Junior doctors are undergoing HIV tests as part of pre-employment occupational health checks without being made aware that such testing is not mandatory, according to research published in the Journal of Medical Ethics. Many junior doctors interviewed by Lee Salkeld and colleagues held the misperception that HIV testing was compulsory and felt unable to decline the test. In addition, interviewees felt that they had not been provided with enough information about the test or about the impact of a positive result.
According to guidance published by the Department of Health in 2007, all new healthcare workers need to undergo tests for tuberculosis and hepatitis B, and should be immunised as necessary. Only those who will perform exposure-prone procedures – i.e. people who will undertake invasive procedures where there is a risk that the patient’s open tissues could be exposed to the blood of the worker – are required to have an HIV test.
Several of the 24 junior doctors (foundation years 1 and 2) and doctors in specialty training (years 1, 2 and 3) interviewed by Salkeld et al., however, commented that the requirement of an HIV test was simply presented as just another part of a long list of tests that were necessary.
This lack of pre-test discussion meant that most of the doctors were unclear about the implications of a positive HIV test. One even asked: “I wonder if they’d have sacked me if it was positive. No one really explained what would happen if it were positive either—would my bosses have been told about it?”
The DoH guidance suggests that healthcare workers could benefit from these regulations “both personally and professionally”. Most of the junior doctors interviewed by Salkeld et al. thought that HIV testing was for the benefit of patients, though; few mentioned the benefit to themselves of knowing their HIV status and being able to access treatment should they be HIV positive.
There have been only two cases of HIV transmission from doctors to patients worldwide – one involving an orthopaedic surgeon and the other an obstetrician, neither of whom were practising in the UK. The risk of HIV transmission from healthcare worker to patient is eximated to be between 1 in 42,000 and 1 in 420,000, although the risk of patient-to-doctor transmission is 1 in 300.
Given these figures, the authors ask “is this somewhat utilitarian Department of Health policy justifiable?”
Salkeld L et al. (2009) HIV testing of junior doctors: exploring their experiences, perspectives and accounts Journal of Medical Ethics 35 (7): 402-406. DOI: 10.1136/jme.2008.027052