Dr. Brian Goldman: Private lives, public stories
The host of CBC Radio's White Coat, Black Art on the delicate balancing act between compelling storytelling and a particularly crucial component of the Hippocratic Oath: confidentiality.
I felt a familiar twinge in my stomach when I sat down to write The Night Shift: Real Life in the Heart of the ER, a book about the patients I've seen throughout my career as an emergency-room doctor. As with my radio show, White Coat, Black Art, I knew that the success of The Night Shift rested on my ability to deliver compelling stories of people in the most dramatic health crises of their lives. And therein lies an uncomfortable truth. I'm bound by my oath as a physician to protect patient confidentiality.
I'm not the only physician to tempt fate. Like Icarus, some of my colleagues have flown a little too close to the sun. The BC internist Dr. Kevin Patterson was on duty as a physician in Afghanistan in 2007 when reservist Cpl Kevin Megeney was brought in suffering from a gunshot wound to the chest by fellow Cpl Mathew Wilcox, which was sustained during what was later described as "a consensual game of quick draw." Later that year, Patterson wrote an article that contained an account of the last few moments of Cpl Megeney's life and Patterson's frantic efforts to save it.
In January 2009, after an investigation, The College of Physicians and Surgeons of British Columbia found Dr. Patterson guilty of professional misconduct for violating patient confidentiality. As part of the finding, Patterson agreed that in any future writing, journalism or otherwise, he would not include the names of patients or use information that could identify them.
Patterson's experience was seared into my brain as I wrote my book. Telling meaningful stories without violating my professional obligation takes some doing. The patients I've written about are inspired by real cases, but names and personal details have been changed substantially. In some cases, I have combined several patients with similar stories into composites. I have also changed the sequencing of some events.
After I wrote the book, HarperCollins and I went through a painstaking process of examining the cases presented to see if people could still identify themselves. With each draft and each review, I made more changes. Some of them were comical. I could tell you, but then I'd have to kill you.
By this point, I had visions of a lineup of former patients and family members suing me for violating their confidentiality. I spoke to not one but two lawyers who specialize in health law. I asked one of them for a reference that could inform me how to disguise patient identities so as to guarantee that their confidentiality is protected.
"There is no such reference," said the lawyer.
I swallowed hard and submitted the book.
Given the admonition not to violate patient confidentiality, why do we do it? I can say that it's in the public interest to know what goes on inside the hospital. You have an insatiable curiosity for what goes on behind the hospital's sliding doors. Some of us have an equally insatiable desire to tell you.
Let's hope I continue to get the balance right.
Brian Goldman is an ER doctor and host of White Coat, Black Art, CBC Radio One's show about the culture of health care. The new season kicks off on September 10 at 11:30 am. His first book, The Night Shift: Real Life in the Heart of the ER will be available in paperback from HarperCollins on September 17.