OK, a quick glance through that only mentions “patient abandonment” without elaboration. As far as I can tell, that only applies after a professional relationship is established, so that shouldn’t be an issue here.
You don’t take retrovirals after a run-of-the-mill needlestick (even if the source patient is unknown). They just get bloodwork drawn asap, and then again at 6 months.
This is the part of the OP that intrigues me. I can’t remember the last time I saw an syringe that didn’t have the auto-retracting needle thingy. Now admittedly, I live in a relatively wealthy suburb, but aren’t the auto-retractors pretty much standard everywhere now? Who caps needles manually any more? And even if you don’t have them, isn’t standard practice to discard the needle in a sharps container without recapping, just to prevent this?
Where I work the person who was stuck isn’t even allowed to be the person who gets consent. I know this because I had to take a quiz on it, despite working in a research building separate from the hospital building.
Those retracting needles malfunction/get stuck sometimes. And IVs are still started with real (enormous) needles. But there are many, many medical facilities that are perennially stuck in the 1960s, outside of the operating room. My mom’s a nurse and used to do clinical work at a hospital like that, before she got into case management.
Also, I don’t think the motivations of the patient are relevant to the legals or ethics in question (although that is an interesting discussion, it belongs in a different thread). Either blood belongs to a patient, morally and legally, or it doesn’t.
I will let your future employer review that issue with you.
It isn’t SOP to take PEP if the donor patient is unknown if the local prevalence of blood borne disease is low and there is no reason to believe the index patient to be high risk.
Which would be the case in the majority of circumstance in the USA.
However- if the donor was known to be a sex worker, an intravenous drug user, an immigrant from a high prevalence area or someone who otherwise had an elevated risk then PEP might be indicated even if the donor’s status was unknown or negative.
If the donor was a locally born woman who regularly donated blood- sure I wouldn’t take PEP, because the risk is low.
The mere fact you refuse to take a test would make me more likely to take PEP though- no-one refuses to take a test they know for certain they’ll pass.
Many physicians are self-employed, or part of a partnership, so that might not be an issue, but in any case I don’t think there’s any intrinsic legal impediment.
In any case, it’s a hypothetical, as even if the patient is the sort of first-class shmuck who’d refuse to allow the test, they’d be fairly unlikely to randomly mention that upfront. It wouldn’t even help to ask about it and have them sign something saying they’d allow me to test their blood in event of accidental exposure, because if consent is in fact required they can still withdraw it at any time.
This would be my concern as well. I wouldn’t know if the person suspected/knew the worst, or was just very concerned about privacy at the expense of my well-being, but I would know which option I can do something about.
The safety features that some types of needles have may help prevent injuries after use, but a lot of needlestick accidents happen DURING use. For example, it’s easy for a needlestick to occur when you’re trying to draw blood/give an injection/put in stitches on a patient who is delirious or high on drugs (or just a very uncooperative little kid!) and thrashing around. Even under normal conditions, sometimes the instrument or needle slips out of your hands and you can get stuck that way.
When a critically ill patient rolls into the ER, it’s very easy for someone to be stuck by a scalpel or needle that someone else was using because multiple people may be in the room doing different things on the patient at once.
There is also the risk of being stuck because your coworker dropped the ball and did something reckless like leave a piece of suture with a needle still attached lying around that you didn’t know about until you pulled the sheets back on the bed and it was flung at you.
I do not understand why you would refuse to be tested in the scenario you describe. Can you explain?
ETA: I do see where you wrote that you feel that needlesticks are an occupational hazard and that you’re not at fault. I just don’t understand why you would refuse the trivial step of allowing testing to be done (even if more blood needs to be drawn from you) to alleviate the distress the other person is going through. If the shoe were on the other foot, would you want the patient to consent to testing?
Why is the testing so offensive to you in this situation?
