Select header/footer to go to
Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
1x Speed
2x Speed
43. Reportable Infections & Illnesses
Select Button
Tis not always in a medical practitioner’s power to cure the sick; at times, the disease is more potent than trained art.
~ Ovid
Contagion Conflict
Balancing Patient Confidentiality and Public Health in Reporting Infectious Diseases
It was a busy day at the clinic for Dr. Jameson. He had seen over 20 patients already and still had a few more to go. His last patient of the day, Mr. Rodriguez, came in with a persistent cough and fever. Dr. Jameson suspected it might be a case of tuberculosis and immediately ordered some tests.
A few days later, the test results came back, and Dr. Jameson’s suspicion was confirmed. Mr. Rodriguez had tuberculosis, a reportable disease that needed to be reported to the state health department. Dr. Jameson was torn between his duty to report the disease and his obligation to maintain patient confidentiality.
He sat down with Mr. Rodriguez and explained the situation, including the legal requirement to report the disease to the authorities. Dr. Jameson also explained that he would do everything possible to protect Mr. Rodriguez’s identity and keep his personal information confidential. Mr. Rodriguez agreed to the reporting, knowing that it was the right thing to do for public health.
However, a few days later, Dr. Jameson received a call from the state health department, notifying him that there were two more cases of tuberculosis in the same area. The department asked Dr. Jameson for any information he might have about the source of the disease. Dr. Jameson realized that he needed to inform Mr. Rodriguez’s close contacts of his diagnosis to prevent the spread of the disease.
He called Mr. Rodriguez and explained that he needed to notify his close contacts of the diagnosis, but he would keep his identity confidential. Mr. Rodriguez agreed, and Dr. Jameson notified his close contacts and the health department.
Unfortunately, the situation took a turn for the worse. One of Mr. Rodriguez’s contacts, an elderly woman, had a severe reaction to the tuberculosis medication and ended up in the hospital. Her family blamed Dr. Jameson for not warning them about the disease, and the case went to court.
Dr. Jameson had followed all the necessary procedures and had done everything possible to protect patient confidentiality. He had even informed Mr. Rodriguez of the potential risks of notifying his contacts. Despite this, he was still being blamed for the woman’s hospitalization.
The case was eventually dismissed, and Dr. Jameson learned an important lesson about the importance of reporting reportable infections and illnesses. He realized that while it was important to protect patient confidentiality, it was equally essential to prevent the spread of communicable diseases and illnesses.
From then on, Dr. Jameson made sure to inform his patients of their legal obligation to report reportable diseases and infections. He also worked closely with the state health department to ensure that the appropriate reporting procedures were followed to protect both public health and patient confidentiality.
Abstract
The reporting of reportable infections and illnesses in America is divided into four categories: written, telephone, number of cases, and cancer registry. Medical practitioners have a patient-centered obligation to maximize the patient’s best interests while adhering to the principles of beneficence (do good) and nonmaleficence (do no harm). The practitioner must disclose their legal and professional obligation to report to the patient, but if informed consent is not obtained, the practitioner must report the minimum information required to the proper authorities. Public policies ensure individual rights and liberties are protected and promote equitable opportunities for all citizens. Failure to report a communicable infection is a misdemeanor punishable with a fine and up to 90 days imprisonment. The medical practitioner must balance their duty to promote patient autonomy and confidentiality with their legal obligation to report and warn those at risk of harm.
**
Think
[43:1] Every state in America have a list of more than 70 reportable infections and illnesses.
[43:2] Reportable infections and illnesses are divided into four main groups; written, telephone, number of cases, and cancer registry.
1. Written
A report of the infection must be made in writing.
Examples are gonorrhea and salmonellosis.
2. Telephone
The provider must make a report by phone.
Examples are rubeola (measles) and pertussis (whooping cough).
3. Number of cases
Examples are chickenpox and influenza.
4. Cancer Registry
Cancer illness cases are reported to the state Cancer Registry.
