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Some medical journals that feature physician narratives state explicitly whether patient permission is required: The , for example, will publish nonfiction about patients only if the patient signs a form. With my piece about the elderly woman already accepted, and thanks to a backlog at the publication, I had time to ponder.I decided to write a letter to my former patient’s daughter to tell her that I’d call the following week about something I had written. Finally, she said that she didn’t really understand why I felt compelled to write this story. And yet, all these years and many personal essays later, there remains a niggling sense that maybe I shouldn’t be exposing the inner lives of my patients, that even with a patient’s okay, even after a careful resection of sensitive elements, I may have taken advantage of a confidence.Recently, we wrapped up our annual writing workshop.
I told her that it might help others in similar situations.
She hesitated, then said that my patient would have done anything I asked him to, so she supposed it would be okay.
But guidelines on narratives about interactions with patients are less clear-cut.
And while it’s easy to avoid including the 18 HIPAA identifiers—name, age, address, social-security number, and so on—the descriptions doctors and other healthcare professionals provide about patients in personal essays are about as private as it gets: a conversation with a man just diagnosed with metastatic lung cancer, an admission of an extramarital affair, a patient who asks for help in dying.
A number of years ago, I wrote an essay about an elderly woman, a patient of mine.
After her death, I spent months cobbling our encounter into a narrative, rich with detail about how her illness had come to define her life, what she looked like, how she sounded. If she were still alive, I could have asked her permission.
When she answered the phone, I summarized my essay. A lot of people might learn from it, I replied—doctors, patients, family members. More troubling, perhaps, is my presumption that I’m safe from offending or angering a patient because many of the people I write about are long dead or unlikely to come across my essays.
About five years ago, I dusted off an unpublished piece about another patient of mine, a man who had since died, and called his only relative, his ex-wife. Why would I want to write about his suffering, and hers?
Power is an inescapable aspect of all socialrelationships, and inherently is neither goodnor evil.
Doctors need power to fulfil theirprofessional obligations to multipleconstituencies including patients, thecommunity and themselves.