53. CASE: Disease Stigma

A patient has been followed by you, his family doctor, for several medical issues and is being seen for a minor work-related injury. He is very negative and tearful but will not acknowledge his symptoms when asked.

You believe he is depressed and you know you can provide treatment for his depression. However, the patient is uncomfortable seeking treatment or having you document your findings in his record because of the stigmatizing effect of having a mental health disorder known in a remote community.

  • What steps should you take to address his depression?
  • What factors external to your family practice must be considered?
  • Do you think that it is likely or unlikely that the patient’s concerns about confidentiality are valid?
  • What policies and procedures should be in place to maintain privacy and confidentiality in rural communities. How should these be enforced?

Some Values and Ethics Issues to Consider

  • Respect for privacy and confidentiality
  • Respect for patient autonomy
  • Community and family relationships
  • Respect for human dignity
  • Honesty, trust and truth-telling
  • Patient-provider relationships
  • Patient safety
  • Stigma
  • Vulnerability
  • Equality of access

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