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0662 Doctor-Patient Confidentiality

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Welcome to English as a Second Language Podcast number 662: Doctor-Patient Confidentiality.

This is English as a Second Language Podcast episode 662. I’m your host, Dr. Jeff McQuillan, coming to you from the Center for Educational Development in beautiful Los Angeles, California.

Our website is eslpod.com. Go there today to download a Learning Guide for this episode that will help you improve your English faster than anything – and, if you’re bald, help you grow hair. It worked for me!

On this episode, we’re going to have a conversation between two doctors who are talking about “confidentiality,” keeping things private or secret between a doctor and his or her patient. Let’s get started

[start of dialogue]

Dr. Green: Can I consult you on a case of medical ethics?

Dr. Hause: Sure, I’m not a lawyer, but I can give you my opinion as another doctor.

Dr. Green: That’s what I’m looking for, your honest opinion. I have a patient who has a medical condition that can be spread to her family, but she doesn’t want to tell them about it. I don’t want to breach doctor-patient confidentiality, but I think that at least her husband should know.

Dr. Hause: That’s a tricky one. We both know that the only way we can get our patients to divulge any sensitive information is if they trust us. We can’t easily put aside that confidentiality.

Dr. Green: I know, but if she doesn’t tell her family, then they are in danger of developing serious medical problems themselves. I took the Hippocratic Oath to do no harm. How can I keep her secret and adhere to the spirit of that oath?

Dr. Hause: I see what you mean. If I were you, I’d sit my patient down and tell her what you think her responsibilities are to her family. Maybe you can convince her to tell them.

Dr. Green: I’ve tried talking to her already, and she didn’t want to listen. I’ll try again. But what if she doesn’t agree?

Dr. Hause: Then you can either drop it, tell her family, or…

Dr. Green: Or what?

Dr. Hause: Hope your patient has a miraculous recovery.

[end of dialogue]

We begin with Dr. Green asking Dr. Hause a question; he says, “Can I consult you on a case of medical ethics?” “To consult” means to talk to someone, often a person who is an expert or who may know more than you do, and ask them for their advice – ask them what they would do in this situation. A person who gets paid to give their opinions and advice, or to do some work for a company, is called a “consultant,” with an “ant” at the end of the word. Dr. Green wants to consult Dr. Hause on a case, or a situation, an example of medical ethics. “Ethics” (ethics) are the ideas and standards about what type of behavior is right or wrong; we might say ethically or morally right or wrong. “Medical ethics” refers to the decisions that doctors may make regarding their patients, whether they are right or wrong. The “patient” is, you probably know, the person who is getting or receiving medical treatment – medical care. It’s the person it’s the person who’s sick.

Dr. Hause says, “Sure (you can consult me), I’m not a lawyer,” an attorney, someone who knows a lot about the law, and who charges you a lot of money to get that information, “but,” she says, “I can give you my opinion as another doctor. Dr. Green says, “That’s what I’m looking for (that’s what I want), your honest opinion. I have a patient who has a medical condition that can be spread to her family.” We explain “patient” is the person who is sick. “To spread to (something or somewhere)” means to expand or to affect a larger group of people or to have a greater impact. Normally, we talk about diseases that spread from one person to another, diseases that are “contagious,” that is, you can get the disease from someone else. The disease that Dr. Green’s patient has can be spread to her family, but this patient doesn’t want to tell her family about it. Dr. Green says, “I don’t want to breach doctor-patient confidentiality, but I think that at least her husband should know. “To breach” (breach) here means to break a promise, not to do what you promised to you, to break a rule. In this case, the doctor would be breaching doctor-patient confidentiality. “Confidentiality” is the agreement or the promise that a doctor gives his or her patient that they will not tell anyone else about their medical condition, at least no one who is not also working with the doctor as a medical expert. In the United States, confidentiality is recognized in law; that is, a doctor has a confidential relationship with his or her patient and cannot be forced to tell the police, for example, about information that is private with that patient. A lawyer has similar confidentiality with his or her clients, the people who pay them to do legal work for them. Dr. Green is worried this woman has a disease that she is going to spread to her family, but he doesn’t want to break his promise to breach that confidentiality. “To breach,” I should mention, has some other meanings; take a look at our Learning Guide for some additional explanations.

