Re: A response to doctors giving ethics the go-by

[Guest guest]

[some of the personal references from this message was edited by the moderator]

I for probably first time have come across a bold stand by a qualified

doctor on the issue of confidentiality. Otherwise most of the times the

Docor-turned-NGOs have become biased to please the funders. I as a qualfied

doctor and AIDS counseller also expressed similar feelings about 6 months

ago and in response to that many NGOs abused me and my my profession and

competance to be a AIDS specialist.

I think this is time to convince every one including NGOs and funding

agencies that only activism is not going to solve the problem ut we have to

tae into confidence the medical community and take integrated approach to

deal with this medico-social problem.

I also never agreed to the argument that it is a sole social problem and

doctors are not required.

I fully endorse the views of Dr. Umesh on the issue of confedentiality and

wish to ask all the concerned to examine the situation on case to case basis

rather than as a policy.

I shall be presenting paper at Barcelona inwhich I have found in my

counselling clinic that in male dominant Indian society not many males are

willing to tell their HIV positive state to their HIV negative wives and

continue to have sex (even unprotected). In such situations I I need to

call his wife and counsell both of them and inform the status of her

husband.

Similarly sometimes the parents of young boys insist to arrange the marriage of

their son, and they need to be informed. I also agree with Dr. Umesh that

sometimes the patient may not come to the same doctor and if the HIv status is

not writen on the prescription letter, and the symptoms are suggestive of AIDs

every new doctor shall ask for HIV tests and hence it will not only be very

costly affair for the poor patient but also unneccessarily increase the number

of HIV cases in every test laboratory (even though the HIV is not a reportable

disease). also this will delay the institution of appropriate treatment.

Dr. Umesh is also very right to mention that it is not only the duty of the

concerned doctor but why not of the society?. Mention of HIV status on the

doctor's prescription can not automatically be considered vulnerability to

the social exloitation. In fact it depend how you interpret the situation.

If I am to interpret it, I will ustify it for several reasons such as: (1)

cost-effective (2) prompt diagnosis and treatment by any doctor who sees the

status (3) reliable national Data and (4) anybody who will see is supposed

to be more sympathetic, offer seats in buses, coaches, trains, they need not

to be stand for long period in queues, and can have preference/ concessions

from various agencies.

This is in fact society that need to be sensitized not to discriminate them

rather than to be more sympathetic.

Dr. Sarman Singh, MD. MNAMS

Head, Division of Clinical Microbiology

Department of Laboratory Medicine

All India Institute of Medical Sciences

P.O. Box. 4938, Ansari Nagar

New Delhi-110 029. India

Phone: 659 4764, 659 4977, 652 8484

Fax: 686-2663, 652 1041

e-MAIL: " sarman singh " <ssingh56@...>

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[Guest guest]

Dear Forum,

Of course it is not a sole social problem and doctors are required to solve

the problem but it is doctors and medical professionals who undermine the

social aspects of the problem and do not believe the requirement of social

activists as many of them consider it as a sole medical problem.

Mention of HIV status on the doctor's prescription may be a good idea in a

stigma and discrimination free society towards People living with HIV/AIDS.

Otherwise, HIV status must keep confidential and breaching of that will be

unethical as it may cause the life of PLWHAs miserable. Moreover, it is the

sole affair of the respective persons, what to do or not to do. The activists

and the doctors are required to inform all pros and cons to the pertinent

persons.

Regards.

A. S. M. Enamul Hoque

CARE Bangladesh

E-mail: <asmenam@...>

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[Guest guest]

Dear Mr Hoque,

I absolutely agree with you that the activists and the doctors are required

to inform all pros and cons to the pertinent persons about the disease.

Also I agree that the doctors of our community is not sensitized enough to

the issue of HIV and its social implications.

But it is true regarding not only HIV but many other disease. Doctors are part

of the same community which does not accept PLWHA .As far as the society is

not ready to accept the PLWHA as part of the society,how can we expect doctors

to do that?

This is due to many reasons which are to be discussed in a wider perspective.

Actually when this issue was raised in the forum I expected much

more active response and discussion from the members.

I feel integrating HIV to society should be attempted with a two pronged

strategy

1. Sensitizing and exposing the society to the fact that the disease here

with you.

2. Enabling the affected to face the society and show that we are not

different and are active members of the society.

The issue raised here was a little different.A doctor was blamed by the

press for witting the diagnosis which contained prescription for Zidolam

which is a 2 drug combination and Co-trimoxazole 1 tab daily.The pharmacist

who spread the news would have done the same even without this diagnosis on

the proscription.There was no mention against the pharmacist in the news

report.More over the news item contained the details of the identity of the

patient.

These are drugs exclusively prescribed for HIV. Not writing the diagnosis would

have helped in the era when there was no treatment available.

As a doctor treating HIV for the last 10 years,I don't write the diagnosis

routinely but there are situations where we cannot avoid disclosing the

diagnosis to other members of the team or colleagues.

Also now the diagnosis do make differences in the management of the diseases.

Also we face the question of mentioning the diagnosis in the discharge

summary which is the only record available with the patient after discharge

We also face situations where patient's relatives insist on not disclosing

the diagnosis in the death certificate in order to make the insurance claim

easier.

I belive as suggested by you discussing the pros and cons of the issue with

the patient is the only solution.But this may not be possible always when

very severely ill patient is brought by relatives and friends who are

ignorant of the diagnosis.Many of our colleagues face difficult situation

when sick patients are brought to them and the relatives who are ignorant

of the diagnosis expect a dramatic improvement par with other immuno

competent individuals.Disclosing the details to the relative will not help

the patient.But without disclosing the prognosis ,it is not easy to plan

the treatment especially if the patient is too sick to make decisions or

plan the life.

One thing we should remember is that we cannot copy what western countries

advocate where at least the standard treatments are available to the

patient from the government.

I am not trying to justify the doctor who prescribed ART without proper

counseling. In this particular instance ,there were much more important issues

to be discussed which were not given much attention in the report

1.Use of 2 drug combination which is not really recommended now.

2.Absolute lack of counseling even before starting ART.

3 Role of the shelters for HIV infected etc.

I hope we people will start discuss real life situations and issues facing

us and make our own modals than just blindly following the western modals-

many a times idealistic prescriptions from people never come across real

life situations of developing countries.

We few of us at Trichur medical College are in the process of evolving a

Trichur modal for HIV/ AIDS care which can be replicated with modifications

in other centers in Kerala.

Dr Ajithkumar.K

Sr Lecturer in Dermatology

Medical College Chest Hospital

MG Kav ,Thrisur,

Kerala,India

PH 0487-333322

E-mail:<trc_ajisudha@...>

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