Intended for healthcare professionals

Letters

GMC's advice in Serious Communicable Diseases

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7251.1727 (Published 24 June 2000) Cite this as: BMJ 2000;320:1727

Is consent to testing necessary for tuberculosis in same way as for HIV infection?

  1. G J Gibson, past chairman of the executive, British Thoracic Society,
  2. A Seaton, past president
  1. Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN
  2. British Thoracic Society, London EC1N 8LD
  3. General Medical Council, London WIN 6JE

    EDITOR—The General Medical Council recently sent all medical practitioners in the United Kingdom its booklet Serious Communicable Diseases,1 which replaces the earlier HIV Infection and AIDS.2 In this the council broadens its earlier advice on consent to testing to include investigation of tuberculosis and hepatitis as well as HIV infection. We completely agree that tuberculosis should be regarded as a serious communicable disease, but treating it in the same way as HIV infection in the context of obtaining consent to investigation and treatment potentially presents major problems, which we wish to draw to the attention of readers of the BMJ.

    Clearly, when the suspicion of tuberculosis is high it is appropriate to explain this to patients at the time of collecting sputum or other specimens for investigation. However, sputum is commonly tested for tuberculosis in patients being investigated for common respiratory symptoms, when the likelihood of having the disease is low. In our view, obtaining consent to specific testing for tuberculosis in such patients may create needless anxiety. Alternatively, it may even mean that appropriate specimens are not examined because of the concerns this might raise. We suggest that asking for general permission to test samples to exclude infection is appropriate without necessarily specifically naming tuberculosis when the probability of the patient having the disease is comparatively low.

    We have raised our concerns about this advice with the GMC but it sees no need to modify its guidance.

    References

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    GMC's reply

    1. Cyril Chantler, chairman, standards committee
    1. Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN
    2. British Thoracic Society, London EC1N 8LD
    3. General Medical Council, London WIN 6JE

      EDITOR—The British Thoracic Society argues that we set a single, overdemanding standard for obtaining consent to testing for serious communicable diseases. In fact, our guidance states that when obtaining consent to testing for a serious condition, doctors should provide information “appropriate to the circumstances and to the nature of the condition or conditions being tested for” (paragraph 4).1

      In correspondence with the British Thoracic Society I have explained that doctors must use their judgment and common sense in considering what is appropriate. If one undertakes an investigation such as a chestx ray examination, which is comparatively non-specific and may reveal a number of different pathologies, then deciding whether to advise the patient about the possibility of tuberculosis would depend on the likelihood of it being found and whether the investigation was being undertaken specifically to exclude it. On the other hand, if one carried out a test which is specifically designed to detect tuberculous infection, the reason why the test is being undertaken needs to be explained beforehand. On this analysis, requesting a sputum sample for examination for acid fast bacillus to exclude or diagnose tuberculosis would merit an explanation to the patient beforehand, except in special circumstances.

      The Standards Committee of the General Medical Council revisited the issue last year after correspondence with the society. The overwhelming view of the committee was that it was no longer acceptable to advise doctors that, as a matter of principle, they may undertake testing for serious conditions without the patient's knowledge or agreement. The whole thrust of our advice both in this guidance and in our booklet Seeking Patients' Consent is that it is for patients to decide, in most cases, what should be done.2 As in other parts of medicine, we as doctors cannot hope to maintain the trust and respect of our patients unless we share information with them, respect their right to autonomy, and treat them as partners in the decision making process.

      References

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      View Abstract