Perspective | Sometimes, my urology patients bring a companion with them to their office visit. Sometimes, that’s a mistake.
Sometimes it’s a good idea to bring a close friend or relative with you to a doctor’s appointment. They can provide support and another perspective. But not always.
I’m a urologist, and I have discovered there are times when my patients have regretted bringing someone with them.
Not everyone knows what urologists do, and many who know of the specialty think that we treat only men. But urologists see men and women for a variety of conditions that deal with the urinary tract, kidney health and the male genitalia. For example, for both sexes I see everything from urinary tract infections to kidney stones to bladder cancer, among other conditions. But for my male patients, I am also the exclusive go-to doctor for their genitalia.
The person you talk to about your reproductive organs often becomes more than just a doctor who examines and treats you. That person may become a confidant — someone you trust to let into the most intimate space in your life.
When stress is a factor in my diagnosis and treatment, for instance in cases of sexual dysfunction or male infertility, I talk to my patients about their work and home lives, as well as their hobbies. I learn about my patients’ personal and professional lives. Because of that, our relationship goes beyond the medical.
So, for my male patients, I am sometimes the only person they feel they can talk to about the deeply personal details of their health and their sexual lives. Those details can range from cancer, to erectile dysfunction, sexual preference, infertility issues and sexually transmitted diseases.
Privacy is a fundamental pillar of medicine — it is primordial in the doctor-patient relationship. To do my job to the best of my abilities, I need to establish a relationship with my patient based on mutual trust: I am trusting them to tell me everything that is going on and answer my questions honestly, and they are trusting me with their health and their privacy.
Sometimes my patients bring someone with them to my office thinking they want the support. But as the appointment gets underway, it may become clear that they should have come to see me alone.
Patients begin to shift in their chairs when I ask about their clinical history, especially if those questions might affect or involve the other person in the room (their romantic partner). Other times, the patient’s plus one wants to direct the patient’s answers to my questions, which is equally unhelpful.
My patients usually don’t have big secrets to hide — sometimes it is simply that they might not be ready to share with their partner, family member or friend that, for example, they are worrying about cancer. Of course, I can always ask the family member or friend to leave the room — but that doesn’t always go over well for the patient during, or after, the consult.
I recently treated a male patient in his early twenties who came with his father complaining of testicular pain and a burning sensation when he urinated. This meant that I had to follow a protocol that includes discussing his sexual history and considering STIs as one potential source of the discomfort.
When I began to ask my patient questions about whether he’d had unprotected sex, he became visibly uncomfortable. So, I asked his father to leave, which the father refused to do. Based on my patient’s symptoms, I treated him for a common STI and scheduled him for a follow-up visit, hoping he’d come alone so we could talk more openly. If my patient feels that they can’t disclose all the details of their health with me, then it’s harder to do my job and find the right diagnosis and treatment.
Similarly, I had a married couple see me recently about a vasectomy. The wife was present while I was explaining the procedure to her husband. He asked whether the vasectomy was reversible, and they started arguing in my office about why he would want to reverse the procedure since they’d decided not to have any more children.
The visit ended with the wife accusing me of hiding her husband’s secrets and saying I was “on his team.” My patient left looking mortified and apologizing to me; his wife left visibly upset.
Of course, I am on my patient’s team — I took an oath to keep secrets and do no harm. My first obligation is always to my patient. You have the right to be accurately and fully informed of the consequences of your medical decisions. And as long as you’re not a minor, you have the right to see the doctor alone. Period.
Urology lends itself to a lot of jokes because it involves the genitals and that can make people uncomfortable. I understand that, I really do. But I also take what I do seriously and need my patients to make the most of their time with me.
Most of the people who come to see their urologist may simply be unable to open up about their health with anyone but their doctor. And it’s your right to be able to speak freely with your physician — whatever the issue or concern may be.
So, unless you’re ready to be open to discussing everything the doctor might ask or tell you in front of the person you brought to your appointment — then better to come alone.
Originally published at https://www.washingtonpost.com.