Annoyed.As.Hell@p0.f69.n154.z1.fidonet.org (Annoyed As Hell) (08/16/90)
Recently, I helped a friend get admitted into a Milwaukee Hospital, who is
diagnosed with AIDS.
30 seconds after we sat down in the waiting room, the receptionist called into
patient admitting, and, in a regular voice audible throughout the waiting room
o any and all others present "Acquired Immune Deficiency Syndrome-Peunomonia."
Additionally, his room has in big black and white letters "Blood & Secretion
Precautions" for all to see, including visitors and other patients on the
entire floor!
Isn't there some way Doctors, Nurses, and Medical Professionals could refer to
these patients and this diagnosis, without alarming everyone else within
earshot? Couldn't a code, or number, or even a red piece of tape on the
patients door be used to alert medical personnal of precautionary conditions?
I cannot tell you how many times I have sat in the doctors office of a major
physician here in town (with numerous AIDS patients) while names, conditions,
symptoms or tests (Such as T-cell counts) are spoken of freely and openly.
WHAT EVER HAPPENED TO THE CONFIDENTIALITY THAT IS SUPPOSED TO BE
ASSURED FOR THESE PATIENTS BY LAW
Or is it that I am just one of the few people intelligent enough to know what
a Doctor or Nurse is talking about?
Is there any other way hospitals or clinics in other areas refer to AIDS
patients, without "disclosing" his/her condition (illegally, I might add). If
there is, can someone out there pass this along to the health care
"professionals" in Milwaukee, Wisconsin?
Or should someone just start another million dollar lawsuit for violation of
these laws?
Annoyed
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Uucp: ...{gatech,ames,rutgers}!ncar!asuvax!stjhmc!154!69.0!Annoyed.As.Hell
Internet: Annoyed.As.Hell@p0.f69.n154.z1.fidonet.orgHAMER%VCUVAX.BITNET@oac.ucla.edu (ROBERT M. HAMER) (08/18/90)
Annoyed.As.Hell@p0.f69.n154.z1.fidonet.org (Annoyed As Hell) writes: >30 seconds after we sat down in the waiting room, the receptionist called into >patient admitting, and, in a regular voice audible throughout the waiting room >o any and all others present "Acquired Immune Deficiency Syndrome-Peunomonia." First, the receptionist should never have, in a "regular voice audible throughout the waiting room to any and all others present," made a statement about your friends condition, complaint, or problem. That is a clear violation of anybody's idea of confidentiality. You should write a letter of protest. In all honesty, however, the letter will probablly wind up in the wastebasket. Now, on to your second objection: >Additionally, his room has in big black and white letters "Blood & Secretion >Precautions" for all to see, including visitors and other patients on the >entire floor! >Isn't there some way Doctors, Nurses, and Medical Professionals could refer to >these patients and this diagnosis, without alarming everyone else within I would assert that the BIG, "Blood and Secretion Precautions" sign on his room is functional and necessary. Everyone, from physicians, nurses, janitors, etc, _and_ visitors, need to be aware that they need to take special precautions. People involved in direct medical intervention need to be aware of the possibility of needle sticks, burst specimen containers, etc. They need to know that they need to be especially to be sure to take all the precautions they are supposed to be taking anyway. The janitors need to be aware that if they are moping up vomit they need to be careful about how they treat it. (Footnote: we all know no one is going to catch HIV from vomit, at least not unless one eats large quantities of it, but the regs and procedures demand that it be treated appropriately.) Visitors need to know so that they can take appropriate pracautions themselves, and more importantly, so that they are careful not to potentially infect an immune-impaired patient. I know it is not fun; I know hospitals are dehumanizing, impersonal, insensitive, often degrading places, but it is pretty much that way for everyone, not just HIV infected folks. People with many other infectious diseases have the same signs on the doors. Some of those diseases may be transmitted by vomit far more easily than HIV disease. >earshot? Couldn't a code, or number, or even a red piece of tape on the >patients door be used to alert medical personnal of precautionary conditions? The precautions aren't and shouldn't be coded. They should be plain and obvious. Everyone who works in that environment needs to be reminded of them so they don't slacken up. >I cannot tell you how many times I have sat in the doctors office of a major >physician here in town (with numerous AIDS patients) while names, conditions, >symptoms or tests (Such as T-cell counts) are spoken of freely and openly. Wrong, unfortunate, and there is probably not much we can do about it. >WHAT EVER HAPPENED TO THE CONFIDENTIALITY THAT IS SUPPOSED TO BE >ASSURED FOR THESE PATIENTS BY LAW In a medical environment, confidentiality is a joke. The physicians, nurses, typists, secretaries, clerks, insurance folks down at BC/BS and medicaid, etc, all know about your friend and are within whatever he signed when he got hospitalized that said essentially that the hospital was free to release any information to anyone who had a reasonable need to it for financial or insurance purposes. Any clerk who knows the procedures can walk into medical records and fill out a form requesting a patient's chart, and get it. (Of course, if it is like our medical records, half the charts are lost anyway...) Any physician, unconnected with your friend's care, can get any chart for "research" purposes. And his/her secretary. And his/her students. Etc. >Or is it that I am just one of the few people intelligent enough to know what >a Doctor or Nurse is talking about? Probably. Most people probably think HIV disease is something only homosexuals get, or, conversely, that you can catch it from bug-bites. I have met physicians with the most illogical and unknowledgable beliefs about HIV. >Is there any other way hospitals or clinics in other areas refer to AIDS >patients, without "disclosing" his/her condition (illegally, I might add). If In many hospitals, for valid reasons, HIV patients reside on HIV wards. By definition, if you on that unit, everyone in the hospital knows that's what you've got. That may be unfortunate, but it makes better treatment sense to have similarly-troubled people grouped in a place where you can group people trained to help them. That's why the heart attack patients are grouped together; the kids are grouped together; etc.
