The co-pilot of Germanwings Flight 9525 was diagnosed as suicidal, but even a weakening of medical confidentiality rules might not prevent such disasters, according to Fabian Schmidt.
One week after the plane crash in the French Alps it seems as if the moment for knee-jerk reactions has arrived; for action at any cost. Since investigations have found that years ago a doctor had diagnosed the co-pilot of the ill-fated Germanwings flight as having suicidal tendencies, voices are increasingly clamoring for a repeal of medical confidentiality rules.
Yet, that is the wrong approach: without medical confidentiality there can be no trust between doctor and patient! Only absolute trust can guarantee that a patient can openly and honestly talk with their doctor about concerns, hardships, and pain.
This is especially true for family doctors and specialists that patients themselves choose. No one can expect a doctor in such a position of trust to make reports for employers.
Already enough exceptions
Besides that, there are already enough exceptions to rules for medical confidentiality. Such as in the case of danger prevention: if a doctor is aware that a patient insists upon driving under the influence of narcotics, then he or she is required to break the oath of silence and notify the police. Naturally a suicidal pilot would also be such a case, but the doctor would have to be aware of the patient's occupation and how acute such suicidal tendencies were.
Company doctors who examine employees' occupational fitness are also obliged to maintain medical confidentiality, and for good reason. When reporting to employers, these doctors must limit themselves to an attestation as to whether the person examined is capable of carrying out a certain job or not.
But to do so the company doctor must first fundamentally examine the potential employee's physical and psychological state. This was apparently not the case in the instance of the Germanwings co-pilot. The patient was able to keep his sickness secret during his yearly medical examinations.
Do we want to be "transparent patients?"
In any case, the solution to the problem cannot be in giving company doctors, or eventually employers, access to patient data held by fiduciary doctors – most likely through an enormous patient database. Such transparent patients would be a nightmare, not only for privacy groups.
The only thing that can help to better guarantee the ability of pilots, engineers, bus drivers, or control room operators at nuclear power plants are more thorough occupational health exams.
This, of course, includes psychological examinations. It also would not hurt if company doctors increasingly examine blood, urine, and hair tests for the residuals of psychotropic drugs in order to verify that what the patient is telling them is accurate. But they should do it with the strictest medical confidentiality.
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