confidential?

i walked out of clinic day today feeling slightly bewildered over an uneasy patient encounter.

Miss A was a single 22 year old lady living with her parents. She has pseudocyosis (false pregnancy) and hepatomegaly (liver and spleen enlargement). She has an abdominal mass that has been increasing in size leading her to believe that she was pregnant. it was reli an incident of lots of coincidences bcz when she started missing her period, she was tested positive on the urine pregnancy test, scanned positive for pregnancy and had morning sickness of vomiting. and her abdomen has been increasing in size. and it was js not long after she had sexual intercourse. weirdly, she's been having intermittent pain n distension over the umbilical region over the past 2 years. the fact that she suspects herself to be pregnant and all the supporting facts were unknown to her parents and all the while they thought she was just suffering from the abdominal pain due to a complication from an appendisectomy 2 years ago.

she was accompanied by her mother to the clinic.

upon being interviewed by me in front of her mum before seeing the doctor, she did not disclose any facts about her suspecting herself to be pregnant. later her mum left us and twds the end of the clerking, i asked her the routine gynae question on whether she has had intercourse before. she replied yes. n i proceeded with routine ques of dyspareunia-pain/post coital bleed. and the history on her being positive on urine pregnancy test, the scan etc spilled out. n she told me her parents were unaware of all these. upon viewing the emergency unit admission clerking sheet i also thought it was reli weird for her to have a dating scan and positive urine pregnancy test and all that and proceed to enquire further about it.

i was wondering how i would present her history to the doctor in front of both her and her mum in the clinic later when it was her right to have all these information remaining confidential betwn doctor n patient.

in the end bcz her history was weird with the false postivie UPT and wrong scan done at GP and all that and the false pregnancy, i didnt get to present my case, but the doctor proceed to obtain history on her own. there was information on the false pregnancy blah on the admission clerking sheet at the emergency unit.

in the end obviously the mother found out she had intercourse before marriage, and her antenatal visits to the GP and all that.

even though she's 22 and working but it can be observed that she stil pretty much depends on her parents and are under their shadow. erm.

subsequent conversation proceed with the doctor discussing the case with the mother with occassional/very hardly references to the daughter. i was feeling very very uneasy at that point and wondering what was going to happen to the poor girl when they left the clinic.

i guess it was not going to be possible to keep the information from the mother as she had accompanied her daughter to the clinic. it was also probably safer for the mother to find out as she can advise her daughter about precautions drg intercourse etc. and the mother has the right to find out all these as her sole guardian.

but patient's confidentiality is also at question. the patient has the right to disclose all the above information to her mother herself instead of her mother finding out about it through the doctor. the patient has the right to have 1st hand discussion with the doctor instead of being just an occassional reference like a 3rd party. she has the right to obtain information on the risks of unprotected intercourse from the doctor without family intervention.

perhaps i'm not in the position to comment on this situation. sometime doctors cannot protect a patient's confidentiality if the patient themselves have brought their family members along with them to the check up. n in the clinic u have like 4 medical students tagging a doctor in a clinic, listening to every patient's details and management.

just felt reli bad for the girl. she was treated like a child and she was reli uneasy when being questioned about having SI and her reason for suspecting pregnancy. SI before marriage doesnt make u a criminal, but in Msian society you can get stigmatised quite badly and even be shunned by ur family. :(

Do we have enough safeguards to protect a patient's confidentiality? it's a two way thing i guess. it's the responsibility not of just the doctor but the patient herself. :S

on a brighter note, palpating an abdomen with polyhydramnios (excessive amniotic fluid) today has made my day. :) postive fluid thrill! blubb.