A response to doctors giving ethics the go-by

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Please reply to Umesh <ajaumesh@...>

Dear Editor,

This letter is in response to the column " Doctors giving ethics the go-by "

by C.Maya in The Hindu on the 9th June.

The statement in the report that Sasikala , the person with HIV Disease

became a social outcast because of the doctor violated confidentiality ,

is a misreading. Even if the doctor has not written in the prescription the

HIV positive status of the person every pharmacist knows that ZIDOLAM tablet is

used only for treating HIV disease. If the pharmacist does not respect issues of

confidentiality , the patient's Status could be revealed to another one ,

Doctors practicing in HIV Medicine , face difficult cases which tempt them

to disclose confidential information in the public interest.

Some patients are not willing to disclose their illness to their partners

and continue to act irresponsibly and practice unprotected sex. with

unsuspected partners.

Most often confidentiality is a decrepit concept in view of the team

approach which characterises modern medicine. Medical records containing

HIVstatus and other sensitive information are available in some hospitals to

dozens of professionals and health workers

On a " need -to-know " basis , the HIV status must be known to other care

givers and specialists involved in the team. The traditional medical

relationship involving the patient as confider and the doctor as confidant,

no longer be applicable accurately in a multispeciality team aproach

essential in HIV care.

It is a wrong medical practice not to record a diagnosis in the case

records. In death certificates , insurance claim forms etc doctors should

disclose the disease.

Doctor, patient ,patient's partner and family need to discuss and agree on

issues of confidentiality and its bounds. At times doctors have to balance

issues of confidentiality against serving the best interests of the patient

by informing family members.

The reporter finds no fault in the community attitude towards the patient

where she was not allowed even to take water from a well and thrown away

to a shelter at Trichur

The community (ie.the family and neighbourhood) should care an HIV POSITIVE.

Disclosure of a patient's HIV POSITIVE STATUS NEED NOT RING BELLS OF

TERROR. The objective of awareness classes and media messages must not be to

terrorise people.

In spite of two decades of awareness classes and media messages the stigma

remains high against the disease . The media and medical officialdom were

unsuccessful in propagating the message that AIDS is not transmissible

through casual social contacts . The national policy on HIV care is

COMMUNITY BASED CARE NOT DISCRIMINATORY CARE AT ISOLATED SHELTORS.

T he stigma attached to the HIV disease , is still due to the NO-DRUG

PROPAGANDA cherishing by the media as well as some group of medical

professionals.

They still prefer propagating a terror among the public and sensationalise

and exceptionalise this illness.

The exceptionalisers create unnecessary auras of confidentiality, secrecy,

terror and sociopolitical concern about this illneess

After the advent of Highly Active Anti-Retroviral Therapy ( HAART|) the HIV

disease is MANAGEABLE LIKE ANY CHRONIC ILLNESS . The tablet ZIDOLAM is a

dual drug salvage therapy which the patient has to take life long with

regular follow up advice from a doctor having HIV CARE EXPERIENCE.

Now HIV disease is just like any other normal communicable disease where

early diagnosis and treatment must be the rule to break the chains of

transmission effectively

So once the no-drug campaigning is over the social stigma will slowly

disappear Not only doctors , but patients and relatives also must respect the

confidentiality issues related to HIV disease. Most often patients and

family members unnecessarily disclose the bad news and causes trouble than

doctors and hospital staff.

Afterall confidentiality is respected in a society where privacy rights of

individuals are considered a societal value and virtue.

DR.UMESH.M.S.

GENERAL HOSPITAL PATHANAMTHITTA

email:ajaumesh@...

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