To think consent is required to do a HIV or hepatitis blood test??

I spent several years working for a pilot rapid test scheme in a developing country, I couldn't begin to tell you the number of positive tests I have conducted on people who couldn't possibly have contracted HIV. Routine testing is designed to catch the people who don't think they have it, because anyone can get it, and people lie. You're taking it personally because of stigma.

Wow!!

I’m shocked by this. YANBU OP- consent should be a requirement.

It's not judgy.

It's just facts.

I couldn't have got through sex.

Needle use.

My mother being pregnant with me.

Or any other way that HIV is transmitted. So how could I have got it? It was a waste of time and resources for the NHS.

Which could have been better spent on my friend Ant who has been living with HIV for the past 20 years and watched his lovely partner die of it in the early 90s.

HIV testing should be done much more routinely than it currently is. Shouldn’t be any different to having any other blood test. Finding out you have it and starting treatment is always going to be better than not knowing, whilst it quietly destroys your immune system.

HIV infections in heterosexual relationships are on the rise

https://www.gov.uk/government/news/rise-in-hiv-diagnoses-steepest-among-heterosexual-men-and-women

You are being tested because it is clinically indicated. Some places operate an opt out system because otherwise patients would refuse the test because of past stigma. The earlier patients are diagnosed the better the prognosis.

You can live a long and fulfilled life with HIV with the advances in modern medicine. Dr Pembleton wrote in the spectator a few years ago that he'd rather have HIV than diabetes.

It’s done as routine in my A&E. I don’t really understand the objection to it, tbh

I think you are quite judgy. There are people with HIV that were also virgins, non drug users and had nice parents.
how horrible that you still talk like that.

But if you have been pregnant in the last 20 years or attended a sexual health clinic you will have had an HIV test. So many, many people will have.

That is appaling and worthy of a complaint to the local trust. I think many of us are a bit too compliant with what information the government holds on us. Look at the ridiculous ideas & suggestions during covid which included a requirement to hold a vaccination card to enter public spaces.

I was tested for HIV as a teenager at A&E with a scalded hand. It was part of a regional pilot.

I explained I would prefer they didn't as I was a virgin who had never taken drugs or used dirty needles, and my parents (due to strict religious beliefs) had been each others only sexual partners so no chance my mother passed HIV on at birth, so it was a complete waste of NHS time and resources. They went ahead anyway and staff member was quite rude to me about "judging lifestyles" and I also had to have a telephone appointment to discuss my (negative) result which appeared to have a 20 minute script that was another waste of NHS time and resources.

I went through it all recently again at A&E with heart issues and wasn't given the option of opting out. They'd already taken the blood and filled out the paperwork. I did say this time, "I think it's a waste of time as I know I don't have HIV, so if there's any chance it's going to delay me in A&E and waste resources, please could we not?" The sexual health HCA then paid me a call, to explain "it's not a moral or value judgement of your lifestyle, it's just a scheme that's being run at the moment..." and I got a long "education" on HIV, the scheme, why it was important, what would happen in the event of a positive result and to cut a long story short was manipulated into giving my consent after my bloods had already been sent to the lab. And probably manipulated into not complaining too.

And the same patronising HCA called me back for another long spiel with the (negative) results, how to keep safe in future etc.

I just had no option but to keep nodding and listening...I was more worried about the heart condition at the end of the day and just wanted to be appropriately cared for.

ETA...I was especially annoyed because the HCA was a general A&E HCA who'd taken on an additional sexual health/HIV screening role and I couldn't believe the waste of resources when there were very sick elderly people in the corridor next to me who were getting next to no attention or care, being left in their own waste, covered in vomit. It was heartbreaking. The NHS really gets it wrong sometimes.

I was in hospital six months ago and they were forever taking blood. I’m sure if I’d of asked they’d of given a detailed run down but really I felt awful so someone saying I’m just going to draw some blood for testing was sufficient. I think they do lots of tests as every time it was 4 or 5 tubes with different coloured lids.

”infection markers” covers any infectious disease. HIV and Hepatitis are infectious diseases.

When they say “I’m just going to take some blood,” and you roll up your fsleeve and allow them to insert the needle, you have given consent for them to test for whatever it is they’re testing for. Including routine screenings for conditions such as HepB and HIV.

Of course you can ask what they’re testing for and they will tell you. Equally if you have a routine blood test booked the elements they’re testing will appear on the blood form.

But to suggest that you need to give consent for each individual element being tested for just isn’t feasible. By all means if you object to being tested for HIV or hepatitis’ B you can easily object at the time by asking “are you testing for HIV?” But a full blood count is massive. And there are multiple elements which are sub counts etc.

When I have blood tests they test so many things I would be there all day if I individually consented to each one of them. When I went for my transplant assessment they took ten bottles 😱. They actually do send the blood results to me as part of the letter they send to my GP, and most of it to me is like another language, except the NT pro BNP level which is my little obsession as it gives an insight into how bad my heart failure level is.

