HIV+ Doctors

ucd_guy

Having a discussion with a mate about needlestick injuries the other day, and we were arguing. If a medical student were to become HIV+, would they be kicked out of college? (He says yes, I say no. What do you say?)

The same question also applies to a HIV+ doctor. Assuming they weren't one of the none procedural specialities - psychiatry, pathology etc - would they be allowed to continue to practice? Would you go to them?

Just interested in other people's points of view....

InFront

I presume it's a similar situation to the HBsAg test youve got to have done for admission into medicine, whereby you have to test nagative for Hepatitis B or you don't get to study. I imagine that if you have HIV, you don't get to practice medicine, or at least partake in any invasive techniques with a patient

Considering how clinical training and invasive techniques are always going to be a requirement for graduation, I don't think such students would be able to graduate.
Maybe the school would offer such a student a degree in medical science after the pre-clinical years or something?

DrIndy

its a very fair point and there is no test case for it yet to see what would happen, the medical school would have to let you finish your degree, but you would then subsequently not be allowed to practise medicine - and you could not even get into other lab disciplines either as you need to do your intern year first.

Quite frightening really. This is an extension of another big problem - if any doctor gets a needlestick and tests positive for any contagious disease, they subsequently lose their job AND there is NO compensation system set up for the occupational injury or retraining for that person by the HSE.

GuanYin

I used to get routine testing, but I did work in an ID environment.

You can get around the intern year as I know at least one case of a candidate being accepted into a PhD program without a completed internship.

DrIndy

True and get the MRCPath through the much more ardurous science route - but it is still a crass injustice.

GuanYin

I think Ireland's laws are more out of date.

That said, they're as bad here, but they'll try phase someone out and get awayway without a lawsuit. Usually though, they'll organise some sort of pay off.

tallaght01

Here in the UK, they're going to start tsting docs who are entering "exposure prone" specialties routinely pretty soon. So, all surgical trainees etc will have to show evidence of a negative HIV test.

Just to put it out there (it's not neccesarily my opinion), does the panel think that if docs have to undergo HIV testing to do invasive procedures, should we have the right to insist the patient undergoes testing before we perform an invasive procedure on them?

InFront

One doctor with HIV is typically a far greater public health threat than one patient with HIV, so no I don't think I'd agree with that. Obviously you need just to be practical about it, I wouldn't have any problem with medics being HIV tested, or tested for any blood borne diseases.

tallaght01

InFront wrote:

One doctor with HIV is typically a far greater public health threat than one patient with HIV, so no I don't think I'd agree with that. QUOTE]

I think the above is a sweeping generalisation. A doctor with HIV isn't neccesarily a greater public health threat than somebody with HIV engaging in high risk behaviour.
If you mean that the doc with HIV is a greater threat within the hospital setting, then you're right. But should it really be an issue of "degree of risk"?...if we were to extend that logic should we maybe only test homosexual males or doctors from sub saharan Africa? As these groups are likely to pose the greatest risk of being HIV positive.

Again, just a thought.

PaddyofNine

This is quite interesting. To be honest if any doctor or intern got sacked or laid off due to a positive HIV status, he or she would have a massive discrimination suit on his hands. I think it's to do with the stigma of HIV - if said doctor was Hepatitis Positive, would they be allowed to carry on working?

Robbiethe3rd

At the same time, you're all assuming the hospital found out, HIV tests are done by codes to ensure confidentiality and the person does not have to disclose their HIV status. So if th hospital were to act by having found out indirectly they would be in even more trouble.

Vorsprung

Robbiethe3rd wrote:

At the same time, you're all assuming the hospital found out, HIV tests are done by codes to ensure confidentiality and the person does not have to disclose their HIV status. So if th hospital were to act by having found out indirectly they would be in even more trouble.

Not necessarily. Confidentiality be be broken in the following cases:

(1) When ordered by a Judge in a Court of Law, or by a Tribunal established
by an Act of the Oireachtas.
(2) When necessary to protect the interests of the patient.
(3) When necessary to protect the welfare of society.
(4) When necessary to safeguard the welfare of another individual or
patient.

Linkage

So if the hospital got hold of the info, it could be reasonably argued that they did so with the interests of patients, and by extension the public at large, at heart. There was a case in Australia a few years ago where a GP didn't tell a patient's partner of his/her HIV (or some other ID) status - he was successfuly sued. Not sure if he was struck off.

