Doctor's order's

decky1 · 20-12-2018 8:18pm #1

If for some reason a wife was suffering from a serious illness and did'nt tell her husband would the doctor be able to tell the husband or is this covered by patient doctor code?

Edgware · 20-12-2018 10:28pm

decky1 wrote: »

If for some reason a wife was suffering from a serious illness and did'nt tell her husband would the doctor be able to tell the husband or is this covered by patient doctor code?

Strictly doctor patient code. If it's a long standing family doctor he/she could encourage dialogue but the finer details are strictly confidential

sullivlo · 20-12-2018 10:57pm

Is it the same case if the husband is at risk? For example, say a wife tested positive for HIV. If the GP was the doctor for both the wife and the husband, could they break confidentiality to protect the husband from contracting it?

MadDog76 · 20-12-2018 11:35pm

sullivlo wrote: »

Is it the same case if the husband is at risk? For example, say a wife tested positive for HIV. If the GP was the doctor for both the wife and the husband, could they break confidentiality to protect the husband from contracting it?

No

Kevin Finnerty · 20-12-2018 11:38pm

MadDog76 wrote: »

No

Then that's wrong imo. He has a right to know.

One eyed Jack · 21-12-2018 12:02am

decky1 wrote: »

If for some reason a wife was suffering from a serious illness and did'nt tell her husband would the doctor be able to tell the husband or is this covered by patient doctor code?

I don’t think that’s what’s generally meant by doctors orders, but then a quick google of the term “doctors orders” turns up advertisements for cannabis, and I’m pretty sure that’s not what doctors orders means either :pac:

decky1 · 22-12-2018 12:15am

One eyed Jack wrote: »

I don’t think that’s what’s generally meant by doctors orders, but then a quick google of the term “doctors orders” turns up advertisements for cannabis, and I’m pretty sure that’s not what doctors orders means either :pac:

WTF I think you could do with a doctor:cool::D

Mrs OBumble · 22-12-2018 12:30am

Kevin Finnerty wrote: »

Then that's wrong imo. He has a right to know.

So does the postman.

Gael23 · 22-12-2018 8:31am

sullivlo wrote: »

Is it the same case if the husband is at risk? For example, say a wife tested positive for HIV. If the GP was the doctor for both the wife and the husband, could they break confidentiality to protect the husband from contracting it?

I believe they can in a case where another person is at risk. They have a duty to protect that person as well as their patient.

Loveinapril · 22-12-2018 8:44am

Your wife is a grown woman so whatever her health issues, they are between her and her doctor. If she decides not to tell people, that's her business.

facehugger99 · 22-12-2018 8:50am

decky1 wrote: »

If for some reason a wife was suffering from a serious illness and did'nt tell her husband would the doctor be able to tell the husband or is this covered by patient doctor code?

Do you have a STD?

sullivlo · 22-12-2018 10:14am

Gael23 wrote: »

I believe they can in a case where another person is at risk. They have a duty to protect that person as well as their patient.

That’s my question... surely they have a duty of care to all of their patients. First do no harm etc.

22-12-2018 10:16am

MadDog76 wrote: »

No

no to which question? no it's not the same or no they can't break confidentiality?

decky1 · 22-12-2018 5:22pm

facehugger99 wrote: »

Do you have a STD?

not unless i've picked it up off my hand.:rolleyes::D:eek:

MadDog76 · 23-12-2018 10:24am

bluewolf wrote: »

no to which question? no it's not the same or no they can't break confidentiality?

Confidentiality, obviously.

seamus · 23-12-2018 12:09pm

Gael23 wrote: »

I believe they can in a case where another person is at risk. They have a duty to protect that person as well as their patient.

They can only do it where a vulnerable person is at risk.

In the case outlined, no a doctoe cannot break confidentiality to let a wife know her husband is HIV+, or vice-versa.

His duty in this respect is to urge both partners to use protection and try encourage the sick partner to tell the other.

23-12-2018 1:04pm

Isn't it illegal to sleep with someone if you have HIV without notifying them?

Surely if that's the case, the doctor can't just let a person go spreading HIV?

Gael23 · 23-12-2018 1:18pm

seamus wrote: »

They can only do it where a vulnerable person is at risk.

In the case outlined, no a doctoe cannot break confidentiality to let a wife know her husband is HIV+, or vice-versa.

His duty in this respect is to urge both partners to use protection and try encourage the sick partner to tell the other.

Would he not have to test said wife for HIV and provide appropriate treatment to her if she had contracted it.

thomasdylan · 23-12-2018 2:38pm

seamus wrote: »

They can only do it where a vulnerable person is at risk.

In the case outlined, no a doctoe cannot break confidentiality to let a wife know her husband is HIV+, or vice-versa.

His duty in this respect is to urge both partners to use protection and try encourage the sick partner to tell the other.

I think in practice what would happen is the HIV positive person is given an opportunity to tell their partner of their diagnosis otherwise the doctor will advise her that she needs to be tested. In this case there is an ethical duty to breach confidentiality. Having said that this is an issue which causes a lot of debate and there aren't any guidelines in place here or in the UK (or if they are I've missed them.

