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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
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48. Sexually Transmitted Infections (STI)
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A medical practitioner is an unfortunate person who is required to perform a miracle, namely to reconcile health with intemperance.
~ Voltaire
Infection Intrigue
Managing the Ethical Considerations of Sexually Transmitted Infections (STIs)
It was a typical day at the medical clinic when a young woman named Sarah came in for her routine check-up. As a medical student, I was eager to learn from my attending physician, Dr. Smith, who was renowned for his expertise in sexually transmitted