Wednesday, June 25, 2008


Before I tell this story, let me just express my intense hatred of all Microsoft programmes. I hate my Microsoft. It is unpredictable and unreliable. I hate it hate it hate it hate it hate it. That off my chest, lets begin...

I recently saw a patient with a serious medical condition and another, even more serious, underlying medical condition.

The patient was started on treatment for the one condition but treatment of the other condition was delayed.

The patient then returned. He had applied for temporary disability leave form his employers and had brought a ton of some forms for me to fill in. Included with these millions of one or two forms was a consent form. The consent form stated that the patient grants permission to his doctor/medical practitioner/health care professional/nurse/any other person who has ever had any medical contact whatsoever with the patient ever to disclose any and all medical conditions/blood results/lab reports/x-rays/correspondence about/any medical information whatsoever pertaining to the patient. Basically.

I asked him if he understood what this form meant and he seemed to have no idea, so I told him that it meant that I could tell his employers about all his medical problems, including the very serious medical condition that he had, and give them copies of all his blood results, etc. He said that he only wanted me to tell his employers about the less serious illness. Again I explained to him that he had signed this form and that it was a legal document giving me permission to disclose all his medical information. He said that he did not want his employers to know about the underlying condition.

This obviously left me in a bit of a predicament. I now had to decide whether I should fill in the forms in their entirety as the employers requested on their forms, in view of the signed consent, or whether to only disclose information about the one condition.

I wasn't sure what the legal implications were - whether I was legally obligated to disclose, all things (including a signed consent form) considered. I reasoned though that consent is fluid and that a patient is allowed to withdraw their consent at any time. I also felt that my ethical obligation to the patient outweighed any other present obligations.

So I filled in the forms, only disclosing information about the one condition and indicated that the patient had asked me not to disclose any other information. There was also a "declaration" section which I had to sign which stated that all information I supplied was true and correct. I had no problem with that, but it also stated that I had not withheld any information. I drew a line through that section and signed it.

Afterwards I felt uneasy about the whole situation and sought legal advice from the medico-legal society of which I am a member. I was advised that I had done the right thing and that I was legally in the clear. I was relieved but felt that I had always been morally in the clear.

Tuesday, June 17, 2008

Germs are NOT for sharing

Anyway, so I’ve been impregnated again by the said caboodle-hole.

Pregnancy really changes your perspective on things. For one, paranoia.

Now I’m paranoid on a good day - I’ve always had mild OCD which I manage to keep reasonably under control in my every day life and doesn’t affect my work too much - but being pregnant elevates my paranoia to a whole new level.

Working with HIV patients on a daily basis, there’s always that fear in the back of your mind that you’ve picked it up somehow. It didn’t help that at a recent conference I attended we were given statistics of doctors
who have seroconverted after exposure to HIV infected blood – some supposedly through blood splashes on the skin. Freakin blood splashes on the skin! Now, I’ve had blood splashes on my skin – who amongst us hasn’t – so that made me worry to no end. Then I thought to myself that I should have myself tested again (my last HIV test having been as an intern after a blood splash. The patient turned out to be negative though, thank God! And so did I) but like most doctors I am terrified of having HIV and even of having an HIV test. It’s ridiculous I know. I’ve discussed it with other doctors before and even though we keep telling patients to “know your status”, the truth is, we're terrified of being tested ourselves in case it’s positive. Anyway, so I reasoned to myself that if I was positive, I’d better find out now since I’m pregnant and it would be irresponsible if I did have it and passed it on to my baby. So I got tested ... and it was negative! WHAT - A - RELIEF!!! Even caboodle-hole was relieved because it basically meant he didn't have it either (and his risk is even bigger than mine. He even went and pricked himself recently.)

Then my assistant got diagnosed with TB (by me FYI) and I started worrying that I had that. I worry about TB everyday anyway but now I felt like it was really possible that I had it. Nevermind the small fact that I was asymptomatic.

I’ve since seen to two people with suspected MDR TB and every day at least one undiagnosed TB patient comes into my room coughing their freakin lungs out. Great. So I’m spending the majority of each day breathing in TB bacilli infested air.

Then, to add to my paranoia, I’ve been having sacro-iliac pain. Now, I know that it’s because of the pregnancy, but at a recent talk, this HIV medicine guru presented a case study about a guy who had chronic sacro-iliac pain which turned out to be caused by a retro-peritoneal TB abscess. I know that I don’t have a retro-peritoneal TB abscess, but I just can’t stop thinking about it.



I've taken a very extended break from blogging, partly because I went
on a long holiday, but mostly because when I got back, someone very
close to me went on a blog radio talk show and failed to mention my
blog when asked a question that was directly relevant to it. This made
me question my writing ability and I lost confidence and motivation.

What his actual reasons were I will never know, but I've since decided
that he was just being a caboodle-hole. So now I'm back...