my best pal in med school just told me that she is HBsAg reactive and couldnt pin-point where she's gotten it. Other pertinent infos in her latest blood picture are as follows: A-HBs non-reactive, HBeAg non-reactie, A-HBe reactive, SGPT/SGOT normal. Her dilemma is that she wanted so bad to go on residency training but the thought of the risk that she may put upon her patients and later on jeopardizing her career. i advised her to seek consult from an infectious disease specialist but she has this fear of being talked about & worst, be recomended not to go on residency because of her conditon. i reall pity her. she is caughht between these options: go on residency training without divulging her condition?seek consult & be ready to be talked about & be outcasted from the practice of medicine? or just go on with the field that require minimal patient exposure?....PLEASE HELP!🙁
HBsAg reactive...HELP!
- Thread starter zitti
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First, she need to think real hard about this decision. If she decided to keep it a secret and somehow the lab result comes out after she has infected some patients, there might be a lawsuit involved.
But just as important she needs to think about the health of her patients and co-workers. It is unethical to know you are infected with a transmittable disease and not allow your patients the option of being treated by another doc or be immunized prior to a procedure. How would you feel if your doctor had hep B (or hep C or HIV), knew about it and didn't make you aware of his/her status and subsequently you got infected? You would feel very angry.
No offense to you or your friend but I think she is highly selfish and it upsets me that she is more worried about being "talked about" (which is highly unlikely due to HIPPA) then safety of those around her. Furthermore, your post is a little bit contradictory. How can she be thinking about not doing a residency b/c of the infection but, at the same time be worried about seeing an ID doc due to fear of residency and later career implications?
How big of a deal this infection is also depends on what specialty she wants to go into. Surgery is probably going to be a big problem where psych probably isn't.
If she keeps it a secret and goes onto residency she might have to get tested anyway.
Here are some interesting articles you and 'your friend' should read:
http://query.nytimes.com/gst/fullpage.html?sec=health&res=9F01E0DB153FF93AA25757C0A9649C8B63
http://www.hbvadvocate.org/hepatitis/hepB/HBV_occurisk_FS.html
But just as important she needs to think about the health of her patients and co-workers. It is unethical to know you are infected with a transmittable disease and not allow your patients the option of being treated by another doc or be immunized prior to a procedure. How would you feel if your doctor had hep B (or hep C or HIV), knew about it and didn't make you aware of his/her status and subsequently you got infected? You would feel very angry.
No offense to you or your friend but I think she is highly selfish and it upsets me that she is more worried about being "talked about" (which is highly unlikely due to HIPPA) then safety of those around her. Furthermore, your post is a little bit contradictory. How can she be thinking about not doing a residency b/c of the infection but, at the same time be worried about seeing an ID doc due to fear of residency and later career implications?
How big of a deal this infection is also depends on what specialty she wants to go into. Surgery is probably going to be a big problem where psych probably isn't.
If she keeps it a secret and goes onto residency she might have to get tested anyway.
Here are some interesting articles you and 'your friend' should read:
http://query.nytimes.com/gst/fullpage.html?sec=health&res=9F01E0DB153FF93AA25757C0A9649C8B63
http://www.hbvadvocate.org/hepatitis/hepB/HBV_occurisk_FS.html
thank you, ive found the article most helpful..but let us not judge a person who has the clearest intention of becoming a doctor. besides, it's not even her fault that she became infected, she might have gotten it during clerkship or intership, who knows?! let us not be judgemental on this. as colleagues, i think we should be addressing this as any concern individual.
problem is, im caught between being sympathetic & being a doctor myself, that was my intention in opening this up, to at least hear your opinions given the same situation as mine.
problem is, im caught between being sympathetic & being a doctor myself, that was my intention in opening this up, to at least hear your opinions given the same situation as mine.
Actually, she should repeat the test... There is a chance of it being misread. Happened with me.
said the same thing to her, but she was really anxious.
what was the time interval between your 1st and 2nd test?
said the same thing to her, but she was really anxious.
what was the time interval between your 1st and 2nd test?
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Talk to your personal physician.
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That is a real shame. I know that at my medical school, we had to provide proof of vaccination against HepB prior to matriculating. I thought that was the standard.... too bad. I'm sorry for your friend
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Did it right after the second test came back..
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She has to have a hep screen as part of pre-employment physical.