Assess
Patient: 1) Autonomy
[43:3] Patients have a patient-practitioner relationship with the medical practitioner, which creates the environment necessary for the patient to provide informed consent. Confidentiality and privacy are central to this relationship, giving the patient the trust necessary for disclosing protected health information (PHI) to the practitioner. This high regard for confidentiality and privacy contributes significantly towards maximizing the patient’s best interests.
[43:4] Reportable infections have a significant negative social impact, and as a result practitioners have a legal, professional, and ethical duty to mitigate those adverse effects without breaching the patient-practitioner relationship. This has been accomplished by including the categories of mandated reporting to be part of the patient-practitioner social contract.
[43:5] The medical practitioner’s legal and professional requirement to report must be disclosed to the patient as soon as possible. The goal is for the patient to understand the practitioner’s responsibility and for the patient to consent to report voluntarily. However, if the patient does not provide informed consent to report, then the practitioner is obligated by legal mandate, professional duty, and moral analysis to report the minimal amount of information required to the proper authorities. Mandatory reporting is not a breach of the patient-practitioner relationship; rather, it is an expectation of that relationship.
Practitioner: 2) Beneficence & 3) Nonmaleficence
[43:6] Medical practitioners have a professional patient-centered obligation to maximize the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities using the professional principles of beneficence (do good) and nonmaleficence (do no harm).
[43:7] If a patient has exposed others to a communicable infection, then the practitioner should either counsel the patient to notify, offer to inform contacts, and notify the health department, all while assuring patient confidentiality.
- 1. Counsel the Patient: Encourage the patient to notify their contact(s) voluntarily. Beneficence (do good)
- 2. Offer to Inform Contact(s): If, after counseling, the patient is emotionally or otherwise still unwilling to notify their contact(s), then the practitioner should offer to inform the contact(s) for the patient without revealing the patient’s identity. Beneficence (do good) and nonmaleficence (do no harm)
- 3. Notify the Health Department: If the patient still refuses, then the practitioner must notify the health department and provide the minimum necessary information to accomplish the intended purpose. The health department will then request a voluntary interview with the patient to construct a list of contacts to be notified. There is no legal penalty for patient noncompliance. Nonmaleficence (do no harm)
- 4. Confidentiality: The patient must know that their identity as the source-patient will always be kept confidential. Nonmaleficence (do no harm)
Public Policy: 4) Justice
[43:8] Public policies are legislated to protect individual rights and liberties within a general structure that promotes equitable opportunities for all citizens as a matter of justice (be fair). Not reporting these designated reportable infections and illnesses is a violation of individual rights and liberties and therefore requires legislation, as a matter of justice (be fair), to bring back into balance the unequal distribution of benefits and burdens.
[43:9] It is unfair not to disclose exposure to those who have been exposed to a communicable infection. Therefore, if a patient refuses to notify a contact, and the practitioner knows who their contact is, although it is not mandatory to notify the contact, the practitioner has legal protection if they notify the contact. Regardless, the practitioner must inform the contact or ask the health department to notify the contact. Not following this process is a practitioner’s failure of the public policy duty of justice (be fair), making the practitioner legally liable for harms that occur because of the failure to report.
[43:10] Failure to report a communicable infection or illness is a misdemeanor punishable with a fine between $50-$1,000 and up to 90 days imprisonment.
Conclude
[43:11] The medical practitioner must balance the duty of promoting patient autonomy and patient confidentiality with the legal mandate to report reportable infections and illnesses to the appropriate agencies and to warn those who are at risk of harm.
[43:12] In summary, medical practitioners must find a balance between upholding patient autonomy and confidentiality while adhering to their legal obligation to report infections and illnesses. By disclosing their responsibility to report and working with patients to ensure the appropriate parties are informed, practitioners can help minimize the negative social impact of reportable infections and illnesses, promoting both public health and individual well-being.
**
43. Review Questions
1. Reportable infections and illnesses, that the practitioner must report should be disclosed to the patient as soon as possible.
2. For reportable infections the goal is for the patient to understand the practitioner’s responsibility and for the patient to consent to report voluntarily.
3. If the patient does not provide informed consent for the practitioner to report a reportable infection, then the practitioner in accordance with the patient-practitioner relationship must keep patient confidentiality and privacy and not report.
