When a dual relationship exists between a physician and a patient, the physician has an obligation to put the patient's health first even at the risk of ending the personal relationship.
Physicians who encounter a patient who is suffering from depression may find it necessary to breach confidentiality and patient autonomy in order to act in the best interest of the patient.
In a case where a physician is treating two related patients, he should weigh the harm done by breaking one patient's confidentiality against the harm that patient may inflict on another if that confidentiality is preserved.
The U. S. health care system encourages patients to take more responsibility for their own treatment decisions and expects their doctors to cooperate in that effort. But the guidelines for exercising that responsibility remain very murky indeed.
Fibromyalgia, with no positive tests, is a “foreigner” in the medical landscape. Medicine looks for signs of pathology, changes in the structure or function of organs. The mantra of physicians facing patients with fibromyalgia: “Your tests are normal.”
The graphic novel Swallow Me Whole highlights the need for patient-centered care that engages not only patients but also extended family and the community.
AMA J Ethics. 2018;20(2):148-153. doi:
10.1001/journalofethics.2018.20.2.ecas3-1802.