CMDA's The Point


CMDA's The Point

My Doctorate in Secret-Keeping

Preparing to meet my next patient, I pick the next chart up off the counter. “Bob Smith,” married middle-aged patient, chief complaint: STD check. “Weird,” I think, “Mary Smith’s husband’s name is Bob, too. What a coincidence.” I open the exam room door, and Mary Smith’s husband, Bob Smith, is sitting inside.

By Autumn Dawn Galbreath, MD, MBA | January 19, 2017


Preparing to meet my next patient, I pick the next chart up off the counter. “Bob Smith,” married middle-aged patient, chief complaint: STD check.

“Weird,” I think, “Mary Smith’s husband’s name is Bob, too. What a coincidence.”

I open the exam room door, and Mary Smith’s husband, Bob Smith, is sitting inside.

In a split second of complete panic and swirling emotions, I don’t decide how to respond to my friend’s husband in front of me. I just open my mouth and speak, “Mr. Smith, hi! I’m Dr. Galbreath. What brings you into the clinic today?”

He follows my lead, reaches to shake my hand and introduces himself. Two pretend-strangers in a small room where secrets are so openly discussed and exchanged. And we proceed with our new relationship—a doctor-patient relationship rather than a friend-to-friend’s-husband relationship or a parents-of-kids-who-are-friends relationship or even an acquaintanceship.

This encounter occurred years ago, but it has played over in my mind countless times since. Had I had time to think and decide, how would I have approached Mr. Smith? How much has knowing his sexual history impacted me in our overlapping real lives? How do we, as healthcare professionals, keep secrets on behalf of our patients, and at what personal cost?

When I write these blog entries, I usually try to substantiate my points with data and studies, rather than just throwing my opinion into cyberspace for your contemplation. But I’m not sure there is data to cite today. Rather than convincing you of a point, my hope is that I prompt you to reflect.

When was the last time you sat down and pondered the things people tell you in your exam rooms every day? And when was the last time you compared those conversations to an everyday conversation? Picture the fallout if I ran into my friend’s husband on the soccer field and asked him, “How many sexual partners do you have? Male or female?” Or even better, “When was the last time you saw a prostitute?” And yet, sitting in that exam room years ago, I asked these exact questions—and, rather than being offended, he simply answered me. In that room, in our doctor-patient relationship, these were relevant questions I had a right to ask, and it was information he was willing to give me. The problem for me was, though I learned these things in our doctor-patient relationship, I still knew them in our other relationships. Once things like this are known, we cannot un-know them.

Often, in our overlapping roles as healthcare professionals and as members of a community, we find ourselves keeping secrets. Of course, HIPAA and privacy laws, as well as our own ethics, prevent us from discussing patient information with others. But what happens when that patient information is more complicated than just gallbladder disease or diabetes? What happens when we know secrets that could alter people’s lives if revealed? The middle-aged man with a secret sex life. The elderly woman dying of cancer who doesn’t want her family to know. The clergy member struggling with addiction. What burdens do other people’s secrets force us to carry?

There are secrets that should be told. The wife needs to know her husband is not faithful. The elderly woman needs the support she would surely receive were others aware of her struggle. The clergy needs the accountability of his colleagues or congregation. And yet, we can’t make the decision to do what we know needs to be done. Because these are not our secrets.

One of my favorite passages of Scripture is John 8:32, “Then you will know the truth, and the truth will set you free” (NIV 2011). I believe with all of my heart in the liberation that comes from truth-telling. As I have worked my way out of the secret-keeping milieu of my earlier years, this verse has proven true over and over again. The liberation is often excruciatingly painful, but in the end, there it is—freedom to tell the truth, freedom to be the person God created me to be, freedom to drop the façade that is so exhausting to maintain. And I want this for my patients. I want them to see how much more difficult and painful it is to hide. I want them to be free. But their secrets are not mine to reveal. I am legally and ethically obligated to keep the secrets they ask me to keep, even when I am convinced that I keep the secret to the patient’s detriment. And I find that this secret-keeping is detrimental to my own heart, as well.

Seeing Bob Smith’s wife and family was painful. It harmed a small, hidden part of my heart to know what lurked behind that beautiful family photo. It harmed my heart to see the elderly woman’s son visiting and know his next visit would likely be her funeral, knowing he would ask, “Why didn’t she tell me?” My heart was battered yet again watching the clergyman cover his personal struggles as he preached “the way, the truth and the life” to others.

In the healthcare profession, we have the unspeakable privilege of being allowed into people’s inner lives, where they reveal their secrets. And we have influence there. We can be used of God in incredible ways with the access our patients give us. But at the end of the day, we are human, too—people who need to be set free by the truth, just as our patients do. The unspeakable privilege of being secret-keepers sometimes comes at a high personal cost. I have no doubt it is worth the cost, for the calling we follow in healthcare is a high and honorable one, indeed. But we must acknowledge the toll it takes on us, and we must intentionally care for ourselves even as we care for others. In fact, we should arguably care for ourselves before we care for others. Remember the safety briefing on every plane you board? “If you are traveling with someone who needs assistance, place your own mask on first, and then turn to the person who needs assistance.” You have to have the oxygen your body needs in order to be of use to anyone else.

If you asked how we care for ourselves—what is the oxygen we need in this scenario—my answer would be truth-telling. Truth-telling is the antidote to the poison of secret-keeping. Of course, we don’t need to tell everything to everyone, but we do need to have a safe place for our own secrets, a place where our secrets will be received and we will be loved and challenged. For me, this place is other Christian women physicians, the people who most understand the challenges of my day to day life. For you, it might be a counselor, small group or pastor. The “who” and the “how” vary greatly, but the need for such truth-tellers in our own lives is universal. If you don’t have any, I urge you to begin to cultivate these relationships in your life. We cannot be set free personally, and we cannot care for others or carry their secrets, if we do not tell the truth in honest relationship. Remember, “Then you will know the truth, and the truth will set you free.” Jesus, the Great Physician, wrote that prescription.

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