excellent answer barry
tom

On Fri, 27 Jun 2008 14:50:10 +0100
  [log in to unmask] wrote:
> [log in to unmask] wrote:
>> Colleagues,
>> 
>> I have just dealt with a complaint surrounding our 
>>management of a
>> patient who had a needlestick injury from a known HIV 
>>positive source.
>> The clinical management is not questioned but the 
>>patient is unhappy
>> that a letter was sent to the GP informing them 
>>explicitly that the
>> patient had had a needlestick injury from a HIV positive 
>>source.
>> 
>> The patient feels that this was a breach of their 
>>confidentiality
> 
> 
> Surely this is a misunderstanding by the patient of 
>"confidentiality", as the information is in confidence 
>when it goes to the GP ... that is the GP is also bound 
>by professional confidence.
> 
> However, if the patient is that concerned about the 
>issue, perhaps a way forward for these cases is to 
>re-direct the GP letter to GUMed, refer the patient 
>(after any immediate E.Dept. interventions) to GUMed, and 
>write-up the rationale in the E.D. notes accordingly?.
> 
> Since GUMed records are 'sealed' by statute law, this 
>might provide the level of "secrecy" (rather than 
>"confidentiality") the patient desires.
> 
>> and
>> also will result in future prejudice when applying for 
>>life/health
>> insurance.
>> 
> 
> Surely this wouldn't apply. If he tests negative for 
>BBV's as a result of this, it shouldn't count against 
>him. If he tested positive, it would be a material fact 
>that he'd need to disclose anyway as part of his 
>application else he may well void the policy.
> 
>> I have explained that we are supposed to inform the GP 
>>of all
>> attendances within 48 hours but the patient feels this 
>>blanket approach
>> is wrong and we should inform each patient that this 
>>will be happening
>> and get their consent for it, or at least in 'sensitive' 
>>cases.
>> 
> 
> Was the incident felt high-risk enough to warrant 
>administration of HIV PEP? It would seem likely so, if it 
>was a high-risk innoculation from a known HIV +ve source. 
>If so, given the high incidence of side effects of HIV 
>PEP, is he planning on not involving his GP if he needs 
>advice on dealing with a side effect? - it is a pretty 
>noxious mix to take.
> 
>> 
>> I think this brings up some interesting issues around 
>>consent,
>> confidentiality and information sharing and wonder if 
>>anyone else has
>> had any similar experience or even better decided upon a 
>>solution.
>> 
> 
> I understand there is a move away from seeing HIV as a 
>'different case' or 'more stigmatising' disease, 
>especially with the increased long term survival with 
>HAART. Should there be a different policy for "sensitive" 
>cases, or should we try to not see HIV and other such 
>pathogens as "different cases", and push that "health is 
>health" - if the issue is trust in his GP rather than his 
>insurance concerns, then if he doesn't trust his GP then 
>perhaps he ought to be changing GP?.
> 
> If the issue is purely regarding insurance - then (as 
>above) it should only matter if he tests +ve for a BBV, 
>and then he would need to disclose this anyway.
> 
> If this is put to the patient (role for an information 
>leaflet?), I'd hope many patients would not be averse to 
>their GP being informed, and the GUM route with careful 
>write up in E.D notes would provide a back-up for those 
>who were still concerned about secrecy.
> 
> Turning the issue around, does the patient understand 
>and accept the risks to him of his GP not being informed 
>of matters relating to his health and care?.
> 
>> Simon McCormick
>> 
> 
> Regards,
> Barry Salkin.
> Locum Consultant, Medical Microbiology. 


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