How I Learned that One Mistake Does not Define Me
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PROFESSIONAL ISSUES
How I Learned that One Mistake Does not Define Me Rachel Vanneste
Received: 9 October 2011 / Accepted: 16 November 2011 / Published online: 26 January 2012 # National Society of Genetic Counselors, Inc. 2012
As genetic counseling students, we learn about the importance of protecting a patient’s confidential health information and the perils of disclosure without consent. I remember wondering, “How anyone could make that mistake? How could someone fail at one of genetic counseling’s most fundamental principles?” However, in my second year as a genetic counselor, I did just that. I was referred a G5P1A3 woman (I will use the pseudonym Mrs. P) whose current pregnancy showed multiple anomalies on ultrasound. Her obstetrician sent me a summary of her obstetric history, which included two lategestation intrauterine fetal deaths that occurred in her home country in Africa. When she presented in my clinic with her husband, I reviewed this history with the couple in an attempt to elicit more information about these past losses, particularly in the context of the ultrasound findings in the current pregnancy. While I asked questions regarding her history, I watched as her body language and demeanor completely changed. She became silent and would not elaborate when I attempted to draw out what she was feeling. I interpreted her reaction as her past losses being too difficult to discuss, especially given her current situation. We arranged a follow-up appointment for the following week. The following day, Mrs. P’s husband came to my office alone and unannounced. He explained to me that he had been unaware of his wife’s first pregnancy loss, as this had occurred prior to them being together, and she had never shared this with him. Mrs. P had kept this loss a secret for almost 15 years. She had never allowed him to be present
R. Vanneste (*) McGill University Health Centre, Montreal, QC, Canada e-mail: [email protected]
for any of her prenatal medical appointments, and he felt that this was due to this secret first pregnancy. When I realized that I had disclosed this woman’s secret to her husband, my initial reaction was panic. I had made one of the fatal errors in genetic counseling. I felt embarrassed and guilty for having failed in my role as a genetic counselor. I was so lost in these feelings that I didn’t notice Mr. P was still talking. He expressed that he wasn’t angry with his wife, but that he did not know what to do with this new information. His wife refused to talk about it, so he was contemplating discussing the situation with her brother. At this point, I took an approach of “damage control”; I wanted to prevent Mrs. P from being harmed any further. This decision resulted in me being much more directive in counseling Mr. P than I typically am. I began to tell him what he should say to his wife and how to approach the situation. I indicated that by no means should he discuss this with anyone else. He agreed to keep the secret to himself and he asked that I not tell his wife that he
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