Do you inform a patient's wife if pt has STD (against pt consent)?

[Belleza156]

I am a lil confused on the issue of whether or not a physician has the duty to inform a patients wife that their husband, his patient has HIV, or some STD. I know bioethics says beneficence rule takes over here, so you have to tell the wife because she is in danger. Than the actual law states physician-patient confidentiality is required to be upheld so you encourage patient to tell wife, report to health department any necessary infections, but you do not tell the wife w/o permission from the patient. So in the end my question is.......if this issue comes up in Step 1......what is the answer the NBME wants me to give?

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[namethatsmell]

If the pt has HIV, his wife is getting told she needs to get tested whether he likes it or not (mechanisms of how this happens vary by state). End of story. Pretty sure it's against the law for a physician to essentially play a part in keeping a high-risk person from being tested/treated for a potentially fatal disease.

If it's something like gonorrhea you could probably just play to his selfishness and alert him to the fact that he could get re-infected by his wife if she doesn't get treated too.

 

[mmmcdowe]

I am a lil confused on the issue of whether or not a physician has the duty to inform a patients wife that their husband, his patient has HIV, or some STD. I know bioethics says beneficence rule takes over here, so you have to tell the wife because she is in danger. Than the actual law states physician-patient confidentiality is required to be upheld so you encourage patient to tell wife, report to health department any necessary infections, but you do not tell the wife w/o permission from the patient. So in the end my question is.......if this issue comes up in Step 1......what is the answer the NBME wants me to give?

No you do not have the right to inform a wife in the case of most STDs. In the case of HIV, it varies a bit from state to state but essentially you get the contact information of all of the partners the patient has had (assuming you CAN get them) and notify some health organization which sends out notices essentially to people that they have been exposed to HIV. In the case of a monogamous couple, the wife will figure it out. You still can't directly tell her.

 

[alwaysaangel]

I remember that question. I think its in USMLE World.

You do not tell the wife. That is illegal and breaks confidentiality.

If its reportable you report it and leave it to the Public Health of your area to deal with it according to the laws in your state. If its not, you keep your mouth shut and feel bad for her.

 

[Jolie South]

I remember that question. I think its in USMLE World.

You do not tell the wife. That is illegal and breaks confidentiality.

If its reportable you report it and leave it to the Public Health of your area to deal with it according to the laws in your state. If its not, you keep your mouth shut and feel bad for her.

Yea, I think this is correct. Before you get to this point, you strong arm the husband into telling the wife by saying that if he doesn't do it, the health department will tell her she's been exposed. It won't be hard for her to figure it out from that point.

 

[exptherainbow]

I remember that question. I think its in USMLE World.

You do not tell the wife. That is illegal and breaks confidentiality.

If its reportable you report it and leave it to the Public Health of your area to deal with it according to the laws in your state. If its not, you keep your mouth shut and feel bad for her.

That's state dependent, in my state you can inform any sexual partners that a "person they may be having sex with" has HIV. You just can't directly disclose the patient's name. Other reportable STDs (Chlamydia, Gonorrhea, and Syphilis) go to Public Health.

 

[Mr hawkings]

That's state dependent, in my state you can inform any sexual partners that a "person they may be having sex with" has HIV. .

I thought public health did that too and not the physician. At least in my state, we have people who are paid to just make those calls and home visits. They all work for the state and not the hospitals.

 

[Smurfette]

Contact the public health department and find out if there is mandatory reporting for said STD. You can paraphrase the story without identifying the patient at first. If it is reportable, give the patient's name and known partners (wife). Usually they will take it from there; however it is state/municipality dependent. I believe HIV is a required reportable disease in just about every state, as is syphilis; usually gonorrhea and chlamydia are as well.

If having the public health department is not a viable option, a physician is often required by law to make a good faith effort to get the patient to disclose it to his partners or to inform the partners without giving the name of the source patient....find out what the laws are before the wife finds out and comes after you for not telling her and developing complications.

Realistically, on step 1 the options would be pretty obvious as it would likely ask which would you do first (try to convince patient to tell wife and any other partners) and have clearly wrong answers like "immediately tell wife her husband gave her X" and "tell patient you will no treat him until he discloses his STD to all contacts".

 

[seelee]

For the sake of USMLE, if the disease is reportable (not all STDs are but HIV/AIDS is) then you report it to the CDC and they will contact the necessary people.

This is one of the exceptions to the doctor/patient confidentiality agreement.

 

[Belleza156]

Thanks so much for your clarification!

 

[rbnsafsadgf]

For the sake of USMLE, if the disease is reportable (not all STDs are but HIV/AIDS is) then you report it to the CDC and they will contact the necessary people.

This is one of the exceptions to the doctor/patient confidentiality agreement.

Please don't try calling the CDC about the 'clap. You contact your local (or state) public health department.

 

[cpants]

Reporting procedure varies according to state law. Some states have what's called permissive physician reporting, which permits (but does not require) the physician to notify people at risk of contracting the infection. In most states you inform the local health department and they sort it out. In all cases you must encourage the patient to inform the interested parties on his own.

 

[Instatewaiter]

I am a lil confused on the issue of whether or not a physician has the duty to inform a patients wife that their husband, his patient has HIV, or some STD. I know bioethics says beneficence rule takes over here, so you have to tell the wife because she is in danger. Than the actual law states physician-patient confidentiality is required to be upheld so you encourage patient to tell wife, report to health department any necessary infections, but you do not tell the wife w/o permission from the patient. So in the end my question is.......if this issue comes up in Step 1......what is the answer the NBME wants me to give?

While I agree the right "answer" is to contact your health dept, I think you should tell the spouse in the case of HIV. For other STDs, I don't think it's appropriate.

You could make the argument that the infected spouse is intending to harm and potentially kill the uninfected spouse, which you have a duty to report.

 

[MossPoh]

While I agree the right "answer" is to contact your health dept, I think you should tell the spouse in the case of HIV. For other STDs, I don't think it's appropriate.

You could make the argument that the infected spouse is intending to harm and potentially kill the uninfected spouse, which you have a duty to report.

We had a guy come in and talk about this. In Florida at least, you are legally allowed to contact the spouse and say she was exposed to HIV or something life threatening. You also should report it to the health department. The health department is SUPPOSED to hunt down and contact all potential exposures, but I've heard from people who were on the exposed end that it doesn't always happen.

The problem most docs have is that it is really friggin time consuming to do all of that.

 

[CBG23]

silly question, but what information do you give to the public health department when you report a disease? The patient's name and address? What if the patient is homeless and does not have a reliable way of being contacted?