Medical Risk to Physician and Patient

Traditionally, the ethical imperative for physicians to provide care has overridden the risk to the treating physician, even during epidemics. In recent decades, with better control of such risks, physicians have practised medicine in the absence of risk as a prominent concern. However, potential occupational exposures such as HIV, multidrug-resistant tuberculosis and viral hepatitis necessitate reaffirmation of the ethical imperative.

Physicians should evaluate their risk for becoming infected with pathogens, both in their personal lives and in the workplace, and implement appropriate precautions. Physicians who may have been exposed to pathogens have an ethical obligation to be tested and should do so voluntarily.

Infected physicians should place themselves under the guidance of their personal physician or the review of local experts to determine in a confidential manner whether practice restrictions are appropriate on the basis of the physician’s compliance with infection control precautions and physical and mental fitness to work. Infection does not in itself justify restrictions on the practice of an otherwise competent health care worker. Health care workers are expected to comply with public health and institutional policies. As the diseases mentioned above may be transmitted from patient to physician and because they pose significant risks to physicians’ health and are difficult to treat or cure, some physicians may be tempted to avoid the care of infected patients.

Physicians and health care organizations are obligated to provide competent and humane care to all patients, regardless of the stage of the disease. Physicians can and should expect their workplace to provide appropriate means to limit occupational exposure through rigorous application of infection control methods. The denial of appropriate care to a class of patients for any reason is unethical. Whether physicians should disclose their condition depends on the likelihood of risk to the patient and relevant law or regulations in their locales. Physicians should remove themselves from care if it becomes clear that the risk associated with contact or with a procedure is significant even if appropriate preventive measures are taken. Physicians are also obligated to disclose their condition after the fact if a clinically significant exposure has taken place.

Physicians have several obligations concerning the risk of infection. They should help the public to understand the low level of this risk and put it in the perspective of other medical risks while acknowledging public concern. Physicians provide medical care to health care workers and part of this care is discussing with health care workers their ethical obligation to know their risk for such diseases as HIV or viral hepatitis, to voluntarily seek testing if they are at risk and to take reasonable steps to protect patients. The physician who provides care for a seropositive health care worker must determine the health care worker’s fitness to work. In some cases, seropositive health care workers cannot be persuaded to comply with accepted infection control guidelines or impaired physicians cannot be persuaded to restrict their practice. In such exceptional cases, the treating physician may need to breach confidentiality and report the incident to the appropriate authorities in order to protect patients and maintain public trust in the profession, even though such actions may have legal consequences.