Doctor Had AIDS

[Admiral Valdemar]

I'm trying to remember the article, but I believe a medical council formed by the AMA and CDC stated that doctors, surgeons, nurses and other medical workers weren't obligated to divulge information about whether they were HIV carrier or not. The debate stemmed from Kimberly Bergalis and her death supposedly caused by an AIDS suffering dentist in Florida.

The council ruled that the transmission risks were insignificant and didn't warrant infringing on human rights (I assume they meant on declaring whether you were HIV infected or not).

Apart from that one case, I don't believe there have been any other infections in that field.

[Darth Wong]

I'm trying to remember the article, but I believe a medical council formed by the AMA and CDC stated that doctors, surgeons, nurses and other medical workers weren't obligated to divulge information about whether they were HIV carrier or not. The debate stemmed from Kimberly Bergalis and her death supposedly caused by an AIDS suffering dentist in Florida.

The council ruled that the transmission risks were insignificant and didn't warrant infringing on human rights (I assume they meant on declaring whether you were HIV infected or not).

Apart from that one case, I don't believe there have been any other infections in that field.

This is precisely what's wrong with medical ethics. In engineering ethics, we speak of the engineer's duty to the public welfare vs the engineer's duty to his own welfare. In medical ethics, we speak of the practitioner's "rights". Is the AMA out to protect doctors, or the public?

An engineer is required to proactively disclose any potential risks; a doctor considers it an imposition upon his rights if he has to do so. Mind you, the medical industry, which is estimated to accidentally kill some 70,000 people every year in America and recommend some tens of thousands of unnecessary surgeries every year, obviously has a different standard of ethics than I do.

[Admiral Valdemar]

This is precisely what's wrong with medical ethics. In engineering ethics, we speak of the engineer's duty to the public welfare vs the engineer's duty to his own welfare. In medical ethics, we speak of the practitioner's "rights". Is the AMA out to protect doctors, or the public?

An engineer is required to proactively disclose any potential risks; a doctor considers it an imposition upon his rights if he has to do so. Mind you, the medical industry, which is estimated to accidentally kill some 70,000 people every year in America and recommend some tens of thousands of unnecessary surgeries every year, obviously has a different standard of ethics than I do.

This is still America, don't forget. I'd have to look it up, but I believe it varies in countries. The AMA decision (which was from 2000, I might add) does not rule the BMA or any other nation and their healthcare.

The problem with this is that it's a human rights issue as well as a health issue. From what I can tell, divulging information such as whether you have HIV and have contracted AIDS is not necessary, in the US at least. The risk factor is minute, I have yet to see anything other than the Florida incident and this article which is merely a warning. There are plenty of procedures that are foolproof for surgeons, but I'd personally stress caution on any delicate surgery that may risk bodily fluid contamination from the operator.

It is my view that such conditions should limit doctors, physicians etc. to certain operations and areas, but my view doesn't matter to this council. It's another classic case of "questionable ethics", there have been hysterical outbursts from the media and families who have found a nurse who is HIV positive working with them. That's the sort of thing the AMA is trying to avoid it seems, such irrational (and it is in these cases, the surgeon is different) actions can ruin a person's life without real cause much like the paedophile vigilante groups a few years back in the UK going after numerous false-positives.

But like I said, US healthcare ruling, I'll look into what other Western nations do in this case.

[Kyle]

The problem with this is that it's a human rights issue as well as a health issue. From what I can tell, divulging information such as whether you have HIV and have contracted AIDS is not necessary, in the US at least. The risk factor is minute, I have yet to see anything other than the Florida incident and this article which is merely a warning. There are plenty of procedures that are foolproof for surgeons, but I'd personally stress caution on any delicate surgery that may risk bodily fluid contamination from the operator.

It is my view that such conditions should limit doctors, physicians etc. to certain operations and areas, but my view doesn't matter to this council. It's another classic case of "questionable ethics", there have been hysterical outbursts from the media and families who have found a nurse who is HIV positive working with them. That's the sort of thing the AMA is trying to avoid it seems, such irrational (and it is in these cases, the surgeon is different) actions can ruin a person's life without real cause much like the paedophile vigilante groups a few years back in the UK going after numerous false-positives.

