Sharing information about a patient’s HIV status
Sharing information with the GP
A patient refuses to have his HIV status revealed to his general practitioner
Background
Jonathan visits a GUM clinic to be treated for anogenital warts. As a new patient he’s offered some standard tests for chlamydia, gonorrhoea, syphilis and HIV. His HIV test comes back positive.
Dr Biggs reassures Jonathan and arranges a follow-up appointment to discuss confirmatory testing, treatment, partner notification and the risks and medico-legal issues around onward transmission.
Scenario
Jonathan immediately expresses anxiety about his privacy. He explains to Dr Biggs that a friend suffered discrimination after accidental disclosure of their HIV status.
Jonathan also doesn’t get on well with his GP is afraid the GP will discriminate against him and disclose his HIV status to others in the practice. Whilst he’s open to partner notification, he says he does not want his GP informed of his diagnosis.
What should the doctor do?
- Accept Jonathan’s decision?
- Try to convince Jonathan to change his mind by reassuring him of why the GP needs to know about the diagnosis but ultimately respect Jonathan’s decision?
- Inform Jonathan that he’s duty-bound to inform the GP because the GP needs to know to provide safe, effective care and to keep themselves and their clinical colleagues safe?
Sharing information with the surgical team
A patient does not want his HIV status revealed to the surgical team carrying out knee surgery
Background
Two years on from his HIV diagnosis, Jonathan visits Dr Briggs again. He is responding well to treatment and his HIV viral load is undetectable. He mentions that he is having knee surgery but he still hasn’t shared his diagnosis with his GP, so the surgeon has not been told.
Scenario
Jonathan tells Dr Briggs that the operation is being paid for by his work’s private health insurance and he doesn’t want his diagnosis getting back to them.
Dr Biggs knows that surgeons sometimes take additional precautions with ‘high risk’ patients like double-gloving or putting them at the end of surgical lists. But he also knows the surgical team should be taking ‘universal precautions’, as any patient could have a blood-borne virus.
Jonathan notices Dr Biggs hesitation and says he’ll complain if his confidentiality is breached. He says that if there’s a needlestick injury, he promises to disclose his HIV status.
What should the doctor do?
- Accept Jonathan’s decision not to disclose his HIV status to the surgeon?
- Explain that he must inform the surgeon with or without Jonathan’s consent, to protect them and their team from the risk of infection?
- Contact the surgeon and say that a patient with a blood-borne virus is booked in on that date but not say who it is?
