Patient confidentiality vs. Public safety

A 19 year old woman came to the ED reporting that she had been raped by a taxi driver. She wanted emergency contraception and wanted to be tested for sexually transmitted infections. She said that she was alone in the taxi, the driver took her to secluded park, raped her and left her at the park. She would not describe the taxi driver, say which company he worked for, or give any details about what happened. She did not want to press charges because she did not want to questioned by the police (she stated that her sister had been sexually abused and went through a terrible time having to relive her experience over and over again after she reported to the police). The attending (and I) were in a conundrum. If what happened to her isn't reported to the police, a taxi driver can very well rape (or murder) someone else. If what happened is reported to the police, we'd be breaking her confidentiality (and making her go through a lot of grief). Eventually, the nurses contacted the hospital lawyers who (probably to save their asses) said that legally we can't break her confidentiality. So, even though it gave both the attending and I a terrible feeling, we let her go and didn't report anything.
Later in the week I talked to a medical ethicist at our institution about this. He didn't say anything clear cut. But, he reminded me that confidentiality can be broken if the information we reveal has a high probability of saving the patient's life or the lives of others. So, assuming she's telling the truth (not sure if she is) and there is a high probability that the taxi driver would rape again (and statistically speaking, it is), ethically we should have reported the incident. Is that right? I'm still on the fence about this. I just hope I don't hear anything about a cab driver raping someone else on the news.

Jenny McCarthy as my pediatrician?

As I expected, in pediatrics I'd run into some anti-vaccine parents. They were beyond convincing (and perhaps not coincidentally, many of them were chiropractors). However, the other day we saw a patient bring her child for her two-month check-up, when the first shots are given. The mom brought up her concern about vaccines causing autism. The pediatrician said that there isn't any evidence that it's the case. Grandma then walked into the room and said, "oh yeah, I heard that the original study that showed a connection between vaccines and autism was a fraud." (yay! word is going around). The pediatrician then said, "Whenever you hear things like that you should ask yourself, if my child had an ear infection, would I ask Jenny McCarthy for advice or would I go to my pediatrician?" The mom and grandma laughed and said, "pediatrician." The baby got her vaccines and the story had a happy ending... but as I was leaving the room I thought, even though it sounds like a silly question, a lot of parents wouldn't think it's such a funny question. There are plenty of people who would be happy to take the advice of celebrities (and quacks) on their kids' health (not just vaccines) over their pediatrician's.

Peds neuro: Can it tear me away from radiology?

On my neurology rotation I was assigned to pediatric neurology, and that random assignment might have changed my career plans. I loved it almost immediately. The patient population seems great. The diseases are often very challenging. And each patient is completely different. Granted for a lot of patients there is no treatment. Although, figuring out the mystery of why something is wrong with someone's child does a lot for both the parents and the child. For those kids for whom a difference can be made, the difference is dramatic. It could change a potentially severely disabled child to a normal, healthy child. Also, adding the normal changes that a child goes through as they get older along with the neurological problems they face is an added factor that makes the field interesting. Finally, the research opportunity is limitless. There is a lot that is not known about the conditions that these kids can suffer from. For many of them there is no treatment available. Also, their disorders shed light onto my field of interest, how the brain works and how the brain's plasticity can be used to overcome their deficits.

Will I go into it? Not sure yet. Radiology is still winning, but peds neuro is a quick second. The training in peds neuro is a little strange (for most people, 2 years of peds, 1 year of adult neuro and 2 years of peds neuro - you have to go through two different matches). Also, I'm not completely sure if I really like the pediatric population... we'll see, my peds rotation is next. Stay tuned.