As far as I'm concerned if you're in a medical profession and have a transferrable possibly lethal disease you should not be allowed to work on patients. It doesn't matter if its HIV or some other disease. I don't care how low the risk is, its still there and the patient should know of that risk.

[Admiral Valdemar]

As far as I'm concerned if you're in a medical profession and have a transferrable possibly lethal disease you should not be allowed to work on patients. It doesn't matter if its HIV or some other disease. I don't care how low the risk is, its still there and the patient should know of that risk.

You get into problems then if a nurse catches Flu off someone or MRSA comes into play. You can't have a perfectly clean hospital all the time, people will have a disease they never knew about and pass it on without knowing or even devloping symptoms.

There is still the risk of contracting MRSA which is far higher than any HIV threat and is equally incurable, but no one can stop that. There will always be a risk of death in operating, that's surgery and while every precaution is taken to minimise that threat, shit happens. People have come out of an op perfectly only to catch a disease off another patient in the recovery wing.

[Darth Wong]

You get into problems then if a nurse catches Flu off someone or MRSA comes into play. You can't have a perfectly clean hospital all the time, people will have a disease they never knew about and pass it on without knowing or even devloping symptoms.

And what does that have to do with someone who knowingly has a potentially lethal disease? Can you say "red herring"?

[Admiral Valdemar]

You get into problems then if a nurse catches Flu off someone or MRSA comes into play. You can't have a perfectly clean hospital all the time, people will have a disease they never knew about and pass it on without knowing or even devloping symptoms.

And what does that have to do with someone who knowingly has a potentially lethal disease? Can you say "red herring"?

I was simply replying to the risk thing, there will always be the problem of getting a disease like that off any member of staff without them even knowing it. That's the reason MRSA exists. It's all very well to disclose that one or more people working there may have a lethal pathogen residing in them, but the problems persist.

It is my opinion that people knowingly infected with the likes of HIV stand down from operating anyway.

[Kyle]

You get into problems then if a nurse catches Flu off someone or MRSA comes into play. You can't have a perfectly clean hospital all the time, people will have a disease they never knew about and pass it on without knowing or even devloping symptoms.

I said potentially lethal. Don't try and change the subject, and yes maybe you can't have a perfectly clean hopsital, but you can try and minimize the risk. Doctors operating on patients while infected with a deadly disease that is potentially transferrable is not minimzing those risks.

[/quote]
There is still the risk of contracting MRSA which is far higher than any HIV threat and is equally incurable, but no one can stop that. There will always be a risk of death in operating, that's surgery and while every precaution is taken to minimise that threat, shit happens. People have come out of an op perfectly only to catch a disease off another patient in the recovery wing.[/quote]

I'm not limiting myself to just HIV, thats just what started this thread. As for other causes, thats not important to this thread. Just because youc an get a disease one way does not mean it's OK to let them contract it another way.

It's about minimizing the risks. You seem to be saying that if we can't stop ten people from getting a lethal disease then it's alright to let an additional four get sick as well.

People have died from catching transferrable diseases from there doctor, and you're jsut shruggin it off. As far as I'm concerend thats morally reprehensible. Why don't you have one of your loved ones die because a doctor was infected with a lethal disease and passed it on and see how you feel about this situation.

[Admiral Valdemar]

I said potentially lethal. Don't try and change the subject, and yes maybe you can't have a perfectly clean hopsital, but you can try and minimize the risk. Doctors operating on patients while infected with a deadly disease that is potentially transferrable is not minimzing those risks.

Flu is potentially lethal, in fact, under surgery a great many diseases suddenly become far more efficient, but then that's why surgeries are so clean and undergo numerous hygiene protocols. That same routine is typically applied to the staff, but you can have mishaps.

I'm not limiting myself to just HIV, thats just what started this thread. As for other causes, thats not important to this thread. Just because youc an get a disease one way does not mean it's OK to let them contract it another way.

It's about minimizing the risks. You seem to be saying that if we can't stop ten people from getting a lethal disease then it's alright to let an additional four get sick as well.

