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Old 09-17-2012
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Default psychiatry question regarding HIV status

A patient in the clinic has a positive HIV test,
fi rst by enzyme-linked immunosorbent assay
antibody assay and then confi rmed by Western
blot. She is married, has three children, and is
sexually active with her husband. After explaining
what the results mean, she is advised that it
is important for the husband to be informed of
these test results. She appears stunned and
frightened by this suggestion. What is the most
appropriate course of action?

(A) Call up the husband and suggest he stop
in for an appointment so that he can be informed
of the results of the test
(B) Contact the public health department and
ask that they inform the husband
(C) Continue persuading the patient of the importance
and necessity of informing her
husband and offer support and resources
to enable her to have this discussion
(D) Send an anonymous letter informing the
husband of the exposure
(E) Tell her that it is illegal for her not to inform
her husband and other sexual contacts
who have been potentially exposed
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Old 09-17-2012
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C...its always a good job to persuade the patient to have an discussion with the significant other.....
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Old 09-17-2012
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Quote:
Originally Posted by K06100 View Post
A patient in the clinic has a positive HIV test,
fi rst by enzyme-linked immunosorbent assay
antibody assay and then confi rmed by Western
blot. She is married, has three children, and is
sexually active with her husband. After explaining
what the results mean, she is advised that it
is important for the husband to be informed of
these test results. She appears stunned and
frightened by this suggestion. What is the most
appropriate course of action?

(A) Call up the husband and suggest he stop
in for an appointment so that he can be informed
of the results of the test
(B) Contact the public health department and
ask that they inform the husband
(C) Continue persuading the patient of the importance
and necessity of informing her
husband and offer support and resources
to enable her to have this discussion
(D) Send an anonymous letter informing the
husband of the exposure
(E) Tell her that it is illegal for her not to inform
her husband and other sexual contacts
who have been potentially exposed
Would go with C, the first step to address these issue is ask, talk & explain to the pt.
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Old 09-17-2012
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(C) Continue persuading the patient of the importance
and necessity of informing her
husband and offer support and resources
to enable her to have this discussion


But just thinking persuading seems kinda unethical.


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Old 09-18-2012
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The correct answer is C. The patient should
be convinced to disclose this information personally
to her husband and the practitioner
should not directly contact the husband; this is
the best way to maintain a trusting and open
doctor-patient relationship. Support should be
made available to the patient so that she can
inform the husband. Disease intervention specialists
or HIV partner counseling and referral
services, operating out of the department of
health, may serve as valuable resources to help
patients contact their partners. These services
vary from state to state, but they can be offered
to patients to facilitate this process.
Answer A is incorrect. Going behind the patient’s
back is inappropriate; however, in some
states there are laws that protect the physician
from legal liability for breach of confi dentiality
if they do inform third parties of HIV exposure.
The physician is protected, however, only after
efforts by the physician have failed to convince
the primary patient to disclose this information
to his or her sexual contacts.
Answer B is incorrect. The ideal situation is
one in which the patient informs her husband,
and so the most appropriate response is to
continue persuading the patient to reveal this
information. However, if the patient does not
feel comfortable revealing this information,
especially in settings of domestic violence, a
public health agency may be asked, with consent
of the patient, to intervene and attempt to
contact the spouse.
Answer D is incorrect. If the patient refuses to
inform her husband, then depending on the
state there might be other avenues by which
sexual partners may be contacted. Sending an
anonymous letter informing the husband of
the exposure, however, would likely damage
the doctor-patient and husband-wife relationships.
Answer E is incorrect. As a rule, partner notifi
cation is confi dential and voluntary. Disease
intervention specialists cannot inform third
parties without the consent of the infected persons.
Contacts are also typically not informed
of the identity of the source.
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