as honestly as possible. Even when the questions do not appear related to your current complaint or reason for your visit, your answers might still be very helpful.
For example, one of the reasons doctors ask about the health of your parents or siblings is to probe for possible genetic or familial diseases. This information can help the doctor decide if you need to be screened for any diseases that appear to run in your family. Medical conditions such as diabetes, hypertension and cancer tend to run in families. If your doctor has information that a family member died of colon cancer at an early age, they may arrange for you to start getting screened for colon cancer earlier than is recommended for the general population and this is a good way to either prevent or catch disease early.
If you complain about having an increased heart rate, your doctor might ask about changes in your menstrual cycle. This may appear unrelated to you, but high levels of certain hormones can affect all metabolic processes and your answer might help your doctor narrow down what tests to request.
When considering birth control options for example, factors like age and lifestyle and family history are very important. Some hormonal contraceptive methods are unsuitable for women who smoke and are over a certain age. If a doctor is unaware of factors like a patient’s smoking history, they might go ahead and prescribe an unsuitable medication and the patient could end up suffering serious long-term complications as a result.
If you do not feel comfortable disclosing things to your doctor, you might consider looking for another doctor who makes you comfortable enough to spill the tea. It is as much the responsibility of the doctor to make sure the patient is comfortable throughout the consultation. Do not hesitate to ask for a female doctor if you do not feel comfortable with a male doctor, and where there is no female doctor available, you should at least be provided a female chaperone as this might make you feel safer.
Understandably, it can be embarrassing to discuss matters relating to sexual and reproductive health matters but remember that your doctor has most likely seen and heard worse, and it is better to report even the most minute symptom than to ignore it. What may feel like an ordinary rash to you, might be a sign of infection or other disease process. If you attend a consultation with a partner or parent, your doctor can ask them to step outside if that will make you more comfortable.
Another concern many patients have is the issue of confidentiality. Doctors are bound by law to keep patients’ information confidential, so there’s not much to worry about in that regard. In most developed countries, your doctor can be penalized for sharing your information without your consent. Underage patients have the right to receive contraceptive care without the permission of their parents and patients with terminal illnesses can choose to keep such information from their family members. Except in cases where there is threat of harm, your doctor is bound to keep your information confidential. The fear of a confidentiality breach shouldn’t keep you from being honest with your doctor.
Remember that your doctor is a professional who is trained to listen to your stories and use them as a tool to find out what might be ailing you. It is important for these stories to be as accurate as possible to get the most benefit.