To expect to be told if a patient of mine is HIV positive

[NCISaddict]

If I have asked them if they have any medical conditions I should be aware of?
I am aware that it is very difficult to catch and that they may have encountered judgemental attitudes in the past, which is totally unacceptable but if your condition could put your HCP at some risk (even though it would be small) then surely you should inform them?

Eminado I have no idea as to the patient's thought processes. I am speculating as to why the OP feels as she does and pondering an alternative reason as to her concerns, which is less about infection and more about her feeling 'unimportant'.

Draylon

"
It's very easy to say 'You should take all the precautions all the time regardless' is simplistic. I know I like to be told if a patient is a higher risk. It won't affect how I relate to them, because I'm a HCP, but it might make me adapt my approach a little,"

You make some good points.
However it is also easy to say that all HCPs are completely professional 100% of the time and that in the world we live in there is absolutely no reaction to\stigma associated with being HIV+. This is categorically not the case.

So it is easy for me to see why a patient may not immediately divulge this info.

I am not saying the OP is wrong to feel aggrieved.

But to suggest the patient was malicious
Or whatever is to me harsh.

Thank you Draylon, you said what I meant considerably more eloquently than I did.

Jessie

If you scroll up you will see I said so earlier.

I'm struggling to understand a paramedic not knowing that aseptic techniques are used to protect the patient from infection risk, not the HCP.

Very interesting thread. HCPs rely for their safety on patient trust, to some extent then. Yet as a pp upthread says, there are lots of reasons not to trust info systems within the NHS. And we are often told, as patients, "off the record" not to stick to the NHS rules. All the time in fact.

Arrgghhj! Just wrote a long post and the Internet bloody ate it!!!!

Ok the one sentence version.

OP, I think you are wrong on this thread. But I sympathize. You get the awful start of stories. When people are at their worst, scared, hurt, panicked, protecting themselves in probably very counter intuitive ways. You don't get to hear the endings, and the rebelling when people say 'my god, the ambulance came and they were amazing'.

But just because you don't hear it doesn't mean it's not true.

Then I wrote a massive post about how bloody amazing the paramedics were that helped me. And how they've made such a massive and lasting impact on me and my life.

And how they won't ever know what they did. How words can't say how wonderful they were. And it's probably good they don't as they'd get scared of the crazy lady hero worshipping them!

But I do think, maybe if you knew how much respect and good will there is for paramedics out there. Which you never get to hear.

Angels in green jumpsuits who swore with me like troopers and did medical wonders with just a bag and a souped up van...

They don't get less status than anyone working inside a hospital. They get a hell of a lot more from me... And every person I bore to death with my story of how paramedics changed my whole life :) By me actually having a life yes, but more than that too, by the way they cared and treated me like a human being when I was literally (actually literally embrassingly) screaming with pain, making no sense, complex medical background, terrified that I was going to die, with just me and my very little boy in the house.

But OP, if you had a disease, would you let your patient know so that they could make an informed decision whether to be treated by you or not?

Pseudonym Unfortunately if an HCP has a disease that can be transmitted then they are not allowed to work in situations where a patient could be put at risk.

NCIS I am a bit confused here. If a patient tells you they are HIV* then what would you then differently at that moment? So why don't you always do that 'differently' stuff just in case IYSWIM? Total respect by the way to all paramedics, they have helped me through some tough times.

If you know the patient is high risk then you are less likely to take gloves off, for example, to find a vein, unless, and this is a personal choice, the patient needed that cannula to save their lives. If it was a choice between potentially watching my patient die or taking gloves off to find a vein then all bets are off and the gloves come off.

I might attempt to take a bit more time to find some eye protection, again that would be based on how ill my patient was. If it's life or death I shoot first and ask questions afterwards so to speak.

A lot of a paramedics job involves making an assessment of when to go against guidelines as the surroundings are often less than ideal.
If I'm on the top floor of a multi storey carpark with a known IV drug user and a rather pathetic torch then I would say keep the gloves on and do your level best to avoid kneeling on a discarded needle.

If I'm attending a cardiac arrest in a care home with a clean floor and good lighting I am likely to be a little less selective about where I kneel. It's about dynamic risk assessment.

I have accepted that IABU btw.

Accidents happen OP and I bet that the patient is besides themselves if they know that you are going through an anti-contimination treatment.

Unfortunately, it's one of the risks that come with the job.

Luckily from the sounds of it the incident was fairly low risk. Still a shock to you though. Fingers crossed all is well and that they're just being fastidious.

OP I mean this in a nice way - though it probably won't sound it - but maybe the patient just didn't like you.

That probably sounds awful, but what I mean is....

You kinda seem to be making this about the patient's perception of your professional status. Now maybe that is it, and your patient is a hotshot lawyer thinking damn that little jumped up paramedic, I'm not giving her any private info.

But more likely they just didn't gel with you and felt weird or wrong disclosing.