Dr. Hause says, “That’s a tricky one.” A “tricky (tricky) one” is a difficult problem or a difficult situation, something that is very complicated. Someone may say, “Well, it’s kind of tricky,” they mean it’s complicated, it’s complex, it’s difficult, there is no obvious solution. That’s how Dr. Hause describes Dr. Green’s problem. She says, “We both know that the only way we can get our patients to divulge any sensitive information is if they trust us.” “Divulge” (divulge) means to tell someone a secret, to share a secret, often one that you are not supposed to share or tell someone else. “Sensitive information” is personal or private information: things about your health, your family, and so forth. “To trust” means to rely on, to count on, to be able to say yes, this is someone I have confidence in; they won’t hurt me; they won’t break their promise; I trust them; I believe them. Dr. Hause says that the only way a doctor can get his or her patients to divulge – to tell any sensitive information to them is if the patients trust the doctors. She says, “We can’t easily put aside that confidentiality.” “To put aside (aside) (something),” or “to put (something) aside,” is a two-word phrasal verb meaning to not consider or not follow some rule or some regulation; to stop considering something as a factor is also another way of using this verb. “I’m going to put aside all of the arguments I have had with my neighbor in order to help him with his car.” I’m going to help him fix his car. Unfortunately, I don’t know anything about repairing cars, but well, I’ll do my best! I’m going to put aside our problems, our arguments. I’m going to say okay, they don’t exist for now – temporarily.

Dr. Hause thinks that you cannot put aside doctor-patient confidentiality just because you have a difficult situation. Dr. Green says, “I know, but if she (his patient) doesn’t tell her family, they are in danger of developing serious medical problems themselves,” they could get sick. He says, “I took the Hippocratic Oath to do no harm.” “The Hippocratic Oath,” named for the famous Greek doctor Hippocrates, is a promise made – or at least used be made by doctors when they begin their medical career, when they begin working as doctors, saying that they will obey, they will follow certain ethical rules and regulations. That isn’t true anymore, at least in the United States, or at least doctors no longer say the original Hippocratic Oath. If they say it, it’s been changed. The oath – any oath is a promise, an official promise. So, Dr. Green says he took the Hippocratic Oath to do no harm. That’s a phrase that’s in the original oath. “To do no harm” means don’t do anything that will hurt another person or another situation. The first thing a doctor should do is not make the patient sicker, not make things worse; that’s the idea of doing no harm, or injury. Dr. Green says, “How can I keep her secret and adhere to the spirit of that oath?” “To adhere (adhere) to (something)” means to follow the rule, to follow some regulation, to do what it says. “The spirit of (something)” is the idea behind something, the general philosophy behind a certain rule. So, it is sort of more than the rule; it is the intention or idea of this rule.

Dr. Hause says, “I see what you mean (I understand what you’re saying). If I were you, I’d sit my patient down and tell her what you think her responsibilities are to her family.” “To sit someone down” means to have a serious conversation with someone about something that requires their complete attention, something that is very serious and important.

Dr. Green says I’ve tried sitting my patient down, “I’ve tried talking to her already, and she didn’t want to listen. I’ll try again. But what if she doesn’t agree?” What if she does not change her mind? Dr. Hause says, “Then you can either drop it, tell her family, or…” Dr. Green says, “Or what?” Dr. Hause says, “Hope your patient has a miraculous recovery.” “To drop it” means to forget about something, usually because it’s too difficult or too uncomfortable. It’s an informal phrase, “to drop it,” often used in the command form. If your wife is arguing with you she may say eventually, “Oh, let’s just drop it,” or “Drop it, okay?” meaning stop talking about it, stop thinking about it. You’re trying to change the subject; you’re trying to move on to something new. In this case, Dr. Hause tells Dr. Green that he can either drop it, meaning forget about this problem, tell the patient’s family, or hope the patient has a miraculous recovery. A “recovery” is when a person – a sick person gets better; they start to feel more healthy, that’s a recovery. “Recovery” has a number of different meanings, none of which are explained in the Learning Guide. However, the word “drop” has meanings that are explained in the Learning Guide. “Miraculous” is something that is outside the ordinary, something that has no scientific explanation. Something that is “miraculous” is something that seems to be unnatural in some ways; it’s something that doesn’t follow the usual laws, we might say, of nature, of the way the world is supposed to work – the physical world.

