Wednesday, August 19, 2009

Informed consent preventing testing?

I recently saw a patient that had pneumocystis pneumonia - an infection that pretty much only occurs in immunodeficient people and is an indication for HIV testing. In many states written consent from the patient is required prior to HIV testing. Consent prior to HIV testing dates from the late 1980's when HIV was a new, stigmatized disease that was essentially a death sentence. States enacted laws to protect patients from health care workers testing them for the deadly disease without them knowing. Now, however, HIV is a treatable disease that, if caught early could allow the patient to live a relatively normal life. The greatest barrier in decrease of HIV-related mortality and the decrease in the spread of HIV is knowledge of HIV status. There was a recent study in the American Journal of Preventive Medicine that showed that states with a written consent law have a decreased rate of HIV testing than those without. And another study showed that the cumbersome requirement for obtaining written consent from the patient has discouraged physicians from performing HIV. I personally think that that HIV should not be singled out as requiring written informed consent prior to testing (I think it continues the stigma associated with HIV). Either all testing for sexually-transmitted or blood-borne infections should require written informed consent or none of them should. But, it's pretty bad that physicians are avoiding the test only because they have to obtain written permission from their patients.

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