It was a hot summer morning of 1992 when a bright young surgery resident stood up to address the Department of Surgery. The venue was a Government Medical College auditorium in Bombay, and the young resident was going to talk on a new subject: ‘AIDS and the Surgeon’. Listening with curiosity (for AIDS was only just beginning to register in Indian minds) were students, postgraduates and teachers of the Department of Surgery.
The resident talked of the HIV virus and the disease, and turned the topic to something far more interesting. “Given that the risk of getting AIDS through a contaminated needle prick during surgery is very low, how much lower are the chances of an HIV positive surgeon transmitting the disease to his patient? Should an HIV positive surgeon be allowed to operate on patients?“, he asked.
That resident was me. Those questions were unanswered then. Today, prompted by Ergo’s post, I will try to answer them.
Look at the issue from a rights perspective. A patient deserves to be informed about his or her risks to be incurred during or after a surgery. For example, if you undergo a bypass surgery, you should know before you sign the papers that there is a risk of a lung infection or bleeding or dying from something else. Would you not like to know if the surgeon you are getting operated on by is HIV positive or not? Not unlike your wanting to know the HIV status of the guy (or girl) you are going to marry.
Looking from the perspective of the surgeon or dentist, any disclosure of a positive HIV status would spell the end of his career, and a major chance of starving to death. Because surgeons are generally not good for anything besides their own craft. Now, how reasonable is it to expect a man to condemn his existence by being honest and truthful to his patients, saying “I would like to operate on your prostate tomorrow, but I would like you to know that I am HIV positive. Don’t worry, I will take care….hey, where are you going? Please come back, lissen, will ya?”
Surprisingly, this has happened in real life. Professor George Browning, an ENT surgeon, was allowed to operate on his patients at a hospital in Glasgow back in the 1990s. His patients were considerate and understanding, and signed consent forms where his HIV positive status was clearly mentioned. He was the first known HIV positive surgeon to be allowed to operate. But would others be as well treated as he was?
The risk of the virus going from the surgeon’s body into the patient’s is said to be very, very small. However, the case of American orthopedic surgeon Dr. Scoles comes to mind. He was thrown out by his hospital because, as an HIV positive surgeon, even though the risk of his transmitting the virus to patients was very low, he was still a “significant risk”. Allegedly, there was a significant chance of his blood coming in contact with the patient’s.
Scoles lost his career, though he won a court case against the corporation owning the concerned hospital.
It is interesting to note that while he was discriminated against on the grounds of the principle that “the only acceptable answer is: no risk”, the hospital concerned had a significantly high death rate when cancer patients were admitted into their intensive care units. So did the hospital inform its patients before admitting them that they were twice as likely to die of pneumonia than in some other center? You bet not!
Scoles’ defendants asked: “With this in mind, who faces the greater risk: [..the hospital’s] cancer patients, or those seeking orthopedic surgery from an HIV-positive surgeon with an unblemished record?”
As a patient, you expect your surgeon to possess certain skills and standards. However, as a human being, is he a risk-taking type? Does he do drugs? Does he get drunk sometimes? Does he abuse people when agitated?
Would every patient be entitled to such personal information about their surgeon, because in specific cases it may be life-saving? Where does a surgeon’s right to privacy end and the patient’s right to know begin?
I have known of ‘great’, macho surgeons being absolute drunkards outside and inside hospitals. They have operated while being piss-drunk, or sniffed anesthetic gases before and after surgery, and no one really knows how many they have killed.
Therefore, these questions do have a valid, rational basis, though they may have sounded far-fetched at the outset.
My opinion is that an HIV positive surgeon, while maintaining his own confidentiality, should shift to mainly consultation, or do minimally invasive procedures, where there is minimal risk of his coming in direct contact with his patient’s blood. He should also keep a back-up surgeon in case something goes wrong and an invasive, open procedure is needed.
In recent years, the issue of HIV positive surgeons is being tackled in a pragmatic way. Various UK Government Health bodies have opined that “…it is no longer necessary to notify every patient who has undergone an exposure prone procedure by an infected HCW because of the low risk of transmission and the anxiety caused to patients and the wider public.”
I started off by talking about a young surgeon, back in 1992, giving a talk on ‘AIDS and the Surgeon’. He ended his talk by advising the audience to wear double gloves to protect themselves against accidental inoculation with HIV-tainted blood. His Professor then took the mike for expert remarks. The Professor said, “…He has given us new issues to deal with. However, one thing I must tell you: as a surgeon, you must do everything you can to prevent getting AIDS from patients. And the best way to do that is….USE A CONDOM!”
*General disclaimer: this blog and its owner have been certified as HIV negative*
*For a fascinating account of the Scoles case, read this article.*