YFlyer · 23-12-2018 2:47pm

A person with HIV having sex with another should be done for GBH.

igCorcaigh · 23-12-2018 2:54pm

Gael23 wrote: »

I believe they can in a case where another person is at risk. They have a duty to protect that person as well as their patient.

Everyone has a duty to protect themselves, that's why people should use protection. It's personal responsibility. I don't think people should be jailed for having sex, or their confidentiality broken by a doctor.

igCorcaigh · 23-12-2018 2:55pm

Gael23 wrote: »

I believe they can in a case where another person is at risk. They have a duty to protect that person as well as their patient.

Everyone has a duty to protect themselves, that's why people should use protection. It's personal responsibility. I don't think people should be jailed for having sex, or their confidentiality broken by a doctor.

thomasdylan · 23-12-2018 3:08pm

igCorcaigh wrote: »

Everyone has a duty to protect themselves, that's why people should use protection. It's personal responsibility. I don't think people should be jailed for having sex, or their confidentiality broken by a doctor.

Say for example, if someone is newly diagnosed with HIV and has a long term partner who they are sexually active with, the partner shouldn't be notified by the doctor if the patient refuses to do so?

igCorcaigh · 23-12-2018 3:16pm

thomasdylan wrote: »

Say for example, if someone is newly diagnosed with HIV and has a long term partner who they are sexually active with, the partner shouldn't be notified by the doctor if the patient refuses to do so?

I don't think so, but the patient should be encouraged to do so. It's a huge betrayal of trust of course, if they don't.

Paddy Cow · 23-12-2018 3:23pm

sullivlo wrote: »

Is it the same case if the husband is at risk? For example, say a wife tested positive for HIV. If the GP was the doctor for both the wife and the husband, could they break confidentiality to protect the husband from contracting it?

I know that in many states in the US you can go to jail for sleeping with someone when you have HIV and you don't tell them beforehand. I'm not sure about Ireland. I think it's a grey area. The doctor though wouldn't be responsible for alerting partners. That would be breaking confidentiality.

thomasdylan · 23-12-2018 3:26pm

igCorcaigh wrote: »

I don't think so, but the patient should be encouraged to do so. It's a huge betrayal of trust of course, if they don't.

The person with HIVs partner's health is more important than confidentiality in this case, for me.

If a patient has epilepsy and are driving a HGV, should a doctor break confidentiality and inform the RSA?

thomasdylan · 23-12-2018 3:29pm

Paddy Cow wrote: »

I know that in many states in the US you can go to jail for sleeping with someone when you have HIV and you don't tell them beforehand. I'm not sure about Ireland. I think it's a grey area. The doctor though wouldn't be responsible for alerting partners. That would be breaking confidentiality.

There are situations where patient confidentiality can be broken and this could be one.

Gael23 · 23-12-2018 3:29pm

thomasdylan wrote: »

The person with HIVs partner's health is more important than confidentiality in this case, for me.

If a patient has epilepsy and are driving a HGV, should a doctor break confidentiality and inform the RSA?

Point one, yes it’s a public health issue so they have to act accordingly. Obviously on a need to know basis and I imagine sparing finer details.

Point two, usually for those sort of jobs you need to undergo a medical where it would be disclosed.

igCorcaigh · 23-12-2018 3:30pm

thomasdylan wrote: »

The person with HIVs partner's health is more important than confidentiality in this case, for me.

If a patient has epilepsy and are driving a HGV, should a doctor break confidentiality and inform the RSA?

Hmm... I guess the difference is that the patient's partner has decided to not use protection on the basis of trust, which has unknowingly to them been broken.

Road users are not in any relation of trust with the HGV driver, who is in any case licensed by an authority.

igCorcaigh · 23-12-2018 3:31pm

thomasdylan wrote: »

There are situations where patient confidentiality can be broken and this could be one.

Legally? Can or should?

Martina1991 · 23-12-2018 3:33pm

thomasdylan wrote:

Say for example, if someone is newly diagnosed with HIV and has a long term partner who they are sexually active with, the partner shouldn't be notified by the doctor if the patient refuses to do so?

How would a doctor contact a patient's partner or anyone else they've had unprotected sex with?

Take any infectious disease or STD. The person diagnosed has the responsibility to inform all partners effected, not the doctor.

Kirby · 23-12-2018 3:40pm

Martina1991 wrote: »

How would a doctor contact a patient's partner or anyone else they've had unprotected sex with?

Take any infectious disease or STD. The person diagnosed has the responsibility to inform all partners effected, not the doctor.

There are plenty of infectious diseases where they lock you up in quarintine to protect other people. Your own rights are secondary when you are a public health risk. The responsibility is not on the patient, it's on the doctors who will call in an infectious disease unit to handle it.

HIV is not airborne like in the above example but still, sleeping with somebody without informing them is not a "breach of trust" as it was so delicately put by somebody else in the thread. It's assault. You are knowingly passing on a potentially fatal and certainly life altering illness.

igCorcaigh · 23-12-2018 3:43pm

Kirby wrote: »

You are knowingly passing on a potentially fatal and certainly life altering illness.