4. Mandatory reporting is a legal and professional requirement that is part of the patient-practitioner relationship, and not reporting would be the practitioner’s violation of the patient-practitioner relationship, a form of professional misconduct.
5. If a patient has exposed others to a communicable infection, then
6. If a patient with a reportable infection refuses to notify a contact(s), then the practitioner does not have legal protection to inform the contact(s), and the practitioner must respect the patient’s decision and not report to authorities.
7. A practitioner’s failure to report a reportable infection or disease is a violation of the public policy duty of justice (be fair), making the practitioner legally liable for harms that occur because of the failure to report.
**
Wrong 😕
[43:5] The practitioner’s legal and professional requirement to report must be disclosed to the patient as soon as possible. The goal is for the patient to understand the practitioner’s responsibility and for the patient to consent to report voluntarily. If the patient does not provide informed consent to report, then the practitioner is obligated by legal mandate, professional duty, and moral analysis to report the minimal amount of information required to the proper authorities. Mandatory reporting is not a breach of the patient-practitioner relationship; rather, it is an expectation of that relationship.
CORRECT! 🙂
[43:5] The practitioner’s legal and professional requirement to report must be disclosed to the patient as soon as possible. The goal is for the patient to understand the practitioner’s responsibility and for the patient to consent to report voluntarily. If the patient does not provide informed consent to report, then the practitioner is obligated by legal mandate, professional duty, and moral analysis to report the minimal amount of information required to the proper authorities. Mandatory reporting is not a breach of the patient-practitioner relationship; rather, it is an expectation of that relationship.
CORRECT! 🙂
[43:5] The practitioner’s legal and professional requirement to report must be disclosed to the patient as soon as possible. The goal is for the patient to understand the practitioner’s responsibility and for the patient to consent to report voluntarily. If the patient does not provide informed consent to report, then the practitioner is obligated by legal mandate, professional duty, and moral analysis to report the minimal amount of information required to the proper authorities. Mandatory reporting is not a breach of the patient-practitioner relationship; rather, it is an expectation of that relationship.
Wrong 😕
[43:5] The practitioner’s legal and professional requirement to report must be disclosed to the patient as soon as possible. The goal is for the patient to understand the practitioner’s responsibility and for the patient to consent to report voluntarily. If the patient does not provide informed consent to report, then the practitioner is obligated by legal mandate, professional duty, and moral analysis to report the minimal amount of information required to the proper authorities. Mandatory reporting is not a breach of the patient-practitioner relationship; rather, it is an expectation of that relationship.
Wrong 😕
[43:5] The practitioner’s legal and professional requirement to report must be disclosed to the patient as soon as possible. The goal is for the patient to understand the practitioner’s responsibility and for the patient to consent to report voluntarily. If the patient does not provide informed consent to report, then the practitioner is obligated by legal mandate, professional duty, and moral analysis to report the minimal amount of information required to the proper authorities. Mandatory reporting is not a breach of the patient-practitioner relationship; rather, it is an expectation of that relationship.
CORRECT! 🙂
[43:5] The practitioner’s legal and professional requirement to report must be disclosed to the patient as soon as possible. The goal is for the patient to understand the practitioner’s responsibility and for the patient to consent to report voluntarily. If the patient does not provide informed consent to report, then the practitioner is obligated by legal mandate, professional duty, and moral analysis to report the minimal amount of information required to the proper authorities. Mandatory reporting is not a breach of the patient-practitioner relationship; rather, it is an expectation of that relationship.
CORRECT! 🙂
[43:5] The practitioner’s legal and professional requirement to report must be disclosed to the patient as soon as possible. The goal is for the patient to understand the practitioner’s responsibility and for the patient to consent to report voluntarily. If the patient does not provide informed consent to report, then the practitioner is obligated by legal mandate, professional duty, and moral analysis to report the minimal amount of information required to the proper authorities. Mandatory reporting is not a breach of the patient-practitioner relationship; rather, it is an expectation of that relationship.