That's an interesting point. Our blood results are uploaded onto their maternity app. Plus we have the ethos of women centred care and working in partnership with the women so we are meant to have informed med consent, it's a standard

If I'm taking pet bloods, I'll say we are looking at liver function, kidney function, full blood count and coagulation. If I'm doing a torch screen I say we are looking for infection markers including toxoplasmosis, parvovirus, rubella etc. Most people are happy with that but if someone wishes to have more detail then that's for them. I've personally never known anyone to want a full breakdown into every result. Yes in a very busy dept it's hard to find the time but that's the patients right.

From the letter it sounds like they haven't done the tests on your blood, although it doesn't say why, so you haven't had the tests you object to and the information you would have been given if you had is conjecture. Presumably you consented to the blood being drawn and could have asked questions then?

If your job was eg changing tyres, would you still consider it right your employer had that information?

As an example working at Kwik Fit which is owned by a massive Japanese corporation. They have holdings within insurance and healthcare among many others.

I'm perhaps a bit anti establishment, but I do have distrust of my personal information being readily available to those who may profit from it. Especially with the amount of data stored about each individual and the ease it can be accessed.

It's hard even to do that tbh as kidney function on NHS app won't be called kidney function. It'll either be "U&E" or "urea and electrolytes" if its written in full as we are inherently lazy and shorten everything

I don't actually know if hospital tests show on NHS app or not

As an anaesthetist it doesn't really feature in my daily life much

I'm sure they did this screen without mentioning it specifically when I was last pregnant. I was surprised my colleague in healthcare said she couldn't do it to a patient without permission I has assumed it's a given bloods will pick up lots of stuff and screen for whatever they need

At the risk of a pile on, I wonder if there is a bit of a split between professionals whose patients will see their results on the NHS App and those who won't.

It can prevent a lot of anxiety if you give patients an overview of the tests being ordered, so that they don't panic when results are uploaded. It is possible to keep in brief, while explaining that you are requesting tests on their blood count and kidney function to check for underlying causes.

It's v individual, I couldn't give a monkeys if my employer knew I was tested (well I wouldn't be allowed to work if I didn't given we get rechecked pretty much annually when changing Hospitals as a trainee or if we get needle stick injuries). But spose we see the test as no different ti checking my blood group type, whereas clearly a lot of people feel otherwise

I'm with you on where does my medical information go beyond my treatment within the NHS. As an example, I bet most of you who have attended orthopedics will have in the following weeks had phone calls from no win no fee solicitors.

Or look at recent cases where whole health services have had their data breached. Despite modern changes in treatment or attitudes, would I want eg my employer to know I have had a test for HIV. Probably not.

Theres posters advertising allowing opt out if people are that bothered. We don't request informed consent to check how your kidney function is doing, we just say we are taking bloods. It's nothing to do with the shop floor staff it's a public health england/government decision to screen for the greater good of society (stop transmission) and the individual (start treatment)

I think the question is, why not ask for consent for 'routine' testing? How is it ethical not to, and how does it fit within a framework of informed consent?

You have no idea how many tests we do on one bottle of blood is the issue.

Everyone that comes into a&e will get an fbc, u&e, lft, and coag as a bare minimum so a test of all the blood cells in the blood (about 12 sub groups), the kidney function including the 3 waste products, the electrolytes in the blood so sodium potassium (often magnesium calcium etc), the liver function whilst is broken down into synthetic function and non synthetic function (how it aids clotting how it breaks down drugs and the enzymes within it that can be abnormal) and coag which tests clotting (the intrinsic and extrinsic pathways) etc etc etc

That's me trying to summarise the absolute bare basics the 3 bottles everyone on arrival gets taken

Then a patient goes soooo why are you checking my clotting function? But what does the intrinsic clotting function even mean? What relevance does that have to do with why I'm here?

Here's a pic of it broken down for curiosity sake

https://www.google.com/search?client=ms-android-samsung-ga-rev1&sca_esv=b3de37e104a03232&sxsrf=ADLYWIJSJ_r8y9W_tPWgeI67YzRbn-5wjg:1736944302820&q=clotting+cascade+diagram&udm=2&fbs=AEQNm0Aa4sjWe7Rqy32pFwRj0UkWd8nbOJfsBGGB5IQQO6L3J4_FwOQtqm4cCg_Qh1pkh2ZthneR6l1GUCLLAfTEbquzaCKoazqq2MHEdExgWbLaefp2xFPyBN4LuHHsu35gG7vU2jtFgTl7QI_T2AaaoZcLhf5rZmOjG0vIhZJn1YEJDDs8rbu7CmMFQmIAJgISHGyZdwId-v0Gwlw0YVk2_KCDhZqj_A&sa=X&ved=2ahUKEwi96qfh3feKAxUNUUEAHVbVM2gQtKgLegQIERAB&biw=412&bih=756&dpr=2.63#vhid=gFU5dYDKzij2wM&vssid=mosaic

Etc etc etc we do not have the time of day for that. Sure if someone asks me what bloods I'm taking ill tell them, but 95% of the population couldn't care less what bloods I'm taking, providing they get better or treated, thankfully.

It shouldn't be different though. If a test needs to be done, informed consent needs to be obtained in advance. It doesn't have to be as difficult as some people are making it out to be. e.g. we'd like to take a blood sample to test for a,b,c,d,e. In line with Trust rules/current national guidelines (whatever the case is), we also run 50 other tests. A list of these can be found on the back of this consent form. If you have any questions, please let me know.