Health InsuranceJunior Doctors Feel "press Ganged" Into Occupational HIV Tests
Junior doctors working for the NHS in England feel "press ganged" into having HIV tests, reveals a small study published in the Journal of Medical Ethics.
The findings are based on in depth interviews with 24 junior doctors, working, between them, for four NHS hospital trusts. All the doctors had been offered an HIV test as part of their pre-employment occupational health checks.
In 2007 the Department of Health issued new guidance relating to health screens for doctors working in the UK. This stipulated that all staff should be offered tests for the serious blood-borne viruses hepatitis B and C, HIV and TB to protect patients from infection.
But the guidance makes it clear that the tests are not mandatory for doctors whose work does not expose them to these viruses, nor are they a prerequisite for employment.
The doctors interviewed during the course of this study said they were unaware that they might need an HIV test until they received the letter from their prospective employer.
They said that they were not given any information about the HIV test or told why they needed to have it - prerequisites of giving informed consent to a procedure - either in this letter or when they actually had a blood sample taken.
One doctor said: "The only discussion I had with somebody about the test was to say: "we"re going to test you for HIV. Is that OK?" and then being stabbed." Another said: "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?"
Only three of the doctors were actually asked about behaviour that would have increased their risk of acquiring HIV; none felt they had been at high risk. Few were offered any follow up counselling or discussion, which would have been provided had they been ordinary patients. Most of the doctors did not feel they had the option to refuse the test; only four did so.
Only two patients in the world have been infected by a doctor. Neither was in the UK.
The risk of transmission from healthcare workers to patients is in the order of 1 to 42,000; the risk of transmission from a patient to a doctor is 1 in 300.
But the authors point out that in addition to the manner in which it is carried out, the HIV testing policy offers false reassurance to patients. It only applies to new employees or those taking up a new post, meaning that senior doctors who may have been performing high risk (for HIV acquisition) procedures would not be tested.
"The new policy provides false reassurances to the general population that doctors performing exposure prone procedures are free from HIV," they say.
Journal Of Medical Ethics