Wrong 😕
[43:5] The practitioner’s legal and professional requirement to report must be disclosed to the patient as soon as possible. The goal is for the patient to understand the practitioner’s responsibility and for the patient to consent to report voluntarily. If the patient does not provide informed consent to report, then the practitioner is obligated by legal mandate, professional duty, and moral analysis to report the minimal amount of information required to the proper authorities. Mandatory reporting is not a breach of the patient-practitioner relationship; rather, it is an expectation of that relationship.
CORRECT! 🙂
[43:7] If a patient has exposed others to a communicable infection, then:
1. Counsel the Patient: Encourage the patient to notify their contact(s) voluntarily. Beneficence (do good)
2. Offer to Inform Contact(s): If, after counseling, the patient is emotionally or otherwise still unwilling to notify their contact(s), then the practitioner should offer to inform the contact(s) for the patient without revealing the patient’s identity. Beneficence (do good) and nonmaleficence (do no harm)
3. Notify the Health Department: If the patient still refuses, then the practitioner must notify the health department and provide the minimum necessary information to accomplish the intended purpose. The health department will then request a voluntary interview with the patient to construct a list of contacts to be notified. There is no legal penalty for patient noncompliance. Nonmaleficence (do no harm)
4. Confidentiality: The patient must know that their identity as the source-patient will always be kept confidential. Nonmaleficence (do no harm)
Wrong 😕
[43:7] If a patient has exposed others to a communicable infection, then:
1. Counsel the Patient: Encourage the patient to notify their contact(s) voluntarily. Beneficence (do good)
2. Offer to Inform Contact(s): If, after counseling, the patient is emotionally or otherwise still unwilling to notify their contact(s), then the practitioner should offer to inform the contact(s) for the patient without revealing the patient’s identity. Beneficence (do good) and nonmaleficence (do no harm)
3. Notify the Health Department: If the patient still refuses, then the practitioner must notify the health department and provide the minimum necessary information to accomplish the intended purpose. The health department will then request a voluntary interview with the patient to construct a list of contacts to be notified. There is no legal penalty for patient noncompliance. Nonmaleficence (do no harm)
4. Confidentiality: The patient must know that their identity as the source-patient will always be kept confidential. Nonmaleficence (do no harm)
Wrong 😕
[43:9] It is unfair not to disclose exposure to those who have been exposed to a communicable infection. Therefore, if a patient refuses to notify a contact, and the practitioner knows who their contact is, although it is not mandatory to notify the contact, the practitioner has legal protection if they notify the contact. Regardless, the practitioner must inform the contact or ask the health department to notify the contact. Not following this process is a practitioner’s failure of the public policy duty of justice (be fair), making the practitioner legally liable for harms that occur because of the failure to report.
CORRECT! 🙂
[43:9] It is unfair not to disclose exposure to those who have been exposed to a communicable infection. Therefore, if a patient refuses to notify a contact, and the practitioner knows who their contact is, although it is not mandatory to notify the contact, the practitioner has legal protection if they notify the contact. Regardless, the practitioner must inform the contact or ask the health department to notify the contact. Not following this process is a practitioner’s failure of the public policy duty of justice (be fair), making the practitioner legally liable for harms that occur because of the failure to report.
Wrong 😕
[43:9] It is unfair not to disclose exposure to those who have been exposed to a communicable infection. Therefore, if a patient refuses to notify a contact, and the practitioner knows who their contact is, although it is not mandatory to notify the contact, the practitioner has legal protection if they notify the contact. Regardless, the practitioner must inform the contact or ask the health department to notify the contact. Not following this process is a practitioner’s failure of the public policy duty of justice (be fair), making the practitioner legally liable for harms that occur because of the failure to report.
CORRECT! 🙂
[43:9] It is unfair not to disclose exposure to those who have been exposed to a communicable infection. Therefore, if a patient refuses to notify a contact, and the practitioner knows who their contact is, although it is not mandatory to notify the contact, the practitioner has legal protection if they notify the contact. Regardless, the practitioner must inform the contact or ask the health department to notify the contact. Not following this process is a practitioner’s failure of the public policy duty of justice (be fair), making the practitioner legally liable for harms that occur because of the failure to report.
