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Old 05-14-2011
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Medicolegal and Ethics His wife does not know that he's HIV Positive!

You are evaluating a new patient that has come to your clinic for management of his HIV infection. He has high CD4 and a low viral load and does not require treatment. He is married and does not practice safe sex with his wife. His wife is unaware or her husband's HIV status-
What is your duty?

a. Encourage discussion between the husband and his wife and strongly suggest he disclose his HIV status to his wife.
b, You must keep his HIV status entirely confidential at all times
c. Have the city Department of Health inform the wife.
d. Send the wife a letter to come to your office because of an "urgent
health issue and then inform her yourself.
e. There is no need for partner notification as long as they are practicing sate sex,
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Old 05-14-2011
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A. Encourage discussion between the husband and his wife and strongly suggest he disclose his HIV status to his wife.
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Old 05-14-2011
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Quote:
Originally Posted by bebix View Post
A. Encourage discussion between the husband and his wife and strongly suggest he disclose his HIV status to his wife.

IT could also be D), patient confidentiality ends when another life is at risk, in the case above, the wife is at risk of contracting the fatal virus.
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Old 05-15-2011
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Default First A then D

It's kind of a tough one... I think I would choose A - this is what you would do first, and HIV is a diagnosis patients are required to share with their sexual partners. You would only tell the sexual partner if you think the patient will not, or if they have not, and while maybe the best way to force that issue would be to call the patient's wife, you'd still give him the chance to be the one to tell her.
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Old 05-15-2011
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Quote:
Originally Posted by Mondoshawan View Post
It's kind of a tough one... I think I would choose A - this is what you would do first, and HIV is a diagnosis patients are required to share with their sexual partners. You would only tell the sexual partner if you think the patient will not, or if they have not, and while maybe the best way to force that issue would be to call the patient's wife, you'd still give him the chance to be the one to tell her.

it's A the right answer indeed , Bravo, I took this question from Kaplan medical ethic 100 cases

but I'm still uncomfortable with this choice, there is another person involved; there is harm for the wife; and how can I be sure that the patient will reveal the truth

the exception of confidentiality is when there is a potential harm to others , and the physician have the duty to warn people at risk (Tarasoff decision)
so I'm still skeptical

How about the duty to report the disease, HIV in this case is a reportable disease, isn't ?
anyone to clear this issue please?
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Old 05-16-2011
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Thumbs Up Discussion first

Discussion and OPEN DIALOGUE are always the first thing to do.
If you feel that its not working, then you could either contact his wife yourself or through the county office.
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  #7  
Old 05-16-2011
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I go with option A.

I believe that the most important point that would allow for a cordial doctor-patient relationship is good communication, which is based on three things:

#1. Discussion
#2. Discussion
#3. Discussion

Rule #3 in Kaplan USMLE medEssential mentions that information [about a diagnosis or health condition] should flow directly through the patient to the family. But, in the case of reportable infectious diseases (including HIV infection), "physicians may take steps to prevent harm" and may have to "warn public officials and identifiable people at risk" (pg 60 of FA 2010 - under exceptions to confidentiality). You may mandatorily have to report this incidence of HIV to your state health dept. (or any equivalent agency); different states have their policy on how infectious diseases should be reported. However, I do not believe that the health dept. should be the one to inform potential individual (s) at risk (choice C).

You must therefore discuss everything possible about HIV transmission with your patient, in layman's terms, and encourage him to directly inform potential person (s) at risk (in this case his wife).

So for instance, if the question further states that the patient refused to tell his wife after his last visit to the clinic (i.e after his physician encouraged him to do so), then I think the physician should call patient's wife to tell her.

I think they wouldn't give a behavioral science case to confuse us, but it's good to always anticipate similar or tougher questions. Thanks for posting!

Last edited by TenderLovingDoc; 05-16-2011 at 08:45 PM.
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Old 05-17-2011
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Step 1 aside, I would go ahead and tell the wife.
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Old 05-17-2011
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My answer to this within a min was C.. after 2 min D.. Am not convinced with 'A'..
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Old 05-17-2011
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Default A

I think a
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