InFront

tallaght01 wrote:

InFront wrote:

One doctor with HIV is typically a far greater public health threat than one patient with HIV, so no I don't think I'd agree with that

I think the above is a sweeping generalisation. A doctor with HIV isn't neccesarily a greater public health threat than somebody with HIV engaging in high risk behaviour.
If you mean that the doc with HIV is a greater threat within the hospital setting, then you're right. But should it really be an issue of "degree of risk"?

Yes, I do just mean public health risk within the hospital. I think that would be a very significant public health risk where an HIV +ve Doctor is engaged in invasive clinical procedures. Obviously this goes for nurses as well.

if we were to extend that logic should we maybe only test homosexual males or doctors from sub saharan Africa? As these groups are likely to pose the greatest risk of being HIV positive.

No I just think it's not a bad idea that medics get tested for blood borne diseases like HIV, I'm not really talking about restricting the test to high risks groups in terms of who is likely to have contracted it, but rather test those who are in a position to pass it on to the general public in such a way that the medic could pose a significant public health threat toward his patients. As the X Files said, 'Trust Nobody'.

tallaght01

I'm not sure that a medic performing exposure prone procedure would in fact pose a huge public health "risk", if we define the word in terms of the odds of the doctor passing on the virus to a patient.

Having said that, I'm in favour of as many people being tested for HIV as is possible. Making testing for an incurable disease compulsory amongst a group of people involves opening a huge can of worms, especially when the individual's right to work depends on the results.

If we were going to deal with compulsory testing issues, and the human rights issues that would involve, is it really worth it in this case? I mean, how many of the 40million+ people living with HIV globally are likely to have caught the virus from a doctor during a procedure? The risk of transmission during heterosexual intercourse is said to be anything from 1 in 300 to 1 in 1000, so what would the risk be from a gloved hand?

I do take the point that if a HIV positive surgeon was operating on me, I'd be a little worried if he cut himself and bled into my wide open abdomen though!

But, I am, however, just trying to put the risk into perspective.

wheresthebeef

i remember reading a document from An Bord Altranais (The Nursing Board) about fitness to practice. And a nurse may be struck from the register for having an infectious disease which poses a risk to patients.
The Hospital does have to respect confidentiality for staff as well as patients. I know that in my hospital, i was unable to view my own Hepatitis Titre level results on the lab system as they are locked out to all staff except the Occ. Health Department.

Hivemind187

DrIndy wrote:

its a very fair point and there is no test case for it yet to see what would happen, the medical school would have to let you finish your degree, but you would then subsequently not be allowed to practise medicine - and you could not even get into other lab disciplines either as you need to do your intern year first.

Quite frightening really. This is an extension of another big problem - if any doctor gets a needlestick and tests positive for any contagious disease, they subsequently lose their job AND there is NO compensation system set up for the occupational injury or retraining for that person by the HSE.

Seriously?

Well well well ... so much for enlightened Ireland. I mean from a purely scientific standpoint the risk is of course an ever present one were the doctor (nurse) to be allowed to continue to practice (particularly surgical activity), but to have absolutely nothing in place to protect the healers of the nation should they be infected while in the course of their duty is unforgivable.

Surely there must be Medical -types kicking up a stink about this at some level? Or is the stereo type of god-complex politics in medicine accurate?

Bottle_of_Smoke

tallaght01 wrote:

The risk of transmission during heterosexual intercourse is said to be anything from 1 in 300 to 1 in 1000, so what would the risk be from a gloved hand?

Is this actually true? And does it assume that at least one of the people HIV+?

Just seems unlikely it would have spread so much if the odds were that low. Is sexual transmission the main cause of HIV infections in African countries with high HIV+ rates?

Hivemind187

Bottle_of_Smoke wrote:

And does it assume that at least one of the people HIV+?

I dont know about the rest but ... eh ... its definitely a requirement for one of the people involved in a sexual transmission of HIV to have the virus.

Victor

Can't HIV+ doctors work with HIV+ patients with no huge increase in risk (I reslise HIV has variants)?

Bottle_of_Smoke

Hivemind187 wrote:

I dont know about the rest but ... eh ... its definitely a requirement for one of the people involved in a sexual transmission of HIV to have the virus.

