GP reprimanded for testing patients for HIV without consent
BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7228.135/a (Published 15 January 2000) Cite this as: BMJ 2000;320:135
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Editor,
Have I missed something? Clare Dyer's report would seem to
indicate that a doctor has been severely reprimanded, almost struck off,
for requesting a blood test for AIDS, a disease known to cause the
symptoms and signs from which the patients suffered. Knowing that to
follow the line of political correctness would cause great harm in terms
of anxieties raised, it would appear that a considered decision was made
by a caring doctor, being aware of the extreme unlikelihood of a positive
test, not to inform the patient unless the result proved positive at which
time appropriate counselling could take place. Meanwhile his
colleagues, for motives which I cannot begin to imagine, invite the patients to "be counselled" to
prepare them for the news of receiving a negative HIV result, and complain
to the GMC. The GMC falls over the PC tripwire and appalls jobbing GPs
like myself yet again.
At least it would appear that the GMC has not succeeded this time in
driving a GP out of the profession, but many of us are still waiting for
the apology demanded for a previous decision (*****sorry, haven't got the
reference but this refers to a Personal View a few weeks ago)
Jim Newmark
General Practitioner
Farrow Medical Centre,
177 Otley Road,
Bradford BD3 0HX
Competing interests: No competing interests
A signed waiver--Protection in the emergency department ?
The status designated to HIV/AIDS (as distinct to syphilis )
poses thorny problems to those who 'work in the trenches', as demonstrated
by the news item by Clare Dyer and Dr Jim Newmark's response. These
problems are not confined to Britain: we have them on this side of the
pond also, as the following demonstrates.
At the 1999 annual meeting of CMA's General Council two thirds of
the delegates passed the motion 'That the CMA recommends that patients
undergoing any procedure where a health care worker could accidentaly be
exposed to the patient's body fluids be required to sign a waiver that
would allow appropriate testing of the patient's serological status of HIV
and hepatitis if such exposure should occur, while ensuring patient
confidentiality'. Drs Tyndall and Schechter (CMAJ 2000 Jan 25 ) say
'Let's waive the waiver'.
They make their case on the grounds that this is vague, impractical,
detrimental, pointless and unnecessary.
Vague ?. What one wonders is vague about signing a waiver. It's
purpose is merely in case of an eventuality. It's inclusion (as
proposed) on the emergency form to protect personel working there would
seem to be unequivocal. There are no arbritary criteria. The form is
presented to all comers, whether they sign or not is up to them.
Impractical ? A large sign proclaiming hospital or emergency policy
on this issue in a position prominent to the public would not seem
difficult to arrange.
Detrimental ? One wonders to who ? The situation of testing only
arises in the eventuality of misadventure. The authors make the stateent
that increased testing will lead to an increased number of false
positives. What about the other side of the coin - the possibility of
detecting an incresed number of true positives ?
Pointless ? 'The vast majority of patients will sign' No problem
there . But what of those who will not ? Forewarned is forearmed. Take
extra precautions. - Wear another pair of gloves. Those who take the
risks (clinicians) deserve to be made aware.
'It is universally agreed that HIV testing muust be accompanied by
proper counselling before and after testing'. I for one am not in favour
of detailed pretest counselling and feel that this has been a stumbling
block to appropriate case finding and disease containment. There are
others who share this view. A signed waiver carries weight in a court of
law. Respecting right to refuse does not render this waiver 'moot'.
Unnecessary ? Tyndall and Schechter despite having 120 accidental
occupational exposures per year at their hospital requiring antiretroviral
prophylaxis say yes. 'If it ain't broke don't fix it I am personally
aware of 5 local situations in which antiretroviral therapy, serial HIV
testing and universal precautions were necessary because the primary
contact declined testing. It has happened twice to one physician of my
acquaintance. To expose anyone unnecessarily to this type of risk and
stress is wrong. While this has been apparent to the vast majority of
physicians across Canada and was previously expressed in 1998 at CMA
General Council when this same resolution was passed, obfuscation by a
group within the establishment continues. The commentary by Drs Tyndall
and Schechter in the association's journal echo's much of this philosophy.
The battle lines would appear to be drawn between the collective
wisdom of the profession and the architects of HIV/AIDS exceptional status
in Canada. In the public's best interests one hopes the wishes and
wisdom of the majority will prevail.
James E Parker MB FRCPC
Competing interests: No competing interests