So basically...lie.
You can't say it is because the patient has aids, so you shove them off on another person because you don't feel qualified to handle a person with HIV/AIDS. 😛
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I don't have AIDS.
Started by ddstobe
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So basically...lie.
You can't say it is because the patient has aids, so you shove them off on another person because you don't feel qualified to handle a person with HIV/AIDS. 😛
I believe extensive periodontal disease would be a good/safe reason to refer them out. But if you said to a patient in his/her face that you didn't want to get contimnated by his dirty HIV bugs then it would be a bad idea.
C
clickytop
Referring out patients who are difficult (ie they are hard to get along with, they frequently break appts, they dont pay for treatment, the treatment required is beyond what the dentist feels comfortable treating) is a time honored tradition in dentistry. It is the dentists prerogative to refer out anyone he/she wants to...and if they are not comfortable treating a patient with HIV, then they can refer them. As someone else mentioned, you need to be careful when you explain to the patient that you are referring them (don't say its because they have HIV)...something along the lines of sending them where they will be able to get the best care.
On a separate note, usually the patients who will tell you that they have HIV are not the ones to worry about. It's the ones who don't tell you that anything is wrong, but present signs of having the disease who cause the most concern.
I'm serious - it's against the law. All it takes is an offended patient and a lawyer with a mortgage to pay.
I understand this, my point is that it's ridiculous. Everyone is trained in dental school to manage a patient who needs a root canal, yet many dentists refer out all their endo. Does this mean that they're discriminating against patients who have infected roots?
No, they simply don't like endo, or don't feel comfortable with an exceptionally hard (for them) case.
Why are the laws different for HIV than they are for any other disease? Why should a practitioner by legally liable if they aren't comfortable treating a patient with a life threatening, highly communicable disease? Because it makes the HIV sufferer feel bad?
I totally agree with you because this is clinically related and has health implications for both the patient and the provider, which is what distinguishes it from typical discrimination in my mind. It's one thing to say that you aren't comfortable working on asians (I'm one so its a good example) and another to say that you aren't comfortable working on someone with HIV (at personal risk to yourself).
However, the general line seems to disagree with this and I guess thats all that really matters in the end.
You can't refer a patient out simply because he/she is HIV+. If such a patient is medically stable there is no valid reason why you can't perform treatment. Chances are you'll treat patients in your practice that are HIV+ and you won't know it (they don't have to tell you, and you can't ask them directly nor can you make disclosure a condition of treatment) - either because they feel it's none of your business or, and this is very likely, they won't know their status. Now, if a patient comes to you that is HIV+ and is medically compromised as a result of their status (basically, they are starting to manifest AIDS) and based on some severe oral complications and their medical history you feel you can't deliver the same level of care as, say, an oral medicince specialist or oral surgeon that has experience treating these patients, you can and should refer the patient out. But you can't do it solely based on a patient's HIV status.
I understand that under the current laws, referring a patient due solely to their HIV status would be considered discrimination. The point I'm trying to make is that this is an illogical designation. We're not talking about race or gender; HIV is something that can be potentially very harmful to the practitioner. If a man walks into the office on fire and asked to be seen, would it be discrimination if we sent him down the street to the fire station?
While I understand that to some people this may seem like a scarlet letter situation, but I have to disagree. The HIV patient is no Hester Prynne, someone with HIV has the capacity to cause disease and if a practitioner isn't comfortable, they should be able to refer to someone who is.
Note that while this is my opinion, I have no qualms about treating HIV+, Hep B+ or really any patient who doesn't have raised black buboes swelling out of their lymph nodes. I do believe that any practitioner who has some doubt should be able to refer to a more confident doctor. Isn't that one of the most basic tenets of referring? If you don't feel capable, refer refer refer?
If a patient's condition won't interfere with their treatment, there's no reason why you can't treat them. Why? Well, HIV patients (as I've already pointed out) are covered under the Americans With Disabilities Act and perhaps a more apt analogy, rather than refering an endo case out (let's compare apples to apples) would be 'would you refer a patient with Down's Syndrome' or because a patient was wheel-chair bound? How is a class II MOD any different on an HIV+ patient than on an HIV- one? Oh, wait, that's right, needlestick injuries! Well, if you're observing Universal Blood Precautions you shouldn't have any worries. If you do get stuck, your chances are about 0.32% with a confirmed HIV+ patient whereas your chances of contracting HepB from a positive person are around 30%. HIV isn't highly communicable (there's a difference between communicability and risk behaviors - unprotected sex doesn't even carry a 100% transmission rate) - it's transmissible only under certain circumstances, the virus is very fragile, and as others have pointed out there are proteins in saliva that significantly reduce the infectivity of HIV. There's a lot working in your favor as far as contracting HIV in the dental setting is concerned.
