Health care is about service, not about discrimination

The ethics seminar seemed so straightforward at first: "If a patient is having an arterial bleed right in front of you and there are no gloves in sight, what do you do?" After a brief discussion on the importance of barrier precautions, all 20 of us agreed that we would plug the wound with our bare hands.

"What if the patient had AIDS?" Silence. One person tried to shift the responsibility from the medical student to a senior staff member: "Find the resident." Another student commented, "We can't be expected to put ourselves at risk." Others insisted that gloves should be easily accessible and that medical students should never be left alone with critical care patients.

Are healthcare students and professionals afraid of AIDS? Will this fear change our response to our patients? And finally, will we discriminate against our patients as a result? We are taught that discriminating against people is wrong, no matter for what reason. Should the same not apply to viral load as well? Some might argue that working with HIV positive patients puts healthcare workers into too much danger, but isn't the purpose of doctors to take care of those who are unwell? Should they suddenly avoid those who need them most?

Back to the seminar: "Should patients be tested for HIV before undergoing surgery?" Most people said yes. "Physicians need to be protected too," they argued. Suddenly, a voice of reason protested from the back: "Knowing that they're HIV positive won't change how you do the surgery. Surgeons have to follow the same precautions at every operation. Any of your patients could be HIV positive."

It is about time that we threw away our prejudices about the danger of AIDS. Nobody wants hepatitis B from a needlestick injury, but just say "AIDS" and people get shivers down their spine.

Like it or not we have chosen a profession that carries certain risks. A family doctor looking after a patient's general health and medication needs to know whether his patient is HIV positive. A surgeon doing an appendicectomy, however, does not need to know the patient's HIV status to do his job.

Pretend that each of your patients and colleagues has AIDS and see if you react or think differently about them. Viral load should not matter because we have to learn to treat everyone in the same way.

Teresa Pun, second year medical student, University of Toronto, Canada
Email: pandora_03@hotmail.com


studentBMJ 2005;13:221-264 June ISSN 0966-6494

       

           

	REVIEWS Health care is about service, not about discrimination       Teresa Pin (June 2005)
	Seye Abimbola (June 02, 2005)       Fifth year medical student, Obafemi Awolowo University, Ile-Ife, Nigeria vosofa@yahoo.com
	If patients for any reasons are to be tested before each procedure then it remains to be asked How many surgeons will be ready to subject themselves to HIV screening on the request of their patients simply for the reason that the transfer could go the other way round i.e. from the surgeon to the patient. I think it is sheer arrogance that makes us always see ourselves as the only party that can be infected.Patients need to be protected too. Doctors like any other group of human beings can be infected without knowing. In fact we are, under the peculiar circumstances of our profession, even more susceptible than many other people. We need to come off our togar of arrogant pride and admit to ourselves that we are not better than our patients.