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Surgeons with Hep B

Discussion in 'Surgery and Surgical Subspecialties' started by DentStud, Nov 5, 2002.

  1. DentStud

    DentStud Junior Member
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    Anyone have any information on surgeons with who have Hep B? Can they still practice legally? Any info at all?
     
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  3. cardiosurg

    cardiosurg Senior Member
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    INTERESTING QUESTION. HERE IS ANOTHER THOUGHT TO PONDER. I THOUGHT THAT DOCS WITH AIDS CAN STILL PRACTICE (EVEN SURGICALLY AND IN TRAUMA) AS LONG AS THEY HAVE PATIENT'S CONSENT.
     
  4. droliver

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    This has been touched upon before. I think a few states have laws that spell out practice restrictions for communicable diseases, but for the most part there is no formal restrictions. There is in practice however, a "scarlet letter" for surgeons with HCV or HIV as far as getting privledges in any given hospital to perform procedures for medical liability reasons. The CDC & AMA as I understand it from one of our transplant surgeons, has not formally taken a position re. restricting privledges but does encourage (but not mandate) informed consent
     
  5. DentStud

    DentStud Junior Member
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    With the risk of transmitting HBV to patients being so small, along with universial precautions and barriers of surgical gloves, do you think it is unethical for a surgeon with HBV to operate on a patient? How you you all feel about this matter? And also, do surgical residency programs have any guidelines against accepting residents who have HBV? Any info or opinion on this would be helpful. Thanks!
     
  6. I am not going to approach the ethics side too much. Suffice it to say, all surgeons should operate as if they have a disease and everyone of their patients have a disease. That is why it is called universal precautions. There are numerous surgeons exposed to HBV every year. Many contract the infection but will be unaware for years.

    As per residency guidelines, the short answer is no. The medium answer is that surgery programs ask you if you have an conditions that may LIMIT your ability to fulfill the requirements of the residency. You do not have to tell the residency you have HBV, HCV, HPV, herpes, GC, Chlamydia, etc... Get treated. If you have no limits, you do not mention it. They will not ask unless you mention it!

    later
     
  7. droliver

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    HBV is not really as serious an infection risk as the HCV/HIV potential, especially in the age of vaccination. Most people who develop it will not progress to serious liver problems & many will clear the infection altogether. In past eras, HBV was considered a routine occupational hazzard & many surgeons died from ESLD. As recently as the early 80's, it was not uncommon for residents to have to have sick leave for flare ups of hepatitis according to one of my transplant attendings.
     
  8. Weeble

    Weeble Senior Member
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    The dean at my school told us a story of a surgeon at UCLA who failed to get the second half of his HBV vaccination, and ended up infecting a bunch of patients even though he was entirely in accordance with sterile procedures. There was a large investigation and, the way our dean told it, he made it sound like the guy's surgical career was pretty much over. Then again, he may have just been trying to scare us into getting our shots....;)
     
  9. DentStud

    DentStud Junior Member
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    Thanks to all those who have posted replies in this forum. I wanted to ask for your opinion on my situation. I am very much passionate about doing surgery residency. Unfortunately last year I found out that I have chronic hepB. Since then I have been on Epivir but several weeks ago my blood test still show that I have not seroconvert, although my liver enzymes are normal. I am currently healthy and do not have any symptoms of liver problems. Should I still pursue to fulfill my dream of a career in surgery or should I choose another specialty? At this point, I don't know if I will seroconvert in the future. Please help! What do you all think?
     
  10. Maybe you should adds some other drugs to the mix to promote sero-conversion?

    If you want to be a surgeon, be one!!! Practice universal precautions to the extreme, double glove, use excellent technique, and become the the universal precautions poster-boy. You need to do what you think is right and practice the type of medicine that will be right for you.

    Later
     

  11. ????Consent in trauma????

    The concept of consent in trauma is extremely limited. The patients are often drunk or post-concussive. Given the circumstances, their families/significant others/guardians are under duress by definition. The same can be said for emergent AAA repair or CABG. Try getting a family to understand the concept of cirrhosis in 10 years in the face of a liver laceration NOW!!! Do you really think their is time for "informed consent"? Just give that concept up and practice the best surgery you can with perfect universal precautions.


    :)


    Later
     
    #10 Skylizard, Nov 11, 2002
    Last edited by a moderator: Aug 30, 2008
  12. droliver

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    Dentstud,

    with a known diagnosis of chronic active dz. before you started your training, you really might have to think twice about pursuing surgery. I would recommend you get good council from a respected Hepatologist about where he/she feels you infection is in the course of the disease & whether the stress of surgical residencies (and some nonsurgical ones) would be likely to adversely affect your own health (I believe HBV is one of those viral processes that tends to be exacerbated by stress, no?). This is all in addition to the informed consent issues that you'd have to address on nearly each & every potential patient contact . There would be a lot of patients who would be reluctant to let a resident with HBV be involved in their surgical treatment & would be within their rights to have you excused from a procedure
     

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