She can't avoid it, it's mandatory.
ok, i gotta ask again, what if it turns out positive again? will it limit her practice of medicine (i feel really stupid asking this, when i know the answer already. like i said, i'm confused as she is).
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That's a very good ethical question... but I can only speak for myself... I would only feel comfortable going into a field like psych, path, or rads
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Ethically speaking, her scope of practice might be somewhat limited. She may not be able to practice safely in the surgical fields (ie. gensurg and it's subspecialties, neurosurg, oto, optho, ortho, uro). I see no reason why she can't practice most internal medicine subspecialties safely (GI and Interventional Cardiology might be tough). Though interventional rads or anesthesia may be a little more risky, there should be absolutely no reason why a psychiatry, diagnostic radiology, radiation oncology, pathology or neurology residency etc would be out of the question. That being said I do no think there is anything legally preventing her from going into any field.
i think the reason why IM is included in the "no-no" option, is because from where i took up my internship, some procedures like peritoneal dialysis, thoracentesis & paracentesis are just some of the procedures being done by an IM resident.
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Yes it would and should. We also have an obligation to protct the health and well being of our patients, not just doing this job because we can.
If you have not started applying for residency, then you should take the options mentioned above and choose non-surgical, non-interventional areas.
Psych is an option, but you still have to complete 6 months IM or 6 months peds, where you can infect unsuspecting and unprotected patients.
If you are in this match and is successful, I would suggest you call your program on the 15th or 16th and fess up. You are playing a dangerous game with other people's lives.
Stop being so selfish and think about the harm you can do. Wasn't it a part of your oath not to cause harm?
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You guys are harsh on the OP - put yourself in his/her shoes.
Consult with your hospitals infectious control officer and see if they can pinpoint the source (they can go through your rotations and find the potential exposure). Next, start treatment per whatever protocol your ID office tells you, including repeat testing in a few months (to see if the disease is progressing or reversing). The fact that A-Hbe is reactive is reassuring in that the viral load is reduced. Most often, those who go on to develop chronic hep B were infected at an early age, and of those, only around 5% do so.
There is still the possibility that your immune system will clear this disease (especially since you were vaccinated prior to starting medical school). Relax, look on the positive side of things, and don't let this interfere with your goals. Time will tell if you go on to active infectivity, but the way things look now, the odds of this are heavily in your favor...
Consult with your hospitals infectious control officer and see if they can pinpoint the source (they can go through your rotations and find the potential exposure). Next, start treatment per whatever protocol your ID office tells you, including repeat testing in a few months (to see if the disease is progressing or reversing). The fact that A-Hbe is reactive is reassuring in that the viral load is reduced. Most often, those who go on to develop chronic hep B were infected at an early age, and of those, only around 5% do so.
There is still the possibility that your immune system will clear this disease (especially since you were vaccinated prior to starting medical school). Relax, look on the positive side of things, and don't let this interfere with your goals. Time will tell if you go on to active infectivity, but the way things look now, the odds of this are heavily in your favor...
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This is a very controversial and emotional subject. HBV transmission from MD to patient has clearly been documented, although it's relatively rare. Here are some useful links:
The most comprehensive review I could find was from SHEA. This was published in 1997. It is a well written article, asking relevant questions and then trying to answer them, using EBM levels of evidence.
JAMA had an editorial about this in 2000 located here.
The CDC's most current guidelines on this subject appear to be here. This dates back to 1991 and not likely relevant anymore.
A case-control study of a single surgeon was reported here in 2002. There are two editorials in this issue also, looking at the issue from different perspectives.
Looking at all of this, here's what I think:
1. The risk of transmission of HBV is very low. Compared with other nosocomial infections that create severe morbidity and mortality in patients, this is really a drop in the bucket. Lack of hand washing and other good hygiene issues are clearly a much bigger public health risk. That being said, this infection can clearly be tracked from doc to patient, which makes it a hot issue.
2. Most people clear the infection. You stated that you are HBeAb positive, which is a very good sign. If the infection clears, then there is no risk and this issue is moot. Following viral loads may be helpful in this regard.
3. Docs who are HBV/HBeAg positive should probably not perform any invasive procedures. Viral loads are extremely high in these patients, and even Universal Precautions seem inadequate to prevent transmission. There is no clear list of what constitutes an invasive procedure, but would clearly encompass all central lines, drainage procedures (thoracentesis, paracentesis). This would include all surgical procedures.