Now let’s listen to the dialogue, this time at a normal speed.

[start of dialogue]

Dr. Green: Can I consult you on a case of medical ethics?

Dr. Hause: Sure, I’m not a lawyer, but I can give you my opinion as another doctor.

Dr. Green: That’s what I’m looking for, your honest opinion. I have a patient who has a medical condition that can be spread to her family, but she doesn’t want to tell them about it. I don’t want to breach doctor-patient confidentiality, but I think that at least her husband should know.

Dr. Hause: That’s a tricky one. We both know that the only way we can get our patients to divulge any sensitive information is if they trust us. We can’t easily put aside that confidentiality.

Dr. Green: I know, but if she doesn’t tell her family, then they are in danger of developing serious medical problems themselves. I took the Hippocratic Oath to do no harm. How can I keep her secret and adhere to the spirit of that oath?

Dr. Hause: I see what you mean. If I were you, I’d sit my patient down and tell her what you think her responsibilities are to her family. Maybe you can convince her to tell them.

Dr. Green: I’ve tried talking to her already, and she didn’t want to listen. I’ll try again. But what if she doesn’t agree?

Dr. Hause: Then you can either drop it, tell her family, or…

Dr. Green: Or what?

Dr. Hause: Hope your patient has a miraculous recovery.

[end of dialogue]

When our scriptwriter tells us that she is going to write a great script for us, we trust her. Why? Because it’s the one, the only, Dr. Lucy Tse.

From Los Angeles, California, I’m Jeff McQuillan. Thank you for listening. Come back and listen to us again on ESL Podcast.

English as a Second Language Podcast is written and produced by Dr. Lucy Tse, hosted by Dr. Jeff McQuillan, copyright 2011 by the Center for Educational Development.

Glossary
to consult – to speak with someone on a particular topic, requesting their expert advice or guidance

* Please consult with a tax attorney before selling your stock.

medical ethics – ideas and standards about what types of behavior are morally right or wrong when healthcare providers interact with patients

* In our medical ethics class, we’re discussing the morality of extending life if the patient will be in a lot of pain.

patient – a person who receives medical care or treatment from a doctor

* Dr. Perez has so many patients that he can spend only about 10 minutes with each one.

to spread to – to expand; to move over a larger area or to affect additional people; to have a larger scope

* Elida went to school when she was sick, and now the virus has spread to almost all her classmates.

to breach – to break a rule or expectation; to break a promise

* They had to leave their apartment because they breached their lease agreement when they didn’t pay the rent on time.

doctor-patient confidentiality – the agreement or promise that doctors will not tell other people what their patients have said without their permission

* Remember that our conversations are covered by doctor-patient confidentiality, so I won’t repeat anything you tell me about your health or lifestyle.

a tricky one – a difficult problem or situation; something that is complex and complicated; something that does not have an obvious solution

* Have you figured out the answer to Problem #8? That’s a tricky one.

to divulge – to share a secret; to tell a secret to someone who shouldn’t know about it

* My grandmother told me that a woman should never divulge her real age.

sensitive information – confidential, personal, or private information that one does not want other people to know, such as bank account numbers and passwords

* Companies are required to use secure storage for customers’ credit card numbers and other types of sensitive information.

to trust – to believe what another person is saying; to believe that another person is reliable; to believe that another person wants to help

* Would you trust a 13-year-old to watch your children for a few hours?

to put aside – to temporarily not consider, follow, or comply with something; to stop considering something as a factor in one’s decision

* We aren’t ready to buy a house. Even putting aside the financial burden, it’s too much responsibility for us!

