Technology | 2009.10.09
Private functions | Mark Lawson
The media may want the doctors\' details, but recent events underline the value of medical confidentiality
The story of Natalie Morton is a very modern tragedy. On Monday she died suddenly after being vaccinated against cervical cancer . Public conclusion: the life-saving jab was a killer. On Tuesday, a preliminary postmortem revealed that she had suffered from a "serious underlying medical condition". Public conclusion: confusion. Yesterday, the coroner disclosed that Natalie had a malignant tumour which "could have killed her at any time". Public conclusion: relief and the belief that the injection is probably safe.
Versions of this news curve happened throughout the first burst of the swine flu epidemic . The death of an apparently healthy person would lead to panic that the population was about to be wiped out. Then the invocation of that viral phrase of 2009 – "serious underlying medical condition" – would lead to relaxation, although not entirely because in most of these cases, unlike Natalie\'s, the nature of the other affliction was rarely reported.
In part, this is a story of the rush to judgment created by the immediacy of modern media. But it also touches on concerns – of doctors\' confidentiality and the language of medical disclosure – which have also been raised by the row over whether internet tittle-tattle over Gordon Brown\'s health should have been raised by Andrew Marr on television, and coincide with this month\'s publication of a document from the General Medical Council confirming guidelines on protection of records.
I was awed, at my Roman Catholic primary school, by the stories of the sanctity of the seal of the confessional: the priests who had died rather than reveal what a penitent had told them. Many works of fiction have turned on this creed of priestly secrecy. And yet, without being hymned in the same way, doctors are bound by conditions almost as severe. For instance, a GP with a sexually infectious patient who insists on having unprotected intercourse is not permitted to pass on this information to partners and can only press the infected party to fess up.
The latest GMC advice gives doctors more leeway than priests. Patient confidentiality can be breached if there is a clear public interest. But the governing assumption remains a right to medical privacy in almost all cases, a position also followed in media codes of practice.
However, in the swine flu and cancer vaccine cases, the difficulty is that medicine moves more slowly and ethically than journalism. On the basis of having seen a few episodes of Casualty, we\'re happy to give an immediate diagnosis of fatality caused by a vaccine or a flu virus from Mexico, while those who actually qualified as doctors take notice of autopsies, tests and the feelings of relatives.
The matter of an allegedly sick or pill-dependent politician (charges both absolutely denied by Gordon Brown) is more problematic. Many leaders have taken advantage of patient confidentiality: François Mitterrand\'s prostate cancer and Harold Wilson\'s cardiac spasms were not reported until long after their electoral chances could be affected. But it was easier then to prevent or deflect speculation. Blogging has moved rumour from the back roads to a freeway, so allegations ignored by the mainstream media may be widely known.
Which raises an intriguing hypothesis: a therapeutic equivalent of those confessional dramas mentioned above. Imagine the case of a doctor who knew that a leader had a serious health condition which he declined to admit to the electorate. Would the medic be justified in this instance in going to the press?
The British Medical Association\'s ethics expert tells me that, if a doctor sincerely believed a politician had become a risk to the country, their duty would be to persuade the leader that his body was telling him or her to go.
Brown\'s right to medical privacy may haunt the election. If David Cameron\'s handlers were very cynical, they would release the Tory leader\'s medical records as the campaign begins, citing the American precedent. This would place Brown in the position of explaining why his own drugs cabinet remained locked.
And yet full disclosure from politicians has drawbacks. It would be absurd to reach a position in which a referral to a clap clinic at college might end a career. One reason records are kept sealed is that gossip makes illness a lasting stigma, ignoring the possibilities of recovery.
However, as the GMC makes clear, there are instances in which lips should not be stitched. No matter how he handles this, the PM would be unwise to release a statement saying that he has "no serious underlying health issues". People would really panic then.
For more information, please visit
http://www.guardian.co.uk/commentisfree/[...]ing-health-issues-gordon-brown