No, that's not what I'm saying. I'm simply highlighting a related fault in healthcare and that is hygiene breaks down somewhere along the way. You won't find me condoning anyone with a disease as bad as HIV working in a hospital as a surgeon or similar high risk position.

People have died from catching transferrable diseases from there doctor, and you're jsut shruggin it off. As far as I'm concerend thats morally reprehensible. Why don't you have one of your loved ones die because a doctor was infected with a lethal disease and passed it on and see how you feel about this situation.

Which people? Are we still talking about HIV, because if we are, where's your evidence for that? And I'm not "shrugging it off", if people die from a disease in surgery then it was either known about (in which case the surgeon shouldn't be operating) or was dormant amongst the staff. But every care is taken to ensure no bugs get in that theatre.

And the appeal to emotion fallacy doesn't work. I say again, I don't, that's "do not", condone the use of surgeons with lethal diseases such as HIV doing surgery. That's simply wrong in my book, but so far I have yet to see any major reason for the HIV scare in hospitals, though I'm still looking.

[Admiral Valdemar]

Just thought I'd mention, I just messaged my mother (registered palliative care nurse) and apparently the BMA insists all medical personnel declare their health status. If a surgeon is tested positive for HIV or Hep B (a far more common disease to be concerned about for both the patient and med staff), then the hospital "absorbs" them and protects them and the patient at the same time.

It seems only the US so far has really had a problem in this area.

[Kyle]

OK I did wander of the main point. All I really meant o say was that if a doctor does have some transferrable a lethal disease, such as HIV. Tthey should inform the patient of this fact. Thats really all I was trying to say, but I tend to ramble on.

Yes I was getting too emotional on this subject, I'm sorry about that. I just have a very firm position on this from personal experience. My father died from Hepatis-C contracted from a dentist. I don't want anyone else to have to deal with a similar situation. So I want any precaution that can be made to be made, and I want the patients to be informed of all risks.

[Broomstick]

No. They wear gloves, don't they?

Gloves won't do squat if the doctor accidentally cuts him/herself with the scalpel.

gloves in this case really don't matter all that much, as they are for the doctors protection NOT the patients.

Not entirely true - sterile procedure, including gloves, also prevents spreading infection from patient to patient as well as between patient and doctor. That's why the doctor is supposed to change gloves between each patient.

[Broomstick]

The debate stemmed from Kimberly Bergalis and her death supposedly caused by an AIDS suffering dentist in Florida.

And the dentist in question was found to have been practicing extremely poor (try non-existant) office hygiene, which had a huge impact on transmission. Among his failures were a refusal to wear gloves, neglecting to wash his hands between patients, and using the same tools on multiple patients without sterilization. Most tattoo artists and body piercers I've know have done better than that.

You can't separate a discussion like this from proper sterile techniques - AIDs is not the only slow, lingering death either doctor or patient can catch during a procedure.

Is the AMA out to protect doctors, or the public?

Doctors. They're pretty up front about that, actually. It's the general public that has the mistaken notion they organized the American Medical Association for the benefit of the patient. Nope, it's a trade association and lobbying organization on behalf of MDs - Osteopaths, Chiropractors, and Podiatrists need not apply, and the AMA lost a lawsuit a couple decades ago that accused the AMA of conspiring to put anyone not an MD out of business.

The CDC is, in theory, for the beneift of the public at large, but being an agency of the US Federal government they are vulnerable to political pressures, or at the very least budget-cutting. Since the anthrax attacks in the US their funding has gone up, but while they are very good at epidemiology their public relations skills can be quite lacking.

The CDC's official position is that when proper sterile procedures are followed the risk of transmission from medical worker to patient is extremely low - but not zero. Which is rather like saying when proper engineering techniques are followed buildings tend to stay standing - but the risk of structural failure never entirely goes away. Yet we still live and work in buildings. Where do we draw the line on the medical risk?

HIV has, paradoxically, reduced the number of infections that medical workers either pick up from patients or transmit to patients. The same procedures that block HIV also block the various forms of hepatitis, syphillis and other blood-borne veneral disease, and reduced TB transmission.

