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MRSA: to disclose or not to disclose?

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39087.651551.BE (Published 15 February 2007) Cite this as: BMJ 2007;334:368
  1. Aran Singanayagam, foundation year 2 doctor, department of general medicine, Royal Infirmary of Edinburgh (aransinga{at}gmail.com)

    During my first foundation programme appointment as a new doctor, I was called by the nurses to speak to a relatively young patient who had spent a considerable time on the ward. The patient was clinically well and progressing with physiotherapy, but a recent superficial nose swab had cultured methicillin resistant Staphylococcus aureus (MRSA). As a result, the patient had been promptly isolated to a side room, and the nurses now wanted a doctor to explain the swab result. They were adamant that I should be open about the fact that MRSA had been cultured as they felt withholding this information could have serious consequences if the patient found out by chance later.

    As I was still inexperienced in such discussions with patients, I asked one of my seniors for advice. He advised a completely different approach, however. He felt it would be unwise to mention MRSA specifically because of the media sensationalism of this infection—it might upset the patient unnecessarily and have negative connotations. He suggested the best thing to do would be to explain that the patient had acquired a skin infection, which required isolation in a side room to prevent spread to other patients, and would need topical treatment to eradicate the infection, without stating explicitly that the infection was MRSA. He reasoned that, if a patient was found to have a urinary tract infection, you would not feel obliged to specify that Escherichia coli was the causative organism but would simply tell the patient that he or she had “an infection of the urine that requires treatment.”

    When giving patients information about their condition, one must strike a balance between providing enough information to allow an informed choice without overwhelming the patient with unnecessary information. This case was made more difficult because of the heightened media and public interest in MRSA and the reporting of several high profile cases of this “hospital acquired” infection. MRSA infection is perceived by patients to be different from other bacterial infections, and it therefore requires special consideration.

    I have subsequently been asked to discuss MRSA positive statuses on several other occasions. I have found that, as long as patients' perceptions of MRSA are explored and they are given accurate information about the implications of colonisation or infection, they are usually satisfied. To disclose or not to disclose MRSA infection is not the question, but rather how to disclose.

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