To Do or Not To Do

That's a 'big' question in millions of circumstances that one may come across in the field of medicine. (in many other fields too, but usually in medicine a life depends on this decision)

One of the issues I was thinking about lately, was that of the conditions in which a doctor is permitted to breach the doctor-patient trust.

Patients put a lot of trust in their doctors, and reveal everything to them. There is no information that a doctor cannot obtain from his/her patients. The patients reveal their inner-most secrets to their doctors, completely trusting the doctor, and expecting their secrets to be in the safest of hands. A doctor-patient relationship is actually built on complete trust and this is the key for diagnosis and treatment of the cases.

However, there are certain conditions in which the doctor is permitted to disregard this trust and do what the circumstance requires him to. For example, on diagnosing a patient with a highly infectious disease which is a possible threat to become an epidemic in the region, the doctor is required to report to appropriate authorities. The patient maybe isolated until complete treatment, or deported from the country (in certain specific countries). Or if the patient was diagnosed with a sexually transmitted disease, it becomes the duty of the doctor to inform the patient's partner (even if the patient does not wish this). In the Gulf countries, it is required by the doctor to report any sexually transmitted disease to the respective authorities, a certain list of infectious diseases and certain other conditions are to be reported.

Yet, during my clinical training hours so far I have witnessed several episodes where the doctors do not do this. Sometimes out of sympathy for the patient, and sometimes I see the doctor has no concern at all.

There have been several instances where the doctor is sympathetic towards the patient (perhaps a labourer who may get deported if reported).

The question is what do you do in these circumstances? What decision do you make? What conditions do you apply when making this decision? Should it be based on ethics? morale? or sympathy?

Hard choice to make in some cases!