The purpose in reporting illnesses is epidemiological in an attempt to interrupt the spread of certain communicable diseases. Reportable illnesses include AIDS, syphilis, tuberculosis, gonorrhea, and all childhood diseases such as measles, mumps, rubella, and pertussis.
Because of the social stigma associated with HIV, there is an additional layer of confidentiality and consent required. When a patient signs a release to distribute or transmit
medical information, there is an additional consent required for HIV or AIDS-related information.
Physicians are legally protected in providing partner notification. The Department of Health takes charge of contact-tracing events and notifies those who have been in close contact with the source. The name of the source patient is always protected.
The Health Department can incarcerate patients with tuberculosis to prevent the spread of this disease, but such incarceration is not part of the judicial system and takes place at a hospital as a last resource to protect the public.
If a patient avoids disclosure to his or her partner, the physician must follow his/her duty to report to protect the innocent third party.
Gunshot Wounds
Reporting of gunshot wounds is mandatory, in pursuit of a criminal investigation, and despite a victim’s objection. Safety of society takes precedence over patient privacy.
Q16 You have a pregnant HIV-positive patient in your office and ask her if she has informed her partner of her HIV status. In the past she had repeatedly resisted your attempts to inform the partner. Now she’s pregnant with his child, sitting in the waiting room, and you have met him in the past?
What should you do?
A-respect for confidentiality
B-the refer patient to another physician
C- inform the partner immediately
D-respect the patient’s confidentiality.
Q17A 26-year-old female is admitted to the hospital with irritability, severe headache, stiff neck and photophobia and mental status remains intact. Tests reveal Toxoplasmosis encephalitis cryptococcal an infection associated with HIV infection. Patient adamantly refuses to be tested for HIV.
How should you proceed in this case?
A-HIV testing despite the patient’s refusal is a matter of public safety.
B-Avoid testing for HIV, as for any other medical procedure, testing should be done only with the informed consent of the patient.
C-Test the patient for HIV anonymously, without any identifying remarks.
D-Report the patient’s toxoplasmosis to the Public Health Department
Q18 A 32-year-old man with AIDS is an active intravenous drug user. He keeps all his clinic appointments. He admits that he is unable to take his medications regularly when using drugs. He is asking your opinion on antiretroviral therapy with protease inhibitors. You recall that HIV viral resistance to protease inhibitors occurs when patients do not take their medications as directed.
Should you consider prescribing protease inhibitors to this patient?
A-Yes because the patient wants the protease inhibitors.
B-No because resistance is a real concern in a patient who cannot take his medicines timely.
C- No because the patient is continuing to use heroin and cocaine.
D- Yes, because the doctor is under a duty not to abandon the patient and to continue an ongoing therapeutic relationship. Patient must be provided with continued guidance and information about his HIV disease and issues of addiction.
