Posted by: Witch Doctor | July 11, 2009

Doctors need to be celibate

witchround

You tell me you are contemplating celibacy today, My Back Cat……

That’s good, for we don’t want hundreds of little unwanted and unloved black kittens wandering about looking for the small number of vacancies that are advertised for witches cats.

You are not contemplating cat celibacy?

You think all doctors will now have to become celebate……

Do you really think that is wise?

Why?

HIV testing has crept.

As we knew it would.

Once upon a time a HUGE amount of counselling went on BEFORE a patient was HIV tested. This test could not be done without consent except in very exceptional circumstances. It had to be confidential. Much was at stake if an individual tested positive for HIV. It had implications for insurance, family relationships, future health, occupation, mental state. It still does. Indeed in The Witch Doctor’s hospital a man once committed suicide immediately after being told he was HIV positive.

Now you are telling me all doctors commencing employment must be HIV tested as part of their terms and conditions of service?

Eh, is that what you’re saying?

And, unlike the rest of humanity in the UK, they are not being adequately counselled?

Where is your evidence for all of this. My Black Cat?

SurgeryFace

“Q. When can you carry out an HIV test without proper counselling or consent?

A. When you are testing a junior doctor.

That is the finding of a study published in the Journal of Medical Ethics (Salkeld LR, McGeehan SJ, Chaudhuri E, Kerslake IM. HIV testing of junior doctors: exploring their experiences, perspectives and accounts. J Med Ethics. 2009 Jul;35(7):402-6) which looked at the experiences of junior doctors having HIV testing as part of their pre-employment screening. The researchers looked at 4 different hospitals in the South West of England. They found that although the doctors who were tested appreciated the rationale for the testing they were dissatisfied with the way in which the testing was conducted.

Individuals working in hospitals may be at risk through their occupation – transmission of HIV from patient to doctor is considerably more common than from doctor to patient – and having an HIV test can be the source of much anxiety. A positive HIV test would be devastating for a doctor in terms of his career, his personal health and that of his immediate family. Current UK Guidelines for HIV http://www.bhiva.org/files/file1031097.pdf advises that pre-test informed consent is obtained, and the process should be confidential.

In contrast the doctors in this study were of the opinion that informed consent to have an HIV test had not been obtained in their case, that they were unable to decline the offer of an HIV test and that the approach adopted by the staff offering the test was nothing more than a cursory gesture towards discussing the issues surrounding being tested for HIV. Many commented that there was little opportunity to ask questions. Few were offered any follow-up counselling or discussion.

“I think there should be pre-test counselling, as we would give patients” commented one doctor. Another commented “The only discussion I had with somebody about the test was to say ‘We’re going to test you for HIV, is that OK’ and then being stabbed!”.

The actual testing was performed very openly. One doctor commented that “You were all stood in a line, one after another in the same room.” Several of them raised concerns about the confidentiality of the process.

Most of the doctors recognised the benefits to patients of being tested, even though HIV transmission from doctor to patient is extremely rare. And current guidelines, from both the Department of Health and the General Medical Council, insist that doctors who perform a procedure which could potentially infect a patient should be aware of their HIV status.

But there is a lack of logic behind this – why are doctors taking up new jobs tested whereas doctors already in-post are not?

The reason given by the DoH is that doctors already in-post have a professional duty to seek professional advice if they have a potential exposure. The authors question the logic of this assumption, especially since doctors who carry out exposure-prone procedures may become HIV positive, and they argue that the policy of testing only new employees may provide false reassurance to the public.”

What about all other heath care workers?

My Black Cat, do you suppose that since the risk is higher of a doctor becoming infected with HIV from a patient than vice versa, and in order to avoid discrimination, all patients need to be HIV tested as well as doctors?

And if so, how often?

Ever time they are to undergo surgery?

And following the logic, how often should doctors be screened?

Every time they operate or are involved in some messy emergency procedure involving patients’ blood?

How will a doctor who had a negative HIV test know whether he/she has contracted HIV from a patient and therefore seek damages from his/her employee?

How will a patient with a negative HIV test know whether he/she has contracted HIV from the hospital setting and therefore seek damages from the government?

Yes My Black Cat, you are right – The Pledge of Celibacy is the only option that doctors now have.

Sexual activity clouds the issue and makes logical conclusions impossible.

Do you suppose all NHS patients should, in addition to being HIV tested, sign The Pledge of Celibacy too as a condition of free healthcare for all?

This, My Black Cat, is end stage creeping logic!

As the late Magnus Magnusson who declared week after week, month after month, year after year:

“I’ve started, so I’ll finish”

The alternative, My Black Cat, is to accept that living is not without risk.

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Responses

  1. Great post, I was directed here following the similarities in my recent post, written about The Sun’s decision to treat a HIV doctor as a second class citizen.
    http://medicnews.wordpress.com/2009/10/29/hiv-doctor-treated-as-secon-class-citizen-by-media/


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