A tragic experience of a friend leads me to post this.
After 4 years of university, another 4 of med school, 7 years in surgical residency, and 2 more doing cardiothoracic fellowship (17 years total!), he finally became the surgeon he always wanted to be. Soon thereafter, he got poked with a very big needle while closing the chest of a Hepatitis B infected patient. He sadly contracted the disease, and due to the rather restrictive laws in his state, is required to disclose this to all his potential future patients. Which effectively and sadly puts an abrupt end to a hard-earned and selfless career.
Doctors are expected to take care of all patients - often putting their own welfare at great risk - whether those patients have Hep B / Hep C/ HIV. Yet patients are never required to disclose their own status. So thus the question - why then should doctors be required to do so?
Sure, one can argue that doctors should be held to a higher standard because they encounter so many individuals. But should this justify the violation of personal privacy rights, not to mention a career?
Straight from the American College of Surgeons - http://www.facs.org/fellows_info/statements/st-22.html
Hepatitis B virus (HBV) and hepatitis C virus (HCV) are more efficiently transmitted blood-borne pathogens than HIV in the health care setting. An estimated 1.25 million people in the U.S. have chronic HBV infection, and more than 4 million have chronic HCV infection. Transmission of these infections to health care workers continues to occur, and approximately 250 health care workers die annually from chronic HBV infection alone.
Medical professionals are trained to assume that *everyone *has hepatitis. Not in our treatment, but in our safety precautions. There’s nothing more to be gained by forcing patients to disclose this information, because we already use every precaution we would if we knew for sure you had it. Universal precautions, we call it. It reduces hepatitis transmission, but things like needle sticks still happen, and it’s a risk you assume when you go into a field involving direct patient care.
You also, if you have a brain in your head, get vaccinated for Hep B before nursing/med school, and you get blood tests to make sure your body has formed enough antibodies to probably protect you against infection later on, and if it hasn’t, you get the vaccine again. It’s still not 100% protection though, so the risk is still real.
Now, that being said, it would be a damn good idea for people to disclose that information for their *own *sake, so that we can try to avoid drugs that cause liver damage or modify doses to account for a less than stellar liver, but that’s another issue entirely.
Why should we disclose to patients? Because they’re not trained to assume their healthcare workers have hepatitis, and have not chosen to assume that risk. While the vaccine is strongly recommended for children, it is not mandatory in every state and lots of older people haven’t had it. The tests to find out if you’ve had a good immune response are not something that most people do. So a random patient is more at risk than most doctors are, and has not knowingly assumed an increased risk, until the doctor tells him his Hep B status and the patient agrees to be treated by him anyway.
Yes, he should be required to disclose that he has the disease. The fact that he was infected by accident while working shows exactly why that should be the case. It sucks to be him, but pity isn’t going to make the disease any less of a hazard.
The obvious problem with requiring patients to disclose their disease is that a surgeon is sometimes going to deal with people who can’t, who have fallen unconscious due to injury or the sudden onset of some other disease and thus prompting their visit to the hospital in the first place.
Where do they let you get so far in a medical education without the Hep B vaccination? It would very difficult to get clinical placements to learn Physical Therapy without proof of vaccination.
Yes, unfortunately that was exactly what happened. The Hep B vaccine is not completely effective, and last I checked there’s no vaccine for Hep C and HIV.
And even with universal precaution, gloves offer only limited protection from needle sticks.
The risks of transmission from patient to doctor are vastly higher than the other way around. Health care workers are much more likely to get poked by a needle contaminated with a patient’s blood, than the other way around.