When the Doctor Has AIDS

December 05, 1990

A study quoted by a Johns Hopkins doctor says that a surgeon operating on an AIDS patient has a 0.2 percent chance of catching the disease from an accidental skin prick, and that the chance of transmitting an infection from doctor to patient is smaller still. That is a statistic the estimated 1,800 women treated by Dr. Rudolph Almaraz before he died of AIDS should keep in mind.

Discovering that your surgeon had AIDS, though, is jolting. But the statistical probabilities should allay the fears of many such patients.

What's needed now is a thorough study of Dr. Almaraz' patients' health, for their reassurance and for verification of the statistics in a real-world case. Theoretical risk assessments are one thing; peace of mind, for these patients and for a nervous public, is quite another. According to other statistics, 5.3 percent of U.S. health-care workers have AIDS, and 37 contracted it at work.

A study that found all of Dr. Almaraz' patients AIDS-free would be the best news of all. While American Medical Association policy says AIDS-infected doctors should "consult colleagues as to which activities the physician can pursue without creating a risk to patients," no law requires it. No law enforces the AMA's recommendation that infected doctors "should not engage in any activity that creates a risk of transmission of the disease to others." Should a study of Dr. Almaraz' patients indicate the doctor did not infect any of them, it would indicate the AMA's policies need no strengthening; a contrary finding could lead to a reconsideration of this policy.

Doctors themselves are pressing for the right to know about patients infected with AIDS before performing surgery. Maryland hospitals are now required to notify paramedics when they have transported people infected with the AIDS virus. As one medical ethicist put it, don't patients have the same right to know?

Some form of disclosure ought to be required. In Dr. Almaraz' case, the doctor refused to tell Johns Hopkins Hospital about his illness. That's bad for the hospital -- which might have wanted to review his assignments -- and unfair to the patients. Requiring an infected health-care worker to tell the medical center about the disease seems prudent. It would make the AMA's recommendations more useful and could ease patient uncertainty. And where the patients themselves have heard rumors of the physician's illness, it's downright foolish to try to keep the facts from them.

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