Case 3. A Puzzled Doctor

Some years ago “Whole-time medical officer of health” wrote to the British Medical Journal, asking what he was to do in the following case: “A medical practitioner has consulted me under the following circumstances: He is attending a railway signalman for asthma. The attacks come on suddenly and are so severe that the patient falls on the floor, struggling for breath, and is totally incapacitated for an hour or longer. He has not yet had an attack in his signal-box, where he is on duty alone, sometimes for many hours at a time. The man declines to inform the railway company of his illness, thinking it would result in his discharge, or at least reduction of wages. The doctor is afraid that if he reports the case to the railway company who are not his employers, and therefore not entitled to a report from him, he will have to stand an action for damages brought against him by the patient. On the other hand, he fears that unless he breaks the seal of professional secrecy, there will probably be a railway accident, possibly on a large scale, as many London and other expresses traverse the line.”

We must take the facts of the case as stated. The signalman's complaint might at any time make him incapable of attending to his duties, and in the doctor's opinion there would probably be a big accident. The signalman had no right to continue at his post to the public danger; under the circumstances he was unfit to hold the post, as he could not, with reasonable certainty, guarantee that he would be able to fulfil its duties. His refusal to tell his employers threatened injury to them and to the public. In such a case the obligation to preserve even professional secrets ceases, and charity obliges anyone who is acquainted with the facts to make them known in the proper quarter. The doctor should therefore inform the company that the man is unfit to be left alone at his post. The rights of the public must be safeguarded, even at the expense of the individual.