HIV-infected physicians and the practice of seriously invasive procedures.

HIV-Infected Physicians and the Practice of Seriously Invasive Procedures Aids is increasingly being viewed as an occupational disease for physicians despite the evidence that human immunodeficiency virus (HIV) is exceedingly hard to transmit in health care settings.(1) Physicians who carry out seriously invasive procedures claim the "right to know" whether their patients are infected with HIV, including the right to screen patients for the virus.(2) Some hospitals, irrespective of what the law may allow, already screen their patients without specific informed consent.(3) Conversely, patients undergoing seriously invasive procedures claim the right to know if their physician is infected with HIV. Eighty-six percent of a Gallup Poll sample taken in 1987 said patients should be told if their physician has AIDS.(4) Most patients would choose not to receive treatment from an infected physician. Their case has been buttressed by a policy statement from the American Medical Association that "a physician who knows that he or she is seropositive should not engage in any activity that creates a risk of transmission of the disease to others."(5) Presumably this advice would extend to other health care workers involved in performing seriously invasive procedures. If it is wrong for infected physicians to treat patients invasively, does this create a correlative duty on the part of hospitals to screen physicians before they carry out such treatment? The prospect of a "right to know" the health status of both doctor and patient, with calls for screening on both sides, together with the potential of litigation for avoidable transmission of HIV, undermine trust within the health care system. The concept of a "right to know" the serologic status of physician or patient is misplaced. Information that a patient is HIV positive is of very limited use to the physician. Physicians have a professional,(6) if not a legal,(7) responsibility to treat infected patients. It is usually not possible to utilize different methods for treating HIV-positive patients to reduce the risk of contracting the infection; and in some cases different methods could result in prolongation of operative time, potentially having an adverse effect on the patient. Further, the Centers for Disease Control recommends,(8) and the Occupational Health and Safety Administration requires,(9) the universal application of barrier protection in all cases of exposure to blood. Information that a patient is HIV-positive should not significantly affect the precautions taken in most cases.(10) Patients, on the other hand, clearly would act upon the knowledge that their physicians were infected with HIV, and when they could choose many would not opt for a physician who is infected with HIV. However, it is not always reasonable for the patient to expect this information. The certain consequence of informing patients that their physician is HIV-positive would be the abandonment of the physician's practice. This article, therefore, does not make a case for a patient's "right to know.c Rather, it argues that the risks inherent in seriously invasive procedures are sufficient for the profession to take patient safety seriously, even before the first case of HIV-transmission to a patient occurs. Professional guidance is required to identify the circumstances where a physician should withdraw from performing certain seriously invasive procedures. This conclusion is based upon the doctrine of informed consent and evolving standards of professional care. Failure to take appropriate preventive action now may result in policies that are overly restrictive. For example, Cook County Hospital already has a policy of allowing patients to refuse to be treated by HIV-positive physicians who "routinely provide direct patient care."(11) The policy would appear to put the careers of infected physicians at risk even if they do not perform seriously invasive procedures. …