What I mean is, is that statistic saying "the chances of HIV transmission occuring with reguards to Heterosexual intercouse where one participant is HIV+ are between 1/300 & 1/1000"

Or

"The chances of catching HIV from heterosexual intercourse on average with any partner is between 1/300 & 1/1000"

Also is this protected or unprotected sex?

Victor wrote:

Can't HIV+ doctors work with HIV+ patients with no huge increase in risk (I reslise HIV has variants)?

Forgot about this - suppose would be a good idea in countries with high rates of HIV - but it also means the doctor would have to be comfortable with Public knowledge of his infection, thus making it unlikely to be feasible.

tallaght01

The statistics I quoted defnitely involve one person being HIV positive. So if you sleep with somebody who is HIV pos, the risk of catching it is between 1 in 300 and 1 in 1000. Having said that, the risk is higher in some circumstances (for eg rape, or anywhere in which intercourse is traumatic. Also higher risk with anal sex).

The point about HIV spreading so much in Africa, with such low transmissabilty is very interesting. I've struggled with this point for ages. I used to work in Africa and I once spoke to a HIV specialist over there about it. His reply "we have more sex than you white boys". This may be true. Some claim it's statistically true. Certainly where I worked it seemed like it was true!!
BUT, you also have to bear in mind that sexual violence is commoner in Africa than in most places. You are also more likely to catch HIV if you're malnourished, which is obviously a problem in Africa. You're also more likely to catch HIV or pass it on if you have another STD, such as syphilis...this is a problem in Africa where the sex trade is thriving, and there are high levels of other STD's. The prostitutes commonly have both HIV and open sores.
There's a lot of other factors at play, which makes Africans (and most people in poverty throughout the world) more susceptibe to HIV at the individual level than most of us in Ireland, but I don't want to bore any more people than I already have :P

Somebody also mentioned HIV docs working with others who have HIV. There's a HIV positive surgeon in the states who I know of, and he operates on most of their HIV positive patients, so it does happen.

"Surely there must be Medical -types kicking up a stink about this at some level? Or is the stereo type of god-complex politics in medicine accurate?"

Ah, it's been a while since the old "God complex" rubbish reared it's head in here. I would seriously doubt a HIV doc wouldn't be sorted out in some way if they contracted the disease in their line of work, or outwith their work. I can't see how it in any way relates to anybody's God complex.

InFront

tallaght01 wrote:

how many of the 40million+ people living with HIV globally are likely to have caught the virus from a doctor during a procedure? ...But, I am, however, just trying to put the risk into perspective.

That's a fair point, doctor negligence is not a significant factor in the transmission of HIV worldwide. To the same effect, however, nor is alcoholism within the profession a major cause of accidental death in general, but medics are still struck off for it.
The point is that HIV transmission is, in itself, a very different issue to the overall fight against AIDS, insofar as the question relates to medics.

If someone is going to have their hands in any number of orifices and open wounds, they should at least be comfortable with what's going in with them, and hospital managers need similiar assurances as a practical measure in patient safety and, to a certain extent, the hospital's financial security.

tallaght01

InFront wrote:

That's a fair point, doctor negligence is not a significant factor in the transmission of HIV worldwide. To the same effect, however, nor is alcoholism within the profession a major cause of accidental death in general, but medics are still struck off for it.
The point is that HIV transmission is, in itself, a very different issue to the overall fight against AIDS, insofar as the question relates to medics.

If someone is going to have their hands in any number of orifices and open wounds, they should at least be comfortable with what's going in with them, and hospital managers need similiar assurances as a practical measure in patient safety and, to a certain extent, the hospital's financial security.

I think a doctor turning up to work drunk is a far greater danger to patients than a doctor who is HIV positive. This is why I'm talking about putting the risk into perspective, insofar as alcohol abuse WOULD be a major cause of accidental death/morbidity if left unchecked. I don't believe HIV would be. The two aren't comparable.
I've already said I'd be less than comfortable with a HIV positive surgeon operating on me, but I'd prefer it to a drunk surgeon.
The point, however, I was making bout doctors and HIV was that forced testing for HIV in order to continue to work opens up huge can of worms. I was simply arguing that I don't think such an enormous ethically questionable move would be worth the can of worms that it opens. Others, of course, have the right to disagree. I just think we should direct the funding and resources somewhere else where it would make more of a difference.