HIV Positive? As Your Therapist, I Need To Know

Great Debates
1

In my line of work, I see a lot of “end-stage” diseases. Sometimes COPD, sometimes lung CA, sometimes AIDS.

My job is not to judge how these diseases came to be. My job is to treat the patient, and I do that to the best of my ability.

However, at certain times I need to know some stuff that my patients may not be willing to let me in on, and that worries me.

Lately we in the medical community have been indoctrinated as to HIPAAA (Health Insurance Portability and Accountability Act) which, in essence is a protective measure to insure a patient’s privacy to the nth degree. That’s fine. No problem, and I have used it recently in protecting one of my patients. (Neighbor parked next door in ER wanted to know what her friend’s ECG showed!)

If one of my patients tested HIV positive, and I am called in to treat that patient, I feel it is my right to know this information, because I or my loved ones may be at risk if I am infected.

Many times I am called on to draw arterial blood to determine respiratory status. Sometimes the patient is still, sometimes not. Even if he/she is still, that’s no guarantee they will remain so after I introduce the needle, so the opportunity exists for a repeat “needle stick”: (Into the patient and then into me.)

So I propose that if a patient has been diagnosed as HIV positive, she/he (or family) needs to let us know this before treatment. It is not pre-judgemental. All kinds of reasons exist for someone to become infected, and those of us in health-care aren’t stupid: We know to take a good history.

If we’re not sure, then BY GOD we need to be held accountable to ourselves and use “Universal Precautions”!
Unfortunately, in an ER situation you can’t stay “dressed out” all the time so we’re “caught short” a lot of the time.

Still, I/We have a right to know.

Thanks

Q

2

I am no longer in the biz but:
ANY known serious communicable disease should be known to all staff in the area including housekeeping who may be cleaning up infectious debris afterwards.

Any medical staff who are displaying judgement in care procedures should have a full history available for the patients safety as well as the staff. Some disease processes contraindicate certain treatment methods (ex. COPD and oxygen administration or using Dextrose infused IV solutions with diabetics).

3

I completely agree that when you as a patient may expect to be treated - sometimes treatments that actually save your life -, those who treat you have every right to demand your respect for their life and health.

The same counts for all the other people involved in your treatment, directly or indirectly.

My son has a rare bloodgroup. (A positive, du negative, he was a rhesus child). He caries a medal to warn about this in case he needs an emergancy blood transfusion.
So if somebody in need for special attention can wear such a protective warning, I don’t see why somebody who forms a danger for those who treats him shouldn’t wear the same to warn them about it.

Salaam. A

4

Well, let’s take this one step further: if you contract an illness from a patient who DIDN’T disclose the fact that they were HIV positive, could you sue them?

My husband’s a firefighter for the city of Dallas, and when a patient that he’s transported turns out to have a serious disease (usually from the autopsy report) he is informed of the risk immediately.

I believe Quasimodem’s point is that health workers are at risk, despite the HIPAAA statute - and further steps must be taken to remedy the situation.

Can I have a donut now? Quasi, what exactly did the HIPAAA ruling state?

5

Don’t be naive; people can be infected without knowing, and they can be infected with other serious diseases.

And once anyone can get personal health information about another, all privacy is lost.

What’s to stop your less ethical co-workers from selling such information?

If we lived in an ethical society, your wish would be reasonable, but we don’t and it isn’t.

6

Please bear with me, trying to make a point but not very good with formulating ideas:

I would worry that by being told if patients have HIV (for example) that medical staff would subconsiously lower their standards for universal precautions - due to a false sense of security. Medical staff may think “oh I know which patients I have to be extra careful around”. This may lead to not being as careful around patients who are considered ‘safe’. Then if someone who is infected but does not know it comes in for treatment there is a greater risk. Universal precautions ensure everyone is equal (in theory).

7

In the days before HIPAAA my wife accidentally got poked with a sharp that had been used on a shy older gent. His chart wasn’t available and it took a lot of pushing and prying to get him to admit he was in for an enlarged prostate, something she needn’t worry about catching but which he was reluctant to mention to a woman.