I am not HIV+ but I do have a history which means I don't do vaginal exams, smears etc. I will often "lie" to HCP, particularly men, about why this is so. Because I don't want to talk to them about the nasty memories and how stupid the whole thing makes me feel. In fact the one HCP I have ever told was a lovely experienced homebirth MW.

I imagine there may be similar complex feelings around having hiv, feeling lesser, angry with oneself for the exposure, shame, or not able to fully come to terms with a disease which was until quite recently regarded as a horrible death sentence. Maybe they just didn't feel comfy, or they thought they could only steel th selves to go thru it once so waited till hospital etc.

What I'm saying is....it's not about you, maybe :)

Yeah....trust.

When the paramedics took me and Dh to hospital I said "thank you very much - you were great".

I didn't "need" to but I chose to because it was polite and I am a nice person.

I think this is similar - it would have been polite for them to tell you.

I think you all do an amazing job

isnt this one of the reasons that doing mouth to mouth isnt taught anymore when resusitating a person ....as in trying to save a member of the public when not in a hospital setting

You have asked the patient a vague question, to which you require a specific answer. Why should you be aware of a condition - is it for your benefit, or their benefit? It would be perfectly, in the way you have worded the question, for the patient to imply that your awareness of their HIV status would be for the patient's benefit - not yours.

This is the trouble with HCPs - patients ask specific questions, and only get vague responses, or HCPs ask vague questions and get a specific response. Then the HCPs moan that patients have omitted to tell them something.

Pseudomym "patients ask specific questions, and only get vague responses"

Patient "Am I going to Die"

Me "We can sort this out, just keep still and let me stick this needle in... and BREATHE"

But... Yup, you are right, that was a bit vague and on reflection, I was doing it wrong for 40yrs, should have been an honest "Yes" every time.

But to NCSIaddict, I promise, promise, that my last HIV was neg, HepB antibodies>1000 and HepC neg so even if I am on the top storey of a dodgy car park when I have my massive coronary/stroke/ruptured AAA please, please get on with it and not faff around getting into a hazmat suit. Thank you, I really would have done the same for you, even if I did not know you were a paramedic.

Paramedics kindly agreed with me that I'd be out by morning and it was hardly worth going and yes it's 1am but maybe just in case I should... Actually it would make them feel better if I went as they'd be worried and of course I was too polite to let them worry

Etc etc etc

As one of them kindly packed a bag for me 'just in case', and blue lighted it to the hospital.

It was really 'just in case I make it' vs stayed the night but I was too scared to admit it one second, but the next they were holding my hand and stroking my hair as I wailed in pain and terror and I knew I was dying like my sister. they told me of course I wasn't going to die, wasn't I was going to come back tomorrow to kiss my little boy? Yes yes, that's what was going to happen.

And round and round in circles.

Bet I was a right pain. So grateful to them and the whole humouring me thing and lying through their teeth really convincingly was a sign of how skilled they were, not a rubbishy inaccurate diagnosis or fact gathering exercise :)

I wasn't home in the morning btw, but I also didn't die, so pretty much nothing that we talked about came true!

It's a sensitive subject. I'm a ward based HCP. I witnessed a colleague removing a cannula, not quick enough with the swab, patient was a "spurter" and the blood went all over my colleague's face. The patient was happy to have her bloods tested for HIV.
I had a patient who was self injecting Clexane. She was careless with sharps disposal, and I trod on a needle which went through my shoe and pierced my foot. This patient refused the blood test, was very angry about being asked and put in a complaint saying she was singled out and victimised.
Another patient declared her HIV status, but put in a complaint because one HCA always gloved up to take her BP, but not for any of the other patients.
I can understand the OP feeling upset that she wasn't told but a&e staff were, I had a new patient refuse me taking bloods as she had seen me taking meals to patients and assumed I was catering staff!

Comments about the adequacy of the OP's raining are beside the point. She has clearly changed/not given specifics for reasons of confidentiality. She is not deficient in training! I understood her to be asking whether a patient should have the courtesy and respect for her as a HCP to tell her something.

I would say the answer is yes.

(Compare this with the chicken pox threads....

But Bluejug don't you think that part of the OP's training should be as follows:?

"people don't have to tell you about HIV status. People often lie. Ill people are often inconsistent, discourteous and irrational (as are well people). You must not let these things get to you and waste mental energy taking offence."

If I was really taking offence then I would have said something to the patient, complained,made a fuss at the time etc.

I have had abuse hurled at me on numerous occasions, in the past week alone I've been called a dyke, a slag and been hit, none of these by people who were more than slightly unwell and I've just carried on but guess what I'm human too and sometimes , at the back of my mind, I do have a twinge of irritation. I'm sorry I'm not perfect but I do try.

I guess it goes back to the opinion of a previous poster that we are more able to withstand abuse than normal people. I guess we are to a certain extent (the frequency of it does make you slightly thicker skinned) and I know that I will probably attend the patient who I know to have HIV again and it will not change my attitude towards them in the slightest even if they don't tell me again.

It's certainly not the first with that condition and won't be the last. I'm equally a bit miffed when a patient with active TB doesn't tell me which has also happened.