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ss nucleus - Christmas 2010,  stewards of words

stewards of words

Andrew Flatt explores confidentiality.

The call to love our neighbour is a broad one, and encompasses use of information – whether to comfort, guide or advise. Knowledge is indeed power, and the facts we know as doctors – both in terms of therapeutic processes and specific patient stories – demands good stewardship.

An Old Testament example of breach of interpersonal trust is the case of Jacob – impersonating his brother Esau to steal his father's blessing. (1) God's faithfulness to Jacob continued despite Jacob's dishonesty, yet the action of stealing from Esau cost him years of labour under the also treacherous Laban. (2) Another example was the fate that befell Samson (3) – seduced into divulging the nature of his strength to the Philistine enemy. It cost him his eyes and ultimately his life.

Biblical examples of confidence breaches in a medical context are few. Elisha's servant Gehazi witnessed the healing of the Syrian commander Naaman's leprosy by God's guidance of Elisha. (4) Naaman had offered to give a gift to Elisha in thanks – a fortune in silver – and Elisha had refused it. Gehazi, presuming this a waste, followed Naaman and asked for it, claiming Elisha had changed his mind. Gehazi was discovered, and cursed with the leprosy that had been Naaman's.

The examples are imperfect parallels to our day-to-day dealings of confidentiality. The information we handle is unlikely to become a matter of national security, as it did for Samson. The danger is not that we fall victim to overt attempts to steal data, but that in quiet times we neglect the importance of our words.

Herod Antipas, the puppet-king of Judea, had had John the Baptist imprisoned, as John had openly criticised Herod for marrying his brother's wife. Yet Herod had not intended to kill John. It was on his birthday that Herod, so impressed by his daughter's dancing, promised her anything – up to half his kingdom. Tragically Herod's wife, who wanted John executed, made this request through her daughter. Herod, enjoying a good time at his party, had underestimated the power of his words of promise. In front of all his officials, he was unable to refuse, and John was beheaded. (5)

Even the generally praiseworthy Hezekiah had a lapse of judgment. Enamoured by gifts sent to him by Babylonian messengers while he was ill, he showed the messengers everything in the Judean kingdom, including the royal armoury and treasury. (6) Such things might have been better remaining secret. A prophecy was then given by Isaiah that one day everything in the kingdom would be taken to Babylon. (7) The actual fall of Judea to Babylon occurs long after Hezekiah's time, and it is unclear whether his act, undeniably foolish, had any direct effects.

On a positive note, we have one example of God specifically warning against disclosure of vital information to certain parties in his grace. The wise men, on their journey home, were warned in a dream that information of the Christ-child's birth place was not for Herod the Great. (8)

how do we respond?

If the main danger to us lies in underestimating the nature of information, how may we guard it well? Scripture informs us of both our nature and the nature of God. Proverbs 25 extols the virtue of trust and sound advice, and warns of perils of gossip.

A word aptly spoken is like apples of gold in settings of silver. Like an earring of gold or an ornament of fine gold is a wise man's rebuke to a listening ear. Like the coolness of snow at harvest time is a trustworthy messenger to those who send him; he refreshes the spirit of his masters. (9)

The letter of James describes the potential evil of the tongue, with power disproportionate to its size. (10) Paul's exhorts the Thessalonians to 'lead a quiet life, to mind your own business and to work with your hands, just as we told you, so that your daily life may win the respect of outsiders and so that you will not be dependent on anybody.' (11)

Furthermore we are called to 'do as God does'. (12) In Christ we have the reality of a saviour carrying the weight of truth through pain and death, despite betrayal by those closest to him.

Just as we each reflect a measure of the love of Christ to those around us, so should we reflect and inspire the trust which is of God. Indeed, as a characteristic, God's faithfulness is echoed across the Scriptures and is secondary only to his love. The psalmist says 'You are the Lord God-All-powerful! No-one is as loving and faithful as you are'. (13) Ecclesiastes states pithily 'For with much wisdom comes much sorrow; the more knowledge, the more grief'. (14) This is sobering for us who swallow detail after detail of case histories or medical guidelines. Doubtless we suffer in turn from the frustration of missed diagnoses, rushed situations and exam burnout. We have solace in our omniscient, suffering God.

We know that we can come before his throne of grace with our worries, confident in his faithfulness. (15) This should be our inspiration for those who would come to us with theirs. Revelation reminds us of God's care for us in the future – 'To him who overcomes … I will also give him a white stone with a new name written on it, known only to him who receives it.' (16) We own nothing so personal as our names; surely this is acknowledgment of what great worth each has in God's sight, and in turn the value we should put into their care; in thought, word and deed.

conclusion

We should nurture attitudes of great respect and love for our patients, such that their treatment doesn't stop with the discharge papers, but continues with the way in which we hold their information. When respecting patients is hard we must ask God to see him in them; when we feel burdened by what we know we must ask to see him in ourselves.

Whether we are people of few words or many words, we must acknowledge their power, and be alert to specific weaknesses and potentially compromising situations. While we may not be involved in pressure through warfare espionage, as was Samson, the possibility of overt bribery remains. Our practice has multiple financial ramifications, whether through insurance or inheritance as a result of disease.

We should pray in advance that should we be offered significant funds for deception, we would resist without thought, allowing the love of God to dwarf any material power.

The greater danger to most of us will come from situations where we do not perceive data protection to be an issue. In one hospital trust I know, the lift announcer system, in between warning of imminently closing doors, states: 'Please refrain from discussing confidential information in the lift'(!) On-call scenarios tend to generate their own issues, such as patient details written on post-stick notes and scrap paper. I know I am not alone on wearing a jacket unworn for a few weeks and finding random evidence of referral dialogue.

When we find ourselves speaking with neighbours, church members or friends we need special alertness. As medics, and especially as those observed to be trustworthy, we may well find that others come to us for counsel over both physical and psychological issues.

'Who are our patients?' is a good question. To say 'everyone!' is laudable. It is a great witness to help those in spontaneity, yet we must be careful. We must be alert and quick to realise where others' problems are beyond our reasonable means, and clarify early on how it is we may help, whether by our action or referral; we must be alert to our own resources. Moses was advised to delegate by his father-in-law Jethro. 17 For those who will naturally take on all thrown at them, the danger of burnout is real. In prayer we should ask God where our effort should be focused. Throughout we must be aware of our identity as a 'people', and not feel uncomfortable about asking others for advice or prayer. Whoever we attend to, we must hold in the same high care.

In prayer as with all things we must dedicate our words to God, and joyfully do our best.

References
  1. 1 Genesis 27
  2. 2 Genesis 29:25
  3. 3 Judges 16:4-7
  4. 4 2 Kings 5
  5. 5 Mark 6:14-29
  6. 6 2 Kings 20:12-19
  7. 7 Isaiah 39:6
  8. 8 Matthew 2:12
  9. 9 Proverbs 25:11-13
  10. 10 James 3:5
  11. 11 1 Thessalonians 4:11-12
  12. 12 Ephesians 5:1
  13. 13 Psalm 89:8, CEV
  14. 14 Ecclesiastes 1:18
  15. 15 Hebrews 4:16
  16. 16 Revelation 2:17
  17. 17 Exodus 18:21
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