Richard.DeWald@f70.n382.z1.fidonet.org (Richard DeWald) (08/19/90)
I am a nursing student and a clerk in an emergency room.
In a message of <13 Aug 90 23:20:06>, Annoyed As Hell (1:154/69) writes:
AA>Recently, I helped a friend get admitted into a Milwaukee Hospita, who
AA>is diagnosed with AIDS.
That was very nice of you.
AA>30 seconds after we sat down in the waiting room, the receptionist
AA>called into patient admitting, and, in a regular voice audible
AA>throughout the waiting room to any and all others present "Acquired
AA>Immune Deficiency Syndrome-Peunomonia."
Called into what? An overhead intercom or a private communication device? If
it was an overhead intercom, this would be unacceptable, if it were a private
line and it was just the loudness of the person's voice that bothered you,
well, that's another issue (less serious than announcing a diagnosis over an
intercom).
AA>Additionally, his room has in big black and white letters "Bloo
AA>& Secretion Precautions" for all to see, including visitors and other
AA>patients on the entire floor!
This is an interesting situation. Actually, all health care workers are asked
to observe something called "universal precautions." In essence, what this
boils down to is we treat every patient as if he or she has AIDS (or Hepatitis
B). We take certain precautions against infection with everyone.
However, in practice, every patient with a known HIV+ status is known to
everyone there on staff (including the clerk). People are extra-special
careful when drawing blood or doing anything that (in the worst possible
scenario) could result in bodily fluids being splashed onto unprotected skin
or membranes.
Formally, "blood and bodily secretions precautions" has been eliminated as an
isolation category because we are expected these days to take these
precautions with ALL patients. Some hospitals still hang these signs on AIDS
or Hepatitis B patients doors and/or charts as a reminder to be extra careful.
AA>Isn't there some way Doctors, Nurses, and Medical Professionals
AA>could refer to these patients and this diagnosis, without alarming
AA>everyone else within earshot? Couldn't a code, or number, or even a
AA>red piece of tape on the patients door be used to alert medical
AA>personnal of precautionary conditions? I cannot tell you how many
AA>times I have sat in the doctors office of a major physician here in
AA>town (with numerous AIDS patients) while names, conditions, symptoms or
AA>tests (Such as T-cell counts) are spoken of freely and openly.
In the strictest theoretical sense, no one but the patient and his (or her)
associated health professionals should know of a patient's diagnosis. In
practice, we talk about our work while at work just like anyone else does. In
a way, your concern for the lack of formality about an AIDS diagnosis may
indicate that your health care workers are treating it like any other
diagnosis (as they should). On the other hand, each of those health care
workers is as familiar with the stigmata associated with the disease as anyone
else. Prudence would suggest a bit more discretion would be kind, at this
stage of the game, I am sympathetic to your concern. It probably isn't much
solace to know that this wouldn't happen in MY emergency room.
AA>WHAT EVER HAPPENED TO THE CONFIDENTIALITY THAT IS SUPPOSED TO BE
AA>ASSURED FOR THESE PATIENTS BY LAW
Nothing. It is not only a legal commitment, but a moral and ethical one as
well.
AA>Or is it that I am just one of the few people intelligent enough to
AA>know what a Doctor or Nurse is talking about?
That would be nice, but it is probably not the case. An emergency room (or a
doctor's office) can be an interesting place to wait around. People hear
things they shouldn't every day. However, hearing that so and so in the next
bed has chest pain is something different from hearing that so and so has
AIDS. Your concerns have some substance.
AA>Is there any other way hospitals or clinics in other areas refer to
AA>AIDS patients, without "disclosing" his/her condition (illegally, I
AA>might add). If there is, can someone out there pass this along to the
AA>health care "professionals" in Milwaukee, Wisconsin?
