AIDS Guidelines for Doctors

January 25, 1991

There is a minuscule chance of a doctor catching AIDS through a skin prick while working on an HIV-infected patient: 0.2 percent, according to a Johns Hopkins study. Last month, when reports surfaced that Baltimore surgeon Rudolph Almaraz died of AIDS, less than 40 U.S. health-care workers had contracted the disease at work.

That small percentage has not mollified physicians seeking routine disclosure of their patients' HIV status, however. Thus, it is no surprise that the even smaller probability of patients catching AIDS from their doctors failed to reassure many of Dr. Almaraz' patients. Fear is a potent motivator.

Florida dentist David Acer, in what is considered the first proven instance of doctor-to-patient infection, left behind three patients infected with the same AIDS strain that killed him. Those infections have heightened the fears of many medical and dental patients, prompting calls for disclosure of any doctor's HIV positive reports.

In reaction to society's fears, both the American Medical Association, representing 300,000 doctors, and the American Dental Association, 150,000 dentists, have called for disclosure or voluntary restraints on infected surgeons. "Until the science is clear, you have to opt on the side of patient protection," said Dr. M. Roy Schwarz, senior AMA vice president for medical education and science. Indeed, the Atlanta-based Centers for Disease Control has been considering new restrictions on HIV-infected health-care professionals who perform invasive procedures. The center's guidelines, due in March, will be based more on science than fear.

The medical and dental associations have over-reacted. Medical personnel have greater chances of contracting or passing hepatitis than AIDS, and hepatitis is unquestionably life-threatening. Yet no AMA-ADA guidelines have been rushed out to restrain care-givers from treating patients without first making sure their inoculations are up to date.

Still, it is clear that hospitals have a right to know the health status of clinical personnel. An individual physician or dentist may have a small chance of passing the AIDS virus, but a medical institution staffed by hundreds of professionals should know about that chance as it treats thousands of patients. A hospital with a surgeon dying of AIDS could review the risks of his assignments. Patients' fears will never be entirely quelled but some reassurance can be gained if the medical institution has the tools to protect patients from potential infection.

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