4. As a medical student, you would need to disclose this to your school. You should not participate in the OR, nor be part of procedures. This becomes a complicated issue from a confidentiality standpoint.
5. As a resident, you will need to disclose this to your program. If you plan a career in psych, I would see no problem -- during your IM blocks in internship, there should be no problem letting your resident / someone else do procedures. In IM, there could be a problem -- if you were the senior resident and a procedure needed to be done, you would need to be sure that someone else was in house to do so. Many programs now have faculty in house, or an ICU fellow, etc.
6. Everyone involved in health care should be vaccinated against Hep B. Get vaccinated and have your titer checked!
7. Disclosure to patients remains a very controversial issue. My personal feeling is that if you refrain from performing any invasive procedures, that there is no ethical requirement to disclose your HBV status to patients, given that the risk of transmission is minimal. However, I am sure there are people who would disagree with this. The safest plan is to have some group (i.e. the ethics panel at your hospital, or the state board of medicine) review the situation independently for you.
The most comprehensive review I could find was from SHEA. This was published in 1997. It is a well written article, asking relevant questions and then trying to answer them, using EBM levels of evidence.
JAMA had an editorial about this in 2000 located here.
The CDC's most current guidelines on this subject appear to be here. This dates back to 1991 and not likely relevant anymore.
A case-control study of a single surgeon was reported here in 2002. There are two editorials in this issue also, looking at the issue from different perspectives.
Looking at all of this, here's what I think:
1. The risk of transmission of HBV is very low. Compared with other nosocomial infections that create severe morbidity and mortality in patients, this is really a drop in the bucket. Lack of hand washing and other good hygiene issues are clearly a much bigger public health risk. That being said, this infection can clearly be tracked from doc to patient, which makes it a hot issue.
2. Most people clear the infection. You stated that you are HBeAb positive, which is a very good sign. If the infection clears, then there is no risk and this issue is moot. Following viral loads may be helpful in this regard.
3. Docs who are HBV/HBeAg positive should probably not perform any invasive procedures. Viral loads are extremely high in these patients, and even Universal Precautions seem inadequate to prevent transmission. There is no clear list of what constitutes an invasive procedure, but would clearly encompass all central lines, drainage procedures (thoracentesis, paracentesis). This would include all surgical procedures.
4. As a medical student, you would need to disclose this to your school. You should not participate in the OR, nor be part of procedures. This becomes a complicated issue from a confidentiality standpoint.
5. As a resident, you will need to disclose this to your program. If you plan a career in psych, I would see no problem -- during your IM blocks in internship, there should be no problem letting your resident / someone else do procedures. In IM, there could be a problem -- if you were the senior resident and a procedure needed to be done, you would need to be sure that someone else was in house to do so. Many programs now have faculty in house, or an ICU fellow, etc.
6. Everyone involved in health care should be vaccinated against Hep B. Get vaccinated and have your titer checked!
7. Disclosure to patients remains a very controversial issue. My personal feeling is that if you refrain from performing any invasive procedures, that there is no ethical requirement to disclose your HBV status to patients, given that the risk of transmission is minimal. However, I am sure there are people who would disagree with this. The safest plan is to have some group (i.e. the ethics panel at your hospital, or the state board of medicine) review the situation independently for you.
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I was on another forum and one person wrote that she was HIV positive, wanted to come to the US because treatment is so much better here, wants to start a general surgery residency and was concerned when she receive treatment if her program could find out in some way.....
I can imagine the uproar and stink that will happen the day a patient is infected.
As so often happens, every member of the group becomes suspect and life will be hell for IMGs. We're already treated like dirt.
Don't try to tell me the mob mentality doesn't exist here (I was born here and I know better) or that it wouldn't happen in the medical profession.
I can imagine the uproar and stink that will happen the day a patient is infected.
As so often happens, every member of the group becomes suspect and life will be hell for IMGs. We're already treated like dirt.
Don't try to tell me the mob mentality doesn't exist here (I was born here and I know better) or that it wouldn't happen in the medical profession.
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Again, as stated, and for the reasons reiterated above, you need to go directly to the Infectious Disease Control office at your hospital/medical school. They will perform monitoring and testing, disclose the necessary infomation to the necessary people, as needed, and you will be protected.