Hippocratic Oath – a promise made by many new doctors, stating that they will obey certain principles and ethics related to medicine

* As part of the Hippocratic Oath, new doctors swear, “I will prevent disease whenever I can.”

to do no harm – to not do anything that hurts another person or animal

* Hopefully this medicine will make you feel better, but even if it doesn’t, at least it will do no harm.

to adhere to – to comply with or follow a rule or guidelines

* Adhering to all the tax laws would mean reporting all of your income – even coins that you find on the sidewalk.

the spirit of – the idea behind something, even if it is not explicitly written down

* There probably aren’t any laws specifically against spitting on your neighbor’s grass, but that act violates the spirit of our homeowners’ association.

to sit (someone) down – to have a serious conversation with another person, trying to get all of that person’s attention

* Did your parents ever sit you down and talk to you about the dangers of illegal drugs?

to drop it – an informal phrase meaning to forget about something or no longer pursue something, usually because it is too difficult or uncomfortable; to change the subject without first getting the answer or response one was hoping for

* One of the keys to a happy marriage is knowing when an argument is necessary and when it would be better to drop it.

miraculous recovery – an unexplained improvement in one’s health so that one is no longer sick, but doctors do not know why

* Molly said she was too sick to go to school this morning, but when I reminded her that today was Saturday, she suddenly had a miraculous recovery.

Comprehension Questions
1. Why does Dr. Green want to tell the patient’s family about the medical condition?
a) Because they are at risk of becoming ill.
b) Because they can help the patient get better.
c) Because it is a fascinating medical discovery.

2. What does Dr. Hause mean when she says, “That’s a tricky one”?
a) The patient’s husband gets angry easily.
b) It’s difficult to know what to do.
c) The patient’s medical condition is very challenging.

Answers at bottom.

What Else Does It Mean?
to breach

The verb “to breach,” in this podcast, means to break a rule or expectation, or to break a promise: “Joyce worked as our accountant for years, so we were all shocked when she breached our trust and stole thousands of dollars from our business.” The phrase “to breach security” means for a hacker to find a way to avoid or trick the security measures that a company or person has used to protect information: “Every time hackers discover a new way to breach security, we have to develop new technologies and practices to protect confidential data.” Finally, the verb “to breach” means to put a hole in a wall or dam that protects a place: “During the storm, a large tree trunk floated down the river very quickly and breached the dam.”

to drop it

In this podcast, the phrase “to drop it” is an informal phrase meaning to forget about something or no longer pursue something, usually because it is too difficult or uncomfortable: “I know these reforms are really important to you, but sometimes it’s important to know when to drop it.” The phrase “to drop it” also means to change the subject without first getting the answer or response one was hoping for: “Just drop it, okay? I don’t want to talk about this anymore.” The phrase “to drop by” means to visit someone casually: “I’ll try to drop by your house after work tomorrow.” Finally, the phrase “to drop out” means to stop going to school before one has earned a degree: “Renee dropped out of high school in ninth grade, and she has always regretted it.”

Culture Note
Doctors have access to a lot of “privileged information” (information shared with only certain people in a private, professional context, and protected by law) when they speak with their patients about their health history, medical conditions, and lifestyle. Often the only reason why patients are willing to share that information is because they believe their doctor will “honor” (comply with; follow) doctor-patient confidentiality and not share their privileged information without the patient’s “written” (in writing; not spoken) “consent” (agreement).

People also refer to “attorney-client privilege” which is the idea that conversations between “attorneys” (lawyers) and their “clients” (customers; people who receive legal services) are confidential and should not be shared with others. Attorney-client privilege is important, because people who have been “accused” (said to have done something bad) of breaking the law need the “full” (complete) guidance and advice of an attorney, but the attorney cannot give “adequate” (sufficient; enough) advice if he or she has only “partial” (some; incomplete) information.

“Priests” (religious leaders, especially in the Catholic Church) also receive private, confidential information from their “parishioners” (people who go to a certain church). This is especially true in the “context” (environment; situation) of “confessions,” when people tell a priest about the “sins” (actions or thoughts that are wrong, against God’s law) that they have “committed” (done; performed). It isn’t clear whether confessions are privileged information. Many people argue that they should be, but many courts have “ruled” (made a legal decision) against it, arguing that priests have to share information they have received from confessions when asked to do so.

Comprehension Answers
1 - a

2 - b