It's understandable to be concerned and to have worries, we all do, myself included, but it's equally important to keep in mind that you are becoming healthcare professionals. People will be turning to for care and assurance and you will soon be in a position to offer a compassionate hand. By becoming dentists you're putting yourself above the fray as individuals that genuinely regard patient's well-being as paramount and that you will understand, appreciate, and abide by a code of ethics the public and your peers will hold you to.
One of the differences is that you refer to endo/perio/oral surgery when it's in the best interest of the patient because you lack confidence in your ability. You're looking out for the patient. If you refer because you're scared of the patient, then you're looking out for yourself. You're not referring him because you can't provide care, you're passing the buck because you don't think he is deserving of yours. You basically feel the minimal risk to you is greater than the benefit afforded the patient.
It's not so much that you don't want to make them feel bad, it's because if one of us is allowed to do it, what will stop everyone else from doing the same thing? It sets a very bad precedent for a practice that has been observed in the past already. The patient could potentially be turned away from every dentist. Discrimination against patients with HIV is very real and a huge reason HIV status is kept strictly confidential.
Imagine if an HIV+ person got in a car accident and the paramedics or ER doctors refused to see him. As long as you're careful and trust the universal precautions, the chances of becoming infected are slim. Remember, we're supposed to be healthcare professionals. As professionals, we have certain obligations to our industry and society. It's not a commercial business where you have the right to refuse service to anyone.
Yeah, so my stance pretty much sucks. That is why we have boards like this though, so guys like me can realize when we're making fools out of ourselves.
Kudos spr and sherm 🙂
Kudos spr and sherm 🙂
Back in the 1980's when HIV became headline news there was a rash of discrimination across the country, from employers to the delivery of healthcare. Why discrimination? Well, HIV isn't very communicable, and there are no cases of someone picking it up from a hug, a handshake, or a door knob. It doesn't prevent HIV+ individuals from working, going to school, and all of the other interactions with society and those they interact with on such grounds have a zero risk of infection, so thus any action taken against them solely on their status was prejudicial. Because HIV+ individuals have a condition in which they are compromised on some level, and this compromise doesn't adversely affect those they interact with on a day to day basis, there's no rational reason for the discrimination, and because it continued (and still does...), HIV was written into the ADA to help protect them from such actions. There's no rational reason why someone with HIV+ can't contribute to socitey. What about the case of healthcare professionals? Well, given the nature of HIV (as opposed to say, small pox or TB - which are highly infectious and highly communicable diseases) and the specific nature of it's transmission as well as the nature of emerging blood-borne diseases, a set of Universal Blood Precautions was established that made it possible to treat a patient without direct contact with blood and blood products. "Capacity" - and let's recognize that term as speaking in the theoretical sense - isn't enough to exclude such patients from care. What if I'm known to get cold sores, that means I have the capacity to give you herpes Whitlow and then what? Does that mean you should never treat me? That beef you bought has the capacity to infect you with a nasty strain of E. coli, but does that mean all raw meat should be banned? With the UBP there's no reason why you can't treat a patient based solely on his/her HIV status. Period. If you dispose of sharps appropriately, handle needles and recap them as you should each time, you won't have a single problem, and that capacity won't mean a thing. If you do get stuck, there are measures and protocols, but then again, you probably weren't observing and practicing the UBP in the first place if this happened.
You have responsibilities as a dentist to treat your patients. I personally feel like we should treat everyone who shows up in our office. However, there are plenty of dentists out there who will label those patients as "high risk patients" and refer them elsewhere.
C
clickytop
The fact remains that some dentists, in the face of all the statistics and science we have, still feel very uncomfortable with treating an HIV+ patient. In this case, it is in the best interest of the patient for the dentist to refer them for treatment; if the dentist did opt to treat them because he/she felt obligated but spent the entire appointment focusing on avoiding all possible behaviors that could even remotely contribute to transmission, is he going to be able to provide the best care for the patient? The patient would be far better off going to a dentist who felt comfortable treating someone with their condition and would focus on doing his best work instead of the virus.