43. Clinical Vignettes
1. Ms. Tiffany Rodriguez, a 35-year-old office worker, presents to the clinic with a persistent cough, fatigue, and shortness of breath. On examination, her oxygen saturation is low, and she is diagnosed with tuberculosis (TB). Which of the following is the most appropriate action for the medical practitioner to take?
2. Ms. Abigail Myers is a 50-year-old accountant who presents to the clinic with fever, malaise, and joint pain. On examination, she is diagnosed with Lyme disease, a reportable infection. However, Ms. Lee refuses to consent to the reporting of her illness. Which of the following is the most appropriate action for the medical practitioner to take?
3. Mr. Jerry Johnson is a 35-year-old accountant who presents to the clinic with a fever, chills, and a painful rash. He reports having unprotected sexual contact with a new partner a week ago. Clinical examination reveals a rash on his genitals, mouth sores, and swollen lymph nodes. Clinical differential diagnosis includes herpes simplex virus (HSV) infection, syphilis, or human immunodeficiency virus (HIV) infection. What is the practitioner's ethical responsibility in reporting communicable infections, and how can they balance their duty to promote patient autonomy and confidentiality with their legal obligation to report and warn those at risk of harm?
4. Mr. James Peterson is a 35-year-old plumber comes to your clinic complaining of fever, headache, and a rash on his arms and legs. He tells you that he spent the past week camping in a wooded area with friends. On examination, you notice a red rash that is flat and non-itchy on his extremities, torso, and palms of his hands. He also has a low-grade fever and enlarged lymph nodes in his neck. You suspect that Mr. Peterson may have contracted Rocky Mountain spotted fever, but there is a differential diagnosis that includes other tick-borne illnesses like Lyme disease and ehrlichiosis. What is the ethical question regarding the reporting of reportable infections and illnesses that arises in this case?
5. Ms. Abigail Johnson is a 30-year-old chef who presents to the emergency department with severe abdominal pain and bloody diarrhea. She reports that her symptoms began 2 days ago and have gradually worsened. Upon physical examination, the patient is found to be severely dehydrated, and laboratory tests show an elevated white blood cell count. The working diagnosis is E. coli O157:H7 infection. What is the ethical obligation of the medical practitioner in reporting the E. coli O157:H7 infection to the proper authorities?
CORRECT! 🙂
Explanation: The most appropriate action for the medical practitioner is to report the case of TB to the health department and inform the patient of the legal obligation to report [43:5]. Medical practitioners have a legal, professional, and ethical duty to report reportable infections and diseases, including TB, to the appropriate agencies. In this case, Ms. Rodriguez's diagnosis of TB is a reportable infection, and failure to report it is a violation of the law [43:10]. The other options are incorrect because; to do nothing as the practitioner has a duty to report the case of TB to the health department, and failure to do so may result in harm to others; the patient's employer does not need to be informed of the diagnosis unless required by law; and the practitioner has a legal and ethical obligation to inform the patient of the legal obligation to report, and the patient must be involved in the process of notifying her close contacts [43:3, 43:7]. By informing the patient of the legal obligation to report and involving her in the notification process, the practitioner balances the duty to promote patient autonomy and confidentiality with the legal mandate to report and warn those who are at risk of harm.
Wrong 😕
Explanation: The most appropriate action for the medical practitioner is to report the case of TB to the health department and inform the patient of the legal obligation to report [43:5]. Medical practitioners have a legal, professional, and ethical duty to report reportable infections and diseases, including TB, to the appropriate agencies. In this case, Ms. Rodriguez's diagnosis of TB is a reportable infection, and failure to report it is a violation of the law [43:10]. The other options are incorrect because; to do nothing as the practitioner has a duty to report the case of TB to the health department, and failure to do so may result in harm to others; the patient's employer does not need to be informed of the diagnosis unless required by law; and the practitioner has a legal and ethical obligation to inform the patient of the legal obligation to report, and the patient must be involved in the process of notifying her close contacts [43:3, 43:7]. By informing the patient of the legal obligation to report and involving her in the notification process, the practitioner balances the duty to promote patient autonomy and confidentiality with the legal mandate to report and warn those who are at risk of harm.
