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19th March: When Silence is Golden

A gossip betrays a confidence, but a trustworthy man keeps a secret. Proverbs 11:13 (NIV)

This verse is a clear precept for everyday medical practice. Indeed, the confidential relationship between doctor and patient is a time-honoured principle. The ancient Hippocratic Oath says: `Whatever, in connection with my professional practice, or not in connection with it, I see or hear in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret'. Its modern counterpart, the World Medical Association's Declaration of Geneva, says: `I will respect the secrets which are confided to me, even after the patient has died'.

There are many good reasons for this restraint. Basically it is essential to an honourable and effective professional relationship. On a purely practical level, if confidentiality is not assured, the patient may withhold sensitive information that is needed for sound diagnosis and management. It certainly belongs to a proper attitude of respect for the feelings, the welfare and sometimes the reputation of someone who has come to the doctor for help -- an attitude which a Christian will acknowledge as part of a genuine caring relationship.

In today's world, respect for confidentiality can produce dilemmas for both doctor and patient. Sometimes the law very properly overrules, as in the compulsory notification of certain infectious diseases. Community interest may make it untenable, as when, for example, a patient's disability (colour blindness, epileptic fits and so on) may in certain occupations endanger other people. The doctor's conscience can then be greatly troubled. An answer to such a dilemma will usually (and indeed should) involve talking it out with the patient and getting his co-operation. A good deal will then depend upon whether the patient respects and trusts the doctor and knows that he has a good reputation for normally observing confidentiality. Otherwise we may well find the patient's relatives and friends echoing another piece of Solomon's wisdom: `A gossip betrays a confidence; so avoid a man who talks too much' (Pr 20:19 NIV). As a pragmatic postscript, we may well remember that `even a fool is thought wise if he keeps silent and discerning if he holds his tongue' (Pr 17:28 NIV).

Grant me, Lord, the wisdom and the respect for other
people's needs that will enable me to know when and
how to keep silent.

Further reading: Browse through the book of Proverbs and note how often there is advice on when to speak and when to keep silent.


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