Also, you can't compare treating an HIV+ patient in a dental office to one who had suffered serious trauma. The patients life does not depend on getting that S&RP, whereas a doctor who refused to treat an HIV+ patient in an MVA would essentially be killing them.
C
clickytop
So you'll never turn away a patient for treatment because they have an HMO or are unable/unwilling to pay? When you graduate, please send me your address so that I'll know where to send people who free treatment...
You are much more likely to die in a car accident than to do anything. Knowing that is great, you can do anything! Go skydiving, bungee jumping, big wave surfing - if you survive the car ride there, you are golden.
0.32% chance of contracting HIV if you get stuck, folks, calm down.
A boulder fell down a mountain side and killed one of my classmates as she lay in her bed. But I'm not stressing about it and neither would you, I don't think. Same thing.
Of course, I still worry about sharks when I'm in the water, even though you are more likely to die by lightning. I guess we all have our irrational fears 😀
It's true that we will all treat patients that have diseases that go unmentioned. Where you are wrong, however, is that we certainly can (and should!) ask them if they are HIV positive (just as you would ask them about any other health condition). In fact, failure to ask that (and any other questions suitable during a new patient/comprehensive exam) would probably put you at greater risk for a lawsuit. It's one thing if the patient doesn't answer the question honestly, and quite another if the clinician never asks it.
You might quickly learn that there are specific types of patients you don't wish to treat. Treating everybody that shows up in your office could bring you additional stress that you don't want (or need?) to assume.
Some patients will have personalities that won't mesh with yours, and the last thing you need to do is be treating them.
clickytop,
I said I "FEEL LIKE" we should. I've never said you have to do it. I am well awared of the reality...ie pressure to pay back loans, pay your overhead%, and all the worries about the uncertainties. I thought it would be nice to have some of that mentality in the back of our mind when we're practicing.
ItsGavinC,
I completely agree with what you're saying. The point is you try to treat them and you don't turn them away at first. "Trying" is the key word. Of course, there are patients that you have to refer because they're above your ability to handle. Hope i'm not being too idealistic.
They have a chart to fill out and you get to look at that chart. Not everyone will be truthful. Most HIV+ patients are well awared of the danger of transmitting HIV, hence feel obligated to put it down on the sheet. Just my theory.
Just some thoughts...
* Most HIV patients receive government aid (i.e. Ryan White programs) to pay for their medical/dental costs, hence, it's to their benefit to tell you they have HIV/AIDS so they can get the treatment they need paid for.
* I can't imagine what other precautions in addition to universal precautions would do any good. Double gloving? To prevent what? If you're going to stick yourself with a needle, an additional layer of .25mm of laytex isn't going to stop the needle. Universal precautions were developed in the late 70's and early 80's in response to AIDS and other infectious diseases. Additional precautions aren't necessary.
* Most people who DO double glove are ignorant about the diseases. A solid understanding of the infectious diseases frequently encountered in dentistry will reinforce the usefulness of universal precautions as the only necessary policy.
* You have a responsibility to ask patient's if they have any infectious diseases because you are responsible for the well-being of your employees who will be treating the patient too. Additionally, it might help explain the hairy leukoplakia, oral candidiasis, NUG/NUP, or other HIV sequelae that you often find associated with HIV/AIDS patients.
* Most HIV patients receive government aid (i.e. Ryan White programs) to pay for their medical/dental costs, hence, it's to their benefit to tell you they have HIV/AIDS so they can get the treatment they need paid for.
* I can't imagine what other precautions in addition to universal precautions would do any good. Double gloving? To prevent what? If you're going to stick yourself with a needle, an additional layer of .25mm of laytex isn't going to stop the needle. Universal precautions were developed in the late 70's and early 80's in response to AIDS and other infectious diseases. Additional precautions aren't necessary.
* Most people who DO double glove are ignorant about the diseases. A solid understanding of the infectious diseases frequently encountered in dentistry will reinforce the usefulness of universal precautions as the only necessary policy.
* You have a responsibility to ask patient's if they have any infectious diseases because you are responsible for the well-being of your employees who will be treating the patient too. Additionally, it might help explain the hairy leukoplakia, oral candidiasis, NUG/NUP, or other HIV sequelae that you often find associated with HIV/AIDS patients.
E,
Looks like a drain to keep the wound open, but it doesn't look like it is wound that will close up anytime soon.
I can't say this has much to do with the topic, but I'm going to name my band "Hairy Leukoplakia."
That is all.
