Duty to warn those at risk vs confidentiality

[tg78]

If the wife of your patient calls to ask if her husband has an STD (which he does), do you tell her to see her gynecologist or do you tell her you cant break his confidentiality?

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[Idiopathic]

Cant break it. Tell her to develop a better relationship with her husband.

 

[mountaindew2006]

I initially thought that was the answer. However, i thought I read somewhere (HY or qbank) that the MD should tell the pt to tell his sexual partners about his STD. If the pt fails to do so, and its someone who is AT risk of getting his STD (ie his wife), the MD needs to intervene and tell the wife for her own sake.

 

[Idiopathic]

Dunno....This obviously doesnt fall under Tarasoff (unless someone confesses their plan to spread said STD), and unless we are talking about HIV (each state is different), I still dont think you tell the partner without exhausting every option to convince the patient to do so.

EVEN THEN, I am not sure I would tell the partner (for test purposes).

 

[imtiaz]

I initially thought that was the answer. However, i thought I read somewhere (HY or qbank) that the MD should tell the pt to tell his sexual partners about his STD. If the pt fails to do so, and its someone who is AT risk of getting his STD (ie his wife), the MD needs to intervene and tell the wife for her own sake.

yep, you tell her. you can't let him infect her, especially if he has HIV.

 

[daisygirl]

I may be wrong here so correct me if that is the case.... Anyhow, I remember learning in the medical ethics class (spans two years) that you are to report HIV to the local health department, which in turn contacts those who have sexual relations with the patient in question in order to divulge that they are at risk of contracting HIV.

 

[chef]

HIPAA states:

Uses and Disclosures: The Chance to Agree or Object is Not Necessary:

Under HIPAA, a health provider may make certain disclosures without obtaining any permission from an individual. These uses and disclosures are ones that either are required or permitted under federal, state or local law.

However, because the individual does not generally have an opportunity to control or restrict these disclosures, the individual has the right to be informed about these disclosures through an ?accounting? or official log.

These situations include uses and disclosures for public health activities, including, but not limited to:

? surveillance; investigations; tracking FDA-regulated products; reporting adverse events; reporting vital events; workplace health surveillance

? reports of child abuse or neglect

? notification of a person who may have been exposed to a communicable disease

? disclosures about adult victims of abuse, neglect, or domestic violence, subject to certain restrictions and requirements

 

[imtiaz]

I may be wrong here so correct me if that is the case.... Anyhow, I remember learning in the medical ethics class (spans two years) that you are to report HIV to the local health department, which in turn contacts those who have sexual relations with the patient in question in order to divulge that they are at risk of contracting HIV.

i think each state is different but i was under the impression that you only report AIDS (not HIV) to the health department (remember that mnemonic in FA? B A SSSMMART Chicken or you're Gone). there were some qbank questions about it as well.

 

[gioia]

Couldn't you just say that it is always a good idea to check w/ your gyno if you suspect something about your partner, thereby avoiding the confidentiality issue? Obviously she is concerned and suspicious enough to call the office.

 

[Idiopathic]

You do not report HIV, only AIDS.

I still am not on board with whether or not you tell the spouse though...remember, the NBME is not HIPAA...

 

[daisygirl]

You do not report HIV, only AIDS.

I still am not on board with whether or not you tell the spouse though...remember, the NBME is not HIPAA...

http://www.health.state.ny.us/nysdoh/hivaids/hivpartner/intro.htm
In NY state you do report HIV, as well as AIDS, to the health department. I looked for the link since I really did remember learning this. With respect to partner notification, I'm not sure yet since I did not thoroughly read the link (and I should be reading about fungi right now....)

 

[jakstat33]

From Fadem (BRS Behav Science), 3rd Edition, pg 220

"Doctors are not required to maintain confidentiality when an HIV-positive patient habitually puts another person at risk by engaging in unprotected sex" (cites Tarascoff)

You do not report HIV, only AIDS.

I still am not on board with whether or not you tell the spouse though...remember, the NBME is not HIPAA...

 

[RonaldColeman]

Perhaps it matters which STD we are talking about? If patient has HIV you definitely tell the partner if the HIV patient won't. I just finished reading a book called Clinical Ethics, and this was a case study. If there is a credible threat to someone's life, you tell that person.

what do you guys think about curable STDs, though?

 

[jakstat33]

According to the Tarascoff decision, patients infected with curable STDs would still be putting others at "risk"... so I would tell the partner

I guess we need to define "risk". Are we talking life-threatening risk? Or just some discomfort?

Perhaps it matters which STD we are talking about? If patient has HIV you definitely tell the partner if the HIV patient won't. I just finished reading a book called Clinical Ethics, and this was a case study. If there is a credible threat to someone's life, you tell that person.

what do you guys think about curable STDs, though?

 

[Idiopathic]

I think Tarasoff is pretty specific about intent to do harm though. Like, you wouldnt notify authorities if a guy had an STD but had a celibate relationship, right? Like a guy threatens to kill his co-workers, and spells the threat out clearly to his shrink...that falls under Tarasoff.

As far as HIV reporting, you do not report HIV unless you get the choice 'depends on the state you live in'...I did get a similar question dealing with age of consent for abortion...it is good to know that many of these laws differ from state to state. If they ask about reportable diseases on a grand scale (i.e. CDC) then HIV is not reported.

As far as the telling of the spouse, I am glad I didnt get that question, because I certainly would have gotten it wrong...I did see an awful one about a 14-year old who wanted to get a tan and wanted advice on what suntan lotion to get...I said we needed to know what her parents thought.

 

[daisygirl]

I think Tarasoff is pretty specific about intent to do harm though. Like, you wouldnt notify authorities if a guy had an STD but had a celibate relationship, right? Like a guy threatens to kill his co-workers, and spells the threat out clearly to his shrink...that falls under Tarasoff.

I agree with this. From what I remember (but my brain is full of amyloid...), we learned that Tarasoff came to be due to some person murdering someone. I cannot remember if a physician knew of the murderer's intended victim, or if the physician reported the looney without having known who the potential victim was. Or, maybe I'm just really wrong about everything I just wrote...

 

[Idiopathic]

Tarasoff does not come up when discussing normal doctor-patient confidentiality, only in extreme cases where someones life is in imminent, premeditated danger.