The other partner is also knowingly taking a risk by not using protection. It's not an assault.

Rachiee · 23-12-2018 3:46pm

Assume everyone you sleep with its riddled and you won't have a problem, if you have a partner who you trust dearly and they say they've only had one previous partner and have no stds, you should both go get the all clear together before moving to unprotected sex. you might trust your parter but do you trust your partners ex?

Incidentally if someone is has an undetectable viral load ( easily achieved with today's medications) they cannot pass on the virus even through unprotected sex

thomasdylan · 23-12-2018 3:46pm

Martina1991 wrote: »

How would a doctor contact a patient's partner or anyone else they've had unprotected sex with?

Take any infectious disease or STD. The person diagnosed has the responsibility to inform all partners effected, not the doctor.

Person presents with cough, weight loss to ED, CXR suggestive PCP, HIV test positive, CD4 count 20. Person admitted to hospital, person says they have long term partner/spouse but has also had unprotected sex with prostitutes which is where they think they picked it up. Partner is frequently attending patient in hospital, patient says they don't want their partner to know diagnosis and will not tell them even though they have always had unprotected sex. Is there an ethical obligation to inform the patient's partner?

thomasdylan · 23-12-2018 3:52pm

igCorcaigh wrote: »

The other partner is also knowingly taking a risk by not using protection. It's not an assault.

People with HIV who've deliberately spread HIV to sexual partners have been convicted of assault and GBH in the UK.

Paddy Cow · 23-12-2018 3:55pm

thomasdylan wrote: »

There are situations where patient confidentiality can be broken and this could be one.

I think a doctor can advise their patient to tell any potential partners they are HIV positive but legally I don't see how they could contact them.

Martina1991 · 23-12-2018 4:02pm

thomasdylan wrote:

Person presents with cough, weight loss to ED, CXR suggestive PCP, HIV test positive, CD4 count 20. Person admitted to hospital, person says they have long term partner/spouse but has also had unprotected sex with prostitutes which is where they think they picked it up. Partner is frequently attending patient in hospital, patient says they don't want their partner to know diagnosis and will not tell them even though they have always had unprotected sex. Is there an ethical obligation to inform the patient's partner?

If your long term partner was in hospital and they refused to tell you what was wrong with them wouldnt that raise suspicion.

What about the ethical obligation to inform the prostitutes that may be effected, to use your example.

thomasdylan · 23-12-2018 4:17pm

Martina1991 wrote: »

If your long term partner was in hospital and they refused to tell you what was wrong with them wouldnt that raise suspicion.

What about the ethical obligation to inform the prostitutes that may be effected, to use your example.

PCP is AIDS associated pneumonia, patient probably tells partner they are being treated for pneumonia which is true.

Certainly the prostitutes should be informed that a client of there has been diagnosed with HIV. The client doesn't have to be named and there is no breach of confidentiality. The difficulty here is tracking/contacting the prostitutes.

I've answered your questions but you didn't answer mine. There aren't really an guidelines for this kind of stuff, there's lots of disagreement over this stuff in the UK. For me, in the hypothetical situation I mentioned, you have someone who has knowingly been exposed to a very treatable illness who is unaware of this and her condition will progress without treatment. I'm sure lots of people will disagree though.

Martina1991 · 23-12-2018 4:29pm

I still believe the doctor should obey doctor patient confidentiality and urge their patient to inform any other party effected.

igCorcaigh · 23-12-2018 4:34pm

thomasdylan wrote: »

PCP is AIDS associated pneumonia, patient probably tells partner they are being treated for pneumonia which is true.

Certainly the prostitutes should be informed that a client of there has been diagnosed with HIV. The client doesn't have to be named and there is no breach of confidentiality. The difficulty here is tracking/contacting the prostitutes.

I've answered your questions but you didn't answer mine. There aren't really an guidelines for this kind of stuff, there's lots of disagreement over this stuff in the UK. For me, in the hypothetical situation I mentioned, you have someone who has knowingly been exposed to a very treatable illness who is unaware of this and her condition will progress without treatment. I'm sure lots of people will disagree though.

I can sympathise with your point here.

One thing to take into consideration though, is what effect will a change in the law have. Will people be less inclined to have a HIV test if they know that the result could be disclosed to other people?

decky1 · 24-12-2018 2:28pm

lots of talk there about std what if it was Cancer?

Miike · 24-12-2018 2:33pm

decky1 wrote: »

lots of talk there about std what if it was Cancer?

Then a doctor has no right to break the patients confidentiality, it's cut and dry. The choice comes down to the patient to inform whoever they deem necessary.

MadDog76 · 24-12-2018 2:35pm

decky1 wrote: »

lots of talk there about std what if it was Cancer?

Cancer isn't contagious......

Gael23 · 24-12-2018 3:01pm

Miike wrote: »

Then a doctor has no right to break the patients confidentiality, it's cut and dry. The choice comes down to the patient to inform whoever they deem necessary.

Cancer poses no risk to anyone else. The only reason there might be in a case where a patient had a career, then they would need to know in order to do their job properly.

Doctor's order's

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