Confidentiality and sensitive history-taking

Medical education in India lays a great deal of emphasis on textbooks. Assessments are made on written and oral examinations that are designed to test only knowledge and memory. Attributes such as compassion, confidentiality, ethics, and communication skills are completely ignored or even trivialised.

When I was doing my obstetric and gynaecology rotation several years ago in a rural hospital in India, I was assigned to a middle-grade doctor who had a diploma in the specialty. One day, a young lady came to the out-patient clinic accompanied by her husband. The two were married only a few weeks ago. I do not quite recall the clinical details, but all of a sudden the doctor asked the lady in a loud voice if she had multiple sexual partners prior to her marriage. She was completely shocked and close to tears. Her husband intervened and speaking in a soft and apologetic tone ruled out such a story on her behalf.

I was taken aback because there was no reason to ask the question in the first place, and second, the husband coul d have got a very wrong message. He would wonder why the doctor asked the question and whether the doctor had found something during the examination that prompted the question. The young lady could perhaps pay for the doctor’s brashness all her life for no fault of hers. This is particularly true in the context of rural India where doctors are highly respected and the social setting is often cruel to women.

Such an insensitive and irresponsible manner of taking a patient’s history could lead to a lifelong strained relationship between husband and wife. This is possibly an extraordinary and extreme case but it nevertheless reinforces the need to train doctors appropriately in how to deal with their patients in a sensitive, caring and confidential manner. The need to measure these attributes as part of assessment cannot be overemphasised.