Surgeons and HIV: a South African study
Date
2008-10-06T11:35:35Z
Authors
Szabo, Christopher Paul
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Abstract
A contentious area of clinical practice in the discipline of surgery, with ethical
implications, relates to disclosure of clinician HIV status to patients, specifically
where exposure prone procedures, performed in a confined body space using
sharp instruments without full vision of the operative area, carrying a technical
risk of blood borne pathogen transmission are being performed by HIV positive
surgeons. Within the context of patient informed consent, it has been proposed
that surgeons who are HIV positive make their status known to patients on whom
they would perform such procedures. Failing which it is proposed that surgeons
who are HIV positive should refrain from such procedures. It has been counterargued
that such disclosure is an infringement on clinician privacy and that
curtailing the scope of practice is prejudicial to both surgeon and patient. The
former in terms of employment prospects and the latter based on the lack of data
supporting a significant risk of clinician to patient transmission with a resultant
unnecessary loss of surgical skills. Existing recommendations appear to be
informed more by sentiment than science and are thus potentially unsatisfactory,
more so in that they do not seem to confer benefit to either patients or clinicians.
Further, whilst such policies emanate from developed countries they may not
address the clinical realities or sentiment of the South African situation. Where
such policies do exist, it is not clear to what extent the recommendations accord with clinician views. Against this background the current study surveyed views of
practicing South African surgeons regarding aspects of this issue i.e. HIV and
surgeons. Some of the salient findings included the view that a patient centred
approach requiring HIV status disclosure to patients would be discriminatory to
surgeons whilst not clearly of benefit to patients. Further that HIV positive
surgeons should determine their own scope of practice. Certainly it appears that
patient centered approaches and restrictive policies, related to this issue, do not
appear to accord with clinician sentiment. In the absence of any comparable data
either locally or internationally, the current study provides a preliminary indication of clinician views with implications for the development of locally relevant
guidelines.
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Keywords
surgeons, HIV, South Africa