Wrong 😕
Explanation: The most appropriate action for the medical practitioner is to report the case of Lyme disease to the health department while informing the patient of the legal obligation to report [43:5]. Although the goal is for the patient to provide informed consent to report voluntarily, the practitioner must report reportable infections and diseases to the appropriate agencies even if informed consent is not obtained [43:5]. Failure to report is a violation of the law and may result in harm to others. The other options are incorrect because the practitioner has a legal and ethical duty to report reportable infections and diseases, and failure to do so may result in harm to others [43:4], the patient's decision to provide informed consent to report voluntarily must be respected, but the practitioner still has a legal obligation to report the case [43:3, 43:5], and the practitioner must inform the patient of the legal obligation to report while trying to involve the patient in the notification process [43:3, 43:5].
CORRECT! 🙂
Explanation: The most appropriate action for the medical practitioner is to report the case of Lyme disease to the health department while informing the patient of the legal obligation to report [43:5]. Although the goal is for the patient to provide informed consent to report voluntarily, the practitioner must report reportable infections and diseases to the appropriate agencies even if informed consent is not obtained [43:5]. Failure to report is a violation of the law and may result in harm to others. The other options are incorrect because the practitioner has a legal and ethical duty to report reportable infections and diseases, and failure to do so may result in harm to others [43:4], the patient's decision to provide informed consent to report voluntarily must be respected, but the practitioner still has a legal obligation to report the case [43:3, 43:5], and the practitioner must inform the patient of the legal obligation to report while trying to involve the patient in the notification process [43:3, 43:5].
CORRECT! 🙂
Explanation: According to [43:7], when a patient has exposed others to a communicable infection, the practitioner should counsel the patient to notify their contacts voluntarily, offer to inform the patient's contacts without revealing their identity, and notify the health department. The patient's confidentiality must be assured, as per the principle of nonmaleficence. If the patient refuses to notify their contacts, the practitioner must notify the health department and provide the minimum necessary information to accomplish the intended purpose. The health department will then construct a list of contacts to be notified. Not reporting these reportable infections and illnesses is a violation of individual rights and liberties and therefore requires legislation, as a matter of justice, to bring back into balance the unequal distribution of benefits and burdens [43:8]. Therefore, all of the above options are ethically responsible for the practitioner.
Wrong 😕
Explanation: According to [43:7], when a patient has exposed others to a communicable infection, the practitioner should counsel the patient to notify their contacts voluntarily, offer to inform the patient's contacts without revealing their identity, and notify the health department. The patient's confidentiality must be assured, as per the principle of nonmaleficence. If the patient refuses to notify their contacts, the practitioner must notify the health department and provide the minimum necessary information to accomplish the intended purpose. The health department will then construct a list of contacts to be notified. Not reporting these reportable infections and illnesses is a violation of individual rights and liberties and therefore requires legislation, as a matter of justice, to bring back into balance the unequal distribution of benefits and burdens [43:8]. Therefore, all of the above options are ethically responsible for the practitioner.
CORRECT! 🙂
Explanation: The ethical question in this case is whether the practitioner should report the case to the local health department to help track the spread of the disease in the community. According to [43:5], the medical practitioner has a legal and professional obligation to report reportable infections and illnesses to the proper authorities. The goal is for the patient to understand this responsibility and to consent to reporting voluntarily. If the patient does not provide informed consent to report, then the practitioner is obligated by legal mandate, professional duty, and moral analysis to report the minimal amount of information required to the proper authorities. In this case, Rocky Mountain spotted fever is a reportable infection, and reporting the case to the local health department would be necessary to help track the spread of the disease in the community and prevent further infections. Therefore, the other options are incorrect.
Wrong 😕
Explanation: The ethical question in this case is whether the practitioner should report the case to the local health department to help track the spread of the disease in the community. According to [43:5], the medical practitioner has a legal and professional obligation to report reportable infections and illnesses to the proper authorities. The goal is for the patient to understand this responsibility and to consent to reporting voluntarily. If the patient does not provide informed consent to report, then the practitioner is obligated by legal mandate, professional duty, and moral analysis to report the minimal amount of information required to the proper authorities. In this case, Rocky Mountain spotted fever is a reportable infection, and reporting the case to the local health department would be necessary to help track the spread of the disease in the community and prevent further infections. Therefore, the other options are incorrect.
