not to look up info on patients on social networking sites or to friend patients

My wife works in the medical ethics field and we actually discussed this. She was exasperated at the end but I think I understand a bit more now.

“Friending” patients is a dumber idea than a cyanide ice cream cone full of cheap mayonnaise and pebbles. But looking at their personal pages? This is where our opinions differ because I’ve been at the receiving end. My wife has her doctorate; I do not. She is a professional in the field; I am not. But I’ll add my dissenting points anyway and all y’all can decide for yourselves.

If there’s one thing a patient does, it’s LIE LIE LIE LIE like a mother-trucking lying carpet in Lying Manor, situated on top of Mount Lie-lie-lie in Lyingville, USA, and there are even good reasons for this behaviour. Often it’s just embarrassment (“I was just vacuuming when I slipped on a banana peel and landed on a precariously standing light bulb in the middle of the floor, and no, I never buy Vaseline® so that clearly can’t be Vaseline® all over my nether regions!”). This is why you get asked that one particular question a dozen times in hospital. And they still don’t believe you.

Ethics demand the doctor take your word until something to the contrary (your saying “I’m a teetotaler” vs that 0.17% BAC blood test) appears. But doctors aren’t stupid and they’ve been through it before and the patient isn’t telling the truth. He’s trying to kind of honest but doing his best to minimise whatever he did. But he’s lying.

The degree of the lie is important, but only up to a point. Is there a lightbulb in the butt? Doesn’t matter how it got there, it needs to come out. To me it gets a lot fuzzier when the question is, “Did you really fall down the stairs?” or “Now how many drinks did you really have and over how many hours?” It’s the same to me as my most favouritest question to everyone I have to deal with at work, “Which nothing did you not change at all since everything was working and now?”

My wife — an ethicist — basically says you have to take them ALL at their word. “You have to assume you’re dealing with a rational person and that the rational person wants to make the best of the options.” Furthermore, even when you catch the person in a lie (that BAC test, for example), you continue talking rationally with the person and let them know “what the consequences might be if something else was happening and of course you understand that they’re not lying to you but the situation could be so severe that I want to make sure I understand because if I write this down incorrectly it could affect your treatment or the treatment outcome so I don’t dare get this wrong so how much did you drink today again?.”

Did you notice that “again” at the end of the sentence? Doctors are taught to add that because it allows the patient to pretend he already gave a truthful answer and is simply repeating it.

Nuts to that say I but She Who Must deals with this daily for a living. I countered with, “What about once you catch them in the lie? Shouldn’t you then access their SocialNetworkDotCom page for their own good since you know they’re acting less than 100% rationally already?”

“You do not take the step when dealing with a rational person of invading their privacy.”

I say bollocks, but then again, I tend to insult the entire populations of major countries on a daily basis on the basis of what a few of their native sons and daughters say and do.

“Unless unconscious or otherwise incapable of communication, a patient is treated as rational until psychological testing shows otherwise,” at which point any person legally loses the ability to make decisions for himself and so you can ignore his stupidity. Except you can’t.

At the heart of it — from the ethicist’s POV anyway — is that the trust relationship is inviolable because once it’s gone, it can’t be repaired or replaced and therefore treatment can’t continue in a normal way.

We went through a few more examples. While you can arrest and jail and then more or less force a heroin addict to quit (for at least the duration of the incarceration), even though you can show with 100% certainty it will kill him inside X days, you can’t lock up a drunk who comes in each week with a rapidly expanding liver. That man is going to kill her but you can’t force a woman who’s back every three days because she “fell down the stairs” or “ran into the door frame” yet again to talk or move or enter a safe house. You can only do your best to enable it, and in the case of battered women, there’s a lot of things they do to enable escape which I won’t publicise.

Me, I admit to moving the goalposts because I don’t see this nearly as black and white as my wife (and that’s probably why I don’t get paid for my opinion on the subject while she gets international scientificalistic grants for hers). If someone is killing himself through voluntary action, no, I don’t think it’s wrong for a treating professional to gather as much information as possible, but I also don’t think that such information should be used in any negative way, (e.g., care-withholding or prioritisation) but rather in positive treatment (ah, since you do X we know you could suffer from Y so we’ll check for and treat it).

Am I still under 1000 characters?