A needle-related test is one I would refuse. I’m terrified of needles and for me to get any blood work or injections or anything done at all is a big, big deal. I spent my lunch break today crying in the bathroom because I have to have a gestational diabetes test done tomorrow, that is how much I hate needles. If someone accidentally stuck themselves I would probably refuse the test but call my doctor and have them send over my last test results and anything else that might be of help to someone who was worried they might have caught something from me.
Yup. My needlestick incident happened when the patient I was drawing blood from jerked his arm away, and the dirty needle I was holding went into the ball of my thumb of my other hand. There are a lot of uncooperative old people, too (dementia, Alzheimer’s, just plain ol’ asshole, etc.).
There are rapid salivary tests for HIV- so that might be an option for someone with a needle phobia.
Any blood sample the lab had in the correct type of bottle from the previous 48hrs could be processed for viral antibodies.
Needles might not be necessary, but a legitimate needle phobia would probably be the only reason I could possibly support for declining testing.
“Privacy” as a reason to decline testing is just odd to me-an index patient where I work can request that their sample is anonymised and identified only as “index patient in relation to needlestick injury suffered by person Y”- it isn’t like everyone needs to know the result.
This is an *amazingly *small-minded view (along the lines of “if you have nothing to hide, why not answer our questions?”). People with privacy concerns or a fear of needles would certainly have reasons to refuse. Again, the motivations of the patient are not salient.
This actually happened in a claim I took today. Surgical techs get stuck by careless surgeons way too freaking often.
The same sort of assholes who refuse airport screening just because they can, or the sort that will start an argument with a cop at a routine traffic stop just because they can.
You can make it a patented Skald hypothetical threadTM, if you like. I’ll vote in it (if you make it private of course:cool:).
You process insurance claims.
I’m a doctor.
I have advised people who want to get tested
who are worried about being tested
who know they should get tested
who don’t know why they should get tested,
who don’t want to get tested
who think there is no point in getting tested because they already know they’re positive.
Knowledge is power- not knowing if you have a potentially fatal but treatable disease is not smart and it isn’t healthy.
Privacy is NOT an issue- samples can be anonymised so that the only person who knows the result is the occupational health consultant advising the needle stick recipient.
Index patients can request anonymous testing at a separate facility and contact occupational health at a later date if the results are positive.
There are options for needlephobics (who I would assume, like pbbth wouldn’t object to anything that doesn’t require further needles, but would try to assist with other risk assessment tools).
What “privacy” concerns do you mean?
The sample can be anonymised.
The index patient can decline to be told their result if they don’t wish to know.
They can decline for a positive result to be put on their records or communicated to their family doctor.
They can decline treatment.
A positive result won’t be shouted from the rooftops or stamped on the front of their chart- but it might help ensure someone else doesn’t end up with HIV.
I have HIV positive patients where LITERALLY only the patient, the other Drs in my practice and the infectious disease consultant know they have HIV. For all I know I may have patients where only they and the ID consultant know, because they don’t want their GPs told.
There is a HUGE drive to normalise HIV testing and make it part of routine medical care. The NHS already has opt-in antenatal testing for all pregnant women, all women having terminations of pregnancy and everyone attending sexual health clinics. HIV testing will also be offered in general practice to all new patients from endemic areas and to patients from at-risk groups on an annual basis.
Do I think HIV testing should be mandatory- no.
Do I reserve the right to think anyone without a legitimate needlephobia who was the index for a sharps injury and then declines testing is a selfish asshole- yup.
[clueless literalist]
Skaldtheticals (WhyNot’s coining, not mine) are not and cannot be patented, as they are not unique mechanical works and I am not Microsoft. Individual ones are copyrighted. In theory I could perhaps trademark the format but I can see no lucre in that.
[/clueless literalist]
expect anything here?
Maybe some of these refusers just want—hypothetically, of course, and directed to no one in particular, certainly no one in this thread!—their bitchy doctors to know that they can’t call all the shots and that they can take their fancy diplomas and shove it up their asses?