Hey, back when I worked for the American Red Cross at a blood donation center no one wore gloves. I routinely handled pints of human blood still warm from the donor. When the bags broke (fortunately a very rare occurance - a pint of blood makes a huge puddle) we cleaned the mess with bare hands and thought nothing of it. That was in 1981 and 1982. Really, not that long ago. When I worked in a clinic in the 1990's it was a constant battle to get people to wash their hands and wear their damn gloves. I think we forget that it was not that long ago people didn't routinely think about gloves and the doctor/nurse/orderly/dentist.

So tell me, Darth Wong, when you take your child to the doctor do you also worry about TB, hepatitis, and possible veneral disease in your child's doctor? Such diseases are transmissible, diagnosis in children is likely to be delayed (except for TB), and untreated can cause a long, lingering, painful, horrible death. Even if it is treated, hepatitis can still result in liver cancer, liver failure, or death. And all of those diseases are actually much more common in the population at large than HIV, at least in North America.

An engineer is required to proactively disclose any potential risks; a doctor considers it an imposition upon his rights if he has to do so. Mind you, the medical industry, which is estimated to accidentally kill some 70,000 people every year in America and recommend some tens of thousands of unnecessary surgeries every year, obviously has a different standard of ethics than I do.

You betcha.

There is a MAJOR difference between medicine and engineering. Sometimes, no matter what a doctor does the patient dies. In some specialties - cancer, for example - it is routine for patients to die (though obviously not desirable) So death is not necessarialy an indication of wrong doing. In engineering, however, if someone gets killed it is usually a strong indication that something went very wrong. (I've been told that the fondest dream of an engineer is to retire and die of old age before anything he builds injures or kills anyone).

But I think, to get back on track, that the original question was - should a doctor with HIV be operating on patients or performing invasive procedures?

My inclincation, as someone who has from time to time been a patient, is to say no. If there was no other alternative I'd choose a doctor with HIV over death, but those situations rarely arise. There are other doctors out there. And there are, in fact, other things doctors can do besides direct patient care. I work with a half dozen MD's who are engaged in medical research, for example, and three of them have not laid hands on a patient for 10+ years. Neither they nor society has to discard their education, or force extensive retraining on them.

A possible exception might be a doctor involved in the care of HIV patients, where the doctor's condition most likely would not increase the risk to the patients, and is a field where such workers are lacking (a shortage of doctors and nurses willing to work with HIV+ patients was, at one time, a serious issue in this country). But I could not condone coercing a general surgeron who contracts HIV accidently into a practice composed of HIV+ patients, even thought I could support banning them from performing invasive procedures.

[Admiral Valdemar]

OK I did wander of the main point. All I really meant o say was that if a doctor does have some transferrable a lethal disease, such as HIV. Tthey should inform the patient of this fact. Thats really all I was trying to say, but I tend to ramble on.

Yes I was getting too emotional on this subject, I'm sorry about that. I just have a very firm position on this from personal experience. My father died from Hepatis-C contracted from a dentist. I don't want anyone else to have to deal with a similar situation. So I want any precaution that can be made to be made, and I want the patients to be informed of all risks.

My condolences, I had an uncle die from cancer and although it's not the same fate as your father's, it did help me choose a career to aid man conquer disease.

Broomstick: Your experience must give you a far better grasp of this situation, I saved myself from commenting on the transmission risks of HIV being higher in blood donors as it strayed too far from the OP and I'd already gone off on a tangent about other medical risks as it was.

But you are absolutely correct, HIV is an Ebola like legend to fear despite it's incredibly low prevalence amongst common people and medical staff in the West. As previously mentioned, Hep B is a far more likely threat to be concerned about, though that doesn't mean the risk of HIV need be discounted, it's just lower on the priority list (other blood borne pathogens can be just as nasty).

This is why I back the BMA strategy of not granting the public access to a doctor's medical records (which are still confidential as are any person's) but also keeping him/her from possible harm with patients, it's helpful for both sides, the doc keeps a good career and the patients don't go apeshit.

Though if anything, the surgeons that work on people regardless of their condition have a tougher life, it may be required to disclose your ailments, but a patient has to be treated as if he/she was an HIV vector given the multiple risks that come with the job in the op-theatre.