CORRECT! 🙂
Explanation: The medical practitioner has a legal and professional obligation to report E. coli O157:H7 infection to the proper authorities [43:4]. The practitioner must balance their duty to promote patient autonomy and confidentiality with their legal obligation to report and warn those at risk of harm [43:11]. In cases where informed consent is not obtained, the practitioner must report the minimum amount of information required to the proper authorities [43:5]. The failure to report a communicable infection is a violation of individual rights and liberties and therefore requires legislation, as a matter of justice, to bring back into balance the unequal distribution of benefits and burdens [43:8]. While the practitioner should encourage the patient to notify their contacts voluntarily and offer to inform the patient's contacts without revealing the patient's identity, the practitioner must notify the health department if the patient refuses to do so [43:7].
Wrong 😕
Explanation: The medical practitioner has a legal and professional obligation to report E. coli O157:H7 infection to the proper authorities [43:4]. The practitioner must balance their duty to promote patient autonomy and confidentiality with their legal obligation to report and warn those at risk of harm [43:11]. In cases where informed consent is not obtained, the practitioner must report the minimum amount of information required to the proper authorities [43:5]. The failure to report a communicable infection is a violation of individual rights and liberties and therefore requires legislation, as a matter of justice, to bring back into balance the unequal distribution of benefits and burdens [43:8]. While the practitioner should encourage the patient to notify their contacts voluntarily and offer to inform the patient's contacts without revealing the patient's identity, the practitioner must notify the health department if the patient refuses to do so [43:7].
**
43. Reflection Vignettes
Dr. Jane Smith, a 35-year-old family medicine practitioner, sees a patient who presents with symptoms of a communicable infection. After performing a thorough examination, Dr. Smith diagnoses the patient with a sexually transmitted infection (STI). During the patient's counseling session, Dr. Smith emphasizes the importance of notifying their partners and contacts of their exposure to the infection to prevent further spread. However, the patient becomes emotionally distraught and refuses to inform their partners and contacts. As a medical practitioner, Dr. Smith is bound by ethical and legal obligations to protect public health and prevent the spread of communicable infections. Failure to report a communicable disease can result in harm to others and even death in some cases. Therefore, Dr. Smith must take action to ensure that the patient's partners and contacts are notified and provided with appropriate testing and treatment. Dr. Smith must explain to the patient the importance of notifying their partners and contacts and the potential harm that can result from not doing so. She can also offer to assist the patient in notifying their partners and contacts or refer them to a public health agency to facilitate the process. If the patient continues to refuse, Dr. Smith may be legally required to report the case to the local public health department, which can take steps to identify and notify the patient's partners and contacts of their exposure to the infection. In addition to protecting public health, Dr. Smith must also prioritize patient confidentiality and privacy. She must explain to the patient the importance of maintaining confidentiality while also notifying partners and contacts of the exposure. Dr. Smith can work with the patient to develop a plan that respects their privacy while also notifying partners and contacts.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
**
2. Dr. Heidi Dunn, a 38-year-old general practitioner, meets with a patient who presents with clinical symptoms consistent with a reportable communicable infection. The patient requests to be treated but only under the condition of strict confidentiality and privacy, meaning that Dr. Dunn should not disclose any information to the state or local health department, the patient’s sexual partners, or any other contacts. The differential diagnosis suggests a few different possibilities, including bacterial vaginosis, chlamydia, gonorrhea, or syphilis. While the patient has the right to confidentiality, Dr. Dunn understands the importance of reporting communicable infections and the potential harm to others if left untreated. Dr. Dunn counsels the patient on the importance of reporting the infection, explaining that reporting is necessary to prevent further transmission and ensure proper treatment. Dr. Dunn also informs the patient that the identity of the patient will remain confidential, but the patient’s partners and contacts will need to be notified for their own health and safety.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
***