8

  1. Granted, but if we’re talking about HIV, you would at least know if you’re at risk.

  2. Our privacy is, of course, intact now. Heh.

  3. Who would the co-workers sell it to??

  4. Ethical society…well, guess you got me there.

You have earned ONE donut point, which can be redeemed at Quasidonuts.com.

9

leechbabe, medical people are very aware of what is out there to be caught and are always cautious. Their guards would only be relaxed relatively if, as in my wife’s case, the patient was in for something safer. He could always be harboring something else.

10

That reasoning is common in hospitals among policy-makers. Unfortunately, as Q points out, it is very difficult for the front-line staff to implement. They simply don’t have the time to use full precautions with every patient.

11

You’d think so wouldn’t you but I’ve worked with some of very uncareful people (is that a word).

Blonde people don’t always know if they are at risk of HIV or even something like Hep B. Actually Hep B is probably a better example than HIV because from memory it is far more contagious.

Another problem with full disclosure is that the patient may come across a narrow minded or intolerant health care provider. One doctor I worked with was very good at implimenting universal precautions but when a patient told him they were HIV + he double gloved, put on a mask the full deal - all this just to give the man a flu shot. Then the doctor wrote on the front of the patients chart 'HIV +" and highlited it. Great so anyone who glances at the front of the chart can find out highly personal info!

It does help health care providers to have your full medical history especially if they are going to have to deal with complications caused by the disease you are suffering from (be it HIV, Hep B, TB or whatever). But sadly discriminatory treatment can make people reluctant to tell all.

12

  1. Nyah, nyah

  2. They could probably sell it E-Bay. Seriously? Insurance companies could buy confidential informations from private researchers who purchased data illegally from bent health-care worker (who are so well paid, very few would be tempted), and then be ‘shocked, shocked I say’ to find the data had been collected illegally.

  3. What about the new resistant TB? SARS? Where do we draw the line?

  4. You got me back.

13

[hijackl] Oh, you’re good…what gender are you, j66, out of pure curiosity? I’m 99% sure I know the answer.[/end hijack]

Given the escalating medical costs facing us (due to insurance claims), it’s a miracle that our hospitals are functioning at all.

14

I will never specify my gender on-line. It so interesting when people get it wrong.

But, yeah, you know.

http://boards.straightdope.com/sdmb/showthread.php?s=&threadid=209349

15

You aren’t going to try to battle me for the Kate Capshaw role, are you, j66? :wink:

Quasimodem - what do you propose in the way of new laws related to the issue? And, do caretakers really ignore the risks by not wearing protective gear?

16

I want to be Bette Davis.

(You know, my uncle used to date her when they were kids?)

17

Hi. I was told there was going to be punch and pie here.

18

j66, your right to privacy ends when my life is in immediate danger, I believe?

19

I’d posit that the time for confidentiality with regards HIV is passé. The time of the AIDS patient as social pariah is fading into the past. Why not require full disclosure of all HIV+ patients, and institute the same controls that would be required for gonœrrhea, syphilis or chlamydia? It seems that the protections for society in general, and health care workers in particular, in this case should trump the privacy rights of the individual.

20

The only way for a caregiver to be infected with a blood-borne pathogen such as HIV is if they commit an egregious breach of safety protocols. You should be just as carefull about not sticking yourself with a needle with every patient as you are with ones you know are HIV positive. As such, it is entirely the responsibility of the caregiver to take reasonable precautions to prevent themselves from contracting a disease.

In the real world, healthcare professionals are, at times, going to decide that they just don’t want to bother with full precautions. When you do this, YOU TAKE YOUR LIFE INTO YOUR HANDS. You fully accept the risks that the patient you are seeing MAY have a communicable disease, and that if you screw up, YOU MAY DIE. It’s just the same as sleeping around without a condom, it’s your risk to take, but you can’t say you didn’t know the risks and the consequences if it bites you in the ass.

As a practical matter, I do think that patients should inform their caregiver of any communicable diseases they may have, as a matter of decency to a fellow human being that is putting themselves at risk for their benefit, even if they accept that risk and have the opportunity to mitigate it. I do not believe that such disclosures should be mandated by law, for the reasons I discussed above.