Dr Phil Hammond column

A DOCTOR'S DILEMMA (continued from last week)

The story so far ...

Man marries woman who insists on fidelity;

couple have children - Jack 3, and Maisey, 6 months and not sleeping through yet;

couple stop having sex;

man goes to sales conference in Bournemouth;

man gets drunk and behaves completely out of character;

man gets gonorrhoea;

man has unprotected sex with wife;

man has gonorrhoea treated with Amoxycillin at special clinic;

man asks GP for more Amoxycillin to conceal in wife's food. "I know she's not allergic to it and I'm certain it's the only way to save my marriage. If you don't engage in this minor deceit, my wife would struggle to cope, I'd get very depressed and two children would be deprived of their father. They'd probably turn to street crime and drugs, doctor. And it'll all be your fault ..."

"I appreciate your predicament Mr Kiloran, but I'm not sure I can help you in that way."

"Why?"

"Because your wife is a conscious, competent adult and so to treat her without her consent would be unethical."

"Says who?"

"Um ... ah ... Hippocrates originally, I suppose, and then the General Medical Council."

"Well, I've got a copy of Duties of a Doctor here ..."

"What's that?"

"It's the General Medical Council's ethical bible for doctors."

"Ah yes, of course."

"And in the Good Medical Practice guide, there is nothing to say you can't treat patients without their consent. In fact, it doesn't even mention consent in the index at all."

"It must be an oversight. Anyway, look here. It says `You must make an adequate assessment of the patient's condition based on the history and clinical signs, including an appropriate examination.' So I can't just treat your wife blind without seeing her."

"What about Jack?"

"What about him?"

"Well, when we phoned you on Friday night to say he had earache, you didn't come out to see him. In fact you left a bottle of Amoxycillin in your letterbox for me to drive round and pick up."

"Yes well, I'd made a full clinical assessment over the phone. And anyway, it was during the second half of Ruth Rendell and I had a rather fine chablis on ice."

"So could you assess my wife by phone?"

"How?"

"Well you could phone her up and say you're doing a random audit of vaginal discharge and does she have any."

"Yes, but 70 per cent of the women with gonorrhoea have no symptoms, and the only way we'll find out for sure is by doing a swab."

"What would happen if we did nothing?"

"The infection can travel upwards to the fallopian tubes, causing a lot of pain, and infertility. And it can get into the blood stream causing pustules on the hands, and joint problems. And also, when you have unprotected sex again you'll get it back."

"I suppose that's one way of knowing if she's got it."

"True, but it's far better to do swabs."

"She's due a smear next week. How about if you do it and say, `Ooh, there looks to be a bit of infection here' and give her the antibiotics. You wouldn't have to say it's the clap and she'd just think it was one of those ones you can pick up from bath towels."

"Yes, but I'd still need to take swabs. Sexually transmitted diseases tend to hunt in packs so you may have picked up and passed on more than one. Like chlamydia, for example."

"So treat her for that too."

"Didn't they test you up at the clinic?"

"I haven't been back yet for the results. But I haven't got any symptoms so I must be fine."

"What about an HIV test?"

"No thank you."

"Well you did have risky sex."

"Heterosexual through the usual channel."

"Without protection with an unknown partner with gonorrhoea ..."

"I'll take that risk."

"Yes, but should your wife?"

"You're not going to tell her are you? Confidentiality and all that."

"Let's see what the GMC says. `There are grounds for disclosure only where there is serious and identifiable risk to a specific individual who, if not so informed, would be exposed to infection.' "

"Yes, but you don't even know if I've got the infection and as I'm never going to have the test it's irrelevant."

"Well I'm not treating your wife blind and I think she needs to be fully informed and assessed urgently."

"And if I tell her, she'll leave me."

"Are you sure?"

"Yes. But on balance I find the weight of your argument compelling and as her health really is at risk, I feel duty bound to confess all."

"Well done. I'm sure you're doing the right thing."

"Just out of interest, though. You know the Amoxycillin syrup you gave me for Jack's ear infection. Would that cure gonorrhoea too?"n