OPINION
DOCTORS Lounge
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deception. In response to holding onto a
secret, our prefrontal cortex imagines all
the possible horrific outcomes of telling,
not keeping, a secret. Quite often, the pre-
fontal cortex wins. Thus, two parts of the
brain vital to executive functioning spar
with each other, instead of helping each
other. This causes the “fight or flight” re-
action, the stress release of increased cor-
tisol and adrenalin. Chronic doses of this
phenomenon impair memory (can’t learn
when you’re often preoccupied, can’t deposit
a solid memory imprint when your brain
is having a civil war). You sleep badly, your
blood pressure might rise, your digestion
suffers, and you show stress the way you
personally do – yell, or cry, or withdraw, or
snap at people, or make even more mistakes,
which you then might try to hide, which
re-triggers the stress cycle.
People who give up their secrets feel phys-
ically lighter, a sensation much described in
novels. How many times has our heroine
“sighed in relief ” or “let her shoulders sag”
or “felt the weight of all those years slide off
her back” - but whom did she tell? Catholics
have had the confessional as mental health
therapy for many centuries. The parishioner
has had a Father Confessor who listened and
advised and absolved (except during the
Inquisition, when he tortured and execut-
ed). The act of confession strengthens the
soul. People of other faiths have ministers,
rabbis, monks, swamis, imams or shamans.
(Witches have covens. I don’t know if there
is a Head Witch, except for Glinda.)
People also have us, their physicians. We
carry the weight of thousands of personal
histories. But is it the same, to carry some-
one else’s, as to carry your own? I found
lots and lots of research about HIPAA,
about the need to break a confidence if a
person is seriously endangered, about the
tightrope pediatricians must walk when a
child confides something hidden from his
parent, but potentially harmful to the child.
But I found very little about the effect on
doctors of massive and decades-long secret
keeping. What I recall reading, however, are
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Connected
with GLMS between publications
memoirs, and fictional doctors, who discuss
that burden or suffer from it.
When I think about it, I feel it not as a
burden, but as my duty, part of accepting
the Hippocratic oath. When you grow into
being a physician, you gradually assume a
greater and greater responsibility. I have
not sworn an oath to the flag, but I believe
that professionally, we swear to stand for
“Duty, Honor and Patient.” I, and you, carry
the worrying part as a burden of duty. We
grieve for our patients, we are anxious about
their deterioration, or the diagnosis we have
just given them, or the fact that yet another
parent we take care of has just lost a child
to heroin. We worry endlessly. But keeping
secrets feels, in our jobs, right and proper.
We cannot absolve, but we can help.
Dr. Barry practices Internal Medicine with
Norton Community Medical Associates-Bar-
ret. She is a clinical associate professor at the
University of Louisville School of Medicine,
Department of Medicine.
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