Sexual Health COPY Flashcards
Case 1:
- 62yr old man presents to Sex Health Clinic with rash on trunk
- Diagnosed secondary syphilis
- Sex with two people in last 3 months - A Kazakh sex worker and His wife
- What needs to be done?
- Both women should be tested for syphilis
- The Kazakh woman is untraceable.
- He agrees to tell his wife but then changes his mind - “It would destroy our marriage!”
______ is relevant for many parts of sexual health
Ethics
what are the 4 principles?
- Respect for Autonomy
- Non-maleficence
- Beneficence
- Justice
Case 1:
what needs to be thought about in the first case in relation to respect for autonomy?
Promote the right to self determination
Should we do what he is asking us to do?
Case 1:
what needs to be thought about in the first case in relation to non-maleficence?
the avoidance of harm
Case 1:
what needs to be thought about in the first case in relation to beneficence?
to do good
Case 1:
what needs to be thought about in the first case in relation to justice?
Fairness/equity
Individual vs population
case 1:
what are the relevant duties of a doctor registered with the GMC in relation to this case?
Useful list of our duties and highlighted ones are relevant in this case
Care of our patient is your first concern
This is about the bigger picture
GMC Confidentiality guidance on Serious Communicable Diseases 2017:
You may disclose information to a person who has close contact with a patient who has a serious communicable disease if you have reason to think what:
- the person is at risk of infection that is likely to result in serious harm
- the patient has not informed them and cannot be persuaded to do so
Both 1 and 2 have to apply to be able to disclose the information
Case 1:
• The man is told again that his wife needs to be tested:
- If he won’t tell her himself then we will tell her
- He reiterates his wish that she isn’t told by us. He will tell her when he’s ready
3 weeks pass, she’s not been tested
We wrote to the man giving him written notice that we will be contacting his wife
He was offshore at the time and his wife opened the letter
She tested negative
Case 2:
- 41yr old man asks for an STI screen – he’d heard that his ex had ‘something’.
- Tests positive for HIV
- He’s a dentist
- What are the issues?
- His wellbeing
- His privacy - Privacy important as could really harm his life
- The wellbeing of his patients
- His future employment - Unable to work then would be bad
Case 2:
what needs to be thought about in the second case in relation to respect for autonomy?
Promote the right to self determination
But can he do whatever he likes with all the other people involved?
Case 2:
what needs to be thought about in the second case in relation to non-maleficence?
The avoidance of harm
Harm to him or other people?
Case 2:
what needs to be thought about in the fsecond case in relation to beneficence?
to do good
Case 2:
what needs to be thought about in the second case in relation to justice?
Fairness/equity
Individual vs population
Want to be fair to him, his partner, his patients and the wider population
case 2:
what are the relevant duties of a doctor registered with the GMC in relation to this case?
Particularly this one think about the patients dignity and privacy
Where possible involve patients in decisions about their care
Coming to a joint arrangement is the best way
Case 2:
what should the outcome be?
- His wellbeing - Started on ART (Start on treatment to get viral load down - but this is treating for occupational benefit, HIV not harming him to significant degree). Not in a conventional Rx group
- His privacy - A challenge
- The wellbeing of his patients - Patient list reviewed for known HIV infected patients (check through his patients and see if any of them has HIV and some did and check to see if there is anything surprises to see if they had it e.g. not by sexual transmission). Look-back exercise sometimes recommended (look at previous patients and invite them for testing but this didn’t need to be done)
- His future employment - If treatment effective, he can resume work under new guidance
Case 3:
- 26yr old woman named as contact of chlamydia
- We contact her and explain situation - “Contact of treatable bacterial infection.” Gets angry, feels insulted, wants to know who named her
- What are the issues?
- Her dignity - Caused harm by affecting dignity and making her upset
- Public health - may have sex with others
- Is she really a contact of chlamydia? (She may not even have it)
Case 3:
what needs to be thought about in the third case in relation to respect for autonomy?
Promote the right to self determination
Case 3:
what needs to be thought about in the third case in relation to non-maleficence?
The avoidance of harm
Case 3:
what needs to be thought about in the third case in relation to beneficence?
To do good
Case 3:
what needs to be thought about in the third case in relation to respect for autonomy?
Fairness/equity
Individual vs population
case 3:
what are the relevant duties of a doctor registered with the GMC in relation to this case?
Respect and protect confidential information
Cant give her the name of the person who named her
Case 3:
- Woman attended clinic
- Tested for chlamydia
- Offered treatment for chlamydia as a precaution
- Accepted that we had a duty to protect her contact’s confidentiality; we wouldn’t give her name to her contacts should the test be positive
Assure her they we wouldn’t give her name to others that she would maybe name