No, and I really don't think they should. AIDS is an equal opportunity
disease. HIV can and will infect anyone if given the opportunity. Your chest
pain patient (in my emergency room) has as much of a chance of getting his
diagnosis overheard as your vaginitis or your AIDS patient. The system isn't
perfect.
I do agree that AIDS patients deserve special attention owing to the severity
of their condition, but we should treat them as we do all patients that are
equally seriously ill--with dignity and care. Singling them out for special
services beyond that invites prejudice.
Richard DeWald, BSN Student
Univ. of TX - Austin.
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Uucp: ...{gatech,ames,rutgers}!ncar!asuvax!stjhmc!382!70!Richard.DeWald
Internet: Richard.DeWald@f70.n382.z1.fidonet.orgbrugler@cis.ohio-state.edu (Dale P Brugler) (08/22/90)
I beleive that the medical workers in a hospital should be informed if a patient is HIV positive. However, in 3 major hopsitals in my city (Columbus, Oh) it is policy that workers not be informed if a patient is positive. This means that I may be working on an HIV positive person and I may not know it at all. The purpose of such policies are to make all personel cautious with everyone. I disagree with such a policy. If I am sent to a room to draw blood from a patient, I want to know that there is a chance that I could be infected. Usually, when it is another disease or infection besides HIV you are informed. However, if the person is HIV you may not even know it yourself. I am curious as to policies at other hospitals on informing the personel of HIV status. Please post with your opinions. dale. -=- Dale Brugler, OSU (614) 292-0915 For personal mail: brugler@cis.ohio-state.edu OSU 2036 Neil Ave. Columbus, Ohio 43210-1277
jay@banzai.PCC.COM (Jay Schuster) (08/23/90)
In <38271@shemp.CS.UCLA.EDU> brugler@cis.ohio-state.edu (Dale P Brugler) writes: >I beleive that the medical workers in a hospital should be informed if >a patient is HIV positive. >However, in 3 major hopsitals in my city >(Columbus, Oh) it is policy that workers not be informed if a patient >is positive. The main hospital here (Medical Center Hospital of Vermont) is on Universal Precautions. As I understand it, this means that you are to assume that everyone is HIV/HepB/place-favorite-blood-borne- disease-here infected. >The purpose of such policies are to make all personel cautious with everyone. >I disagree with such a policy. If I am sent to a room to draw blood >from a patient, I want to know that there is a chance that I could be >infected. The problem seems to be that you and other people want to know so that you can be *more* careful with the infected patient. The hospital doesn't want to test everyone, or deal with the liability in the case of a messed up test, or deal with the privacy issues involved (once everyone in your town knows that you are HIV positive, you will get treated very differently -- and although that stuff is *supposed* to be private, medical staff tend to blab more stuff than is necessary most of the time, from personal experience). -- Jay Schuster <jay@pcc.COM> uunet!uvm-gen!banzai!jay, attmail!banzai!jay The People's Computer Company `Revolutionary Programming'
rhc@PacBell.COM (Robert Cohen) (08/25/90)
In article <38314@shemp.CS.UCLA.EDU> jay@banzai.PCC.COM (Jay Schuster) writes: ->In <38271@shemp.CS.UCLA.EDU> brugler@cis.ohio-state.edu (Dale P Brugler) writes: ->>I beleive that the medical workers in a hospital should be informed if ->>a patient is HIV positive. -> ->>However, in 3 major hopsitals in my city ->>(Columbus, Oh) it is policy that workers not be informed if a patient ->>is positive. -> ->The main hospital here (Medical Center Hospital of Vermont) is on ->Universal Precautions. As I understand it, this means that you are ->to assume that everyone is HIV/HepB/place-favorite-blood-borne- ->disease-here infected. -> ->>The purpose of such policies are to make all personel cautious with everyone. -> ->>I disagree with such a policy. If I am sent to a room to draw blood ->>from a patient, I want to know that there is a chance that I could be ->>infected. ->jay@pcc.COM writes: ->The problem seems to be that you and other people want to know so ->that you can be *more* careful with the infected patient. The ->hospital doesn't want to test everyone, or deal with the liability ->in the case of a messed up test, or deal with the privacy issues ->involved (once everyone in your town knows that you are HIV positive, ->you will get treated very differently -- and although that stuff ->is *supposed* to be private, medical staff tend to blab more stuff ->than is necessary most of the time, from personal experience). Don't forget that someone may be infected and able to tranmit the virus _without testing positive on the antibody test_. There is always the chance you could be infected if you don't take precautions, regardless of whether someone has been tested. I understand why medical professionals want to protect themselves, but the safest policy seems to be universal precautions. There is still rampant discrimination around this disease in this country. Until that changes, disclosure of HIV infection will continue to be a civil rights issue as well as a medical one. Take care, -- Robert Cohen San Francisco, California rhc@PacBell.COM {att,bellcore,sun,ames,pyramid}!pacbell!rhc work: 415-542-5517 home: 553-4033