REMEDYUK: ACTION GROUP of UK DOCTORS

COMPULSORY HIV TESTING for Junior Doctors in UK


Consent for HIV testing



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 advise 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. “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 there is evidence that patients want to know the HIV status of their health care workers. 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.