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

[Onionbhajisandwich]

Hi all,

Please tell me if I’m wrong here but do the NHS require consent to test for HIV or Hepatitis?? I would have thought they did.

I attended A and E last month (sent by my GP) as I had suspected pneumonia. I received a text today stating this:

“You recently attended the Emergency Department. We are part of an NHS programme testing for HIV, Hepatitis B and C but your test wasn't processed due to technical issues. Please attend one of the walk-in blood test centres, Mon - Fri 8am- 4.30pm. We requested the repeat test electronically, so please give your NHS number on arrival. We will only contact you if the test is positive and you need care”

I’m a bit surprised that they can screen you without consent - as far as I knew the blood tests that they did we for infection markers and a full blood count, along with one that checks for clotting.

I won’t be attending to get the tests done as it’s within work time but aibu to think this isn’t ok??

When it’s a clear yes/no diagnostic result the test should be explained beforehand. All illness checked for in a blood test needs consent for the test.

As others have posted, back in the 90s it was certainly the case that just having had an HIV test was a negative marker for some insurers, leading to either higher premiums or no cover. Not becuase you had a positive result, but becuase the fact you'd even had a test was an indcator you led a more 'dangerous' lifestyle.

Now, thats not the case today, so at one level there is no problem. However, with the current government talking about selling access to anonymised medical data to 'turbocharge growth' I think it's even more important than ever that consent is given for every test / procedure

Genetic testing takes a huge amount of counselling. We have to consent parents for genetic testing at times, and the consent form has to cover things like incidental findings which can have a massive implications.

HIV testing / Hepatitis testing is and should be becoming more routine, it is in pregnancy, it actually disadvantages those who don't become pregnant if they are never tested. Would you be upset if they had tested you for high cholesterol or diabetes ?

It would take forever for eg when I send an fbc off I get about about 12 different sub components of the blood back. Most I'm not bothered about as I'm not a haematologist but to sit and explain every one would take an age and lots of cell diagrams

Another eg ... vascular patients are high risk for diabetes, if they haven't had a test in the last 12m it should be done as part of their admission, we don't always (often do) say we are specifically testing it. Same with recurrent abscesses, more than one abscess needing iv antibiotics or surgery = diabetes check. There is so much we do routinely that is just part of the job that if people consent to treatment comes as part of that.... would you rather not know you have diabetes and hence no treatment and risk vision loss/toe amputations etc... its not much different

When you go in to A&E and they take routine bloods to find eg infection markers for pain etc etc they don't tell you the individual breakdown of things they are looking for / requesting. They just say we will take a few tests, take a couple of vials of blood and on they go. Nobody questions what things they are being tested for but I am sure if you asked, you'd be told.

Why would looking for tuberculosis cultures for example not be scrutinised but looking for HIV would? I agree with stigma as PPs have said.

People put a lot of responsibility on other people when in actual fact, it costs you nothing to simply ask 'could you please let me know the exact things you're testing me for before you take my blood'.

How would people feel if the test in question was liver function tests? These are also frequently done on first presentation in A&E for a number of conditions, along with assessment of kidney function, blood counts and inflammatory markers.

What about checking the cholesterol and diabetes status of people with heart disease?

FWIW I do think as HCP we should tell people what tests we are requesting (and I do so long as people are well enough), but I suspect this is more about misplaced perception of prejudice relating to HIV, than a blanket concern that HCP are looking for underlying causes of disease without explicit consent.

I just don't understand why you'd object to this.

I would like the choice to decline any and all testing because I believe in bodily autonomy and the right to informed consent

From the NHS website about consent “Consent to treatment means a person must give permission before they receive any type of medical treatment, test or examination”
The example of a nurse doing a blood test is given.
Consent is required.

OP hasn't come back to the thread yet, but I assume her issue is around informed consent. If there's a clinical reason to test for something, what's the problem expecting a Dr to explain that to their patient?

Yes.

And typically when I have had that done (rarely) they have gone through with me in detail what tests they are sending away for and why.

(I have never had diagnostic tests done on the NHS or even in the UK so maybe they are less bothered about ensuring patients are fully aware of what is being done and why.)

The consent is, "you're unwell, we are trying to find out why, please can we take your blood?"

its pretty damn hard to take blood without consent, having spend a year working on dementia wards

As the drs on the thread have explained, if there is a clinical reason for doing so we do tell people. The op is referring to the routine screening of all a&e pts which is something different

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.

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.

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?

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'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.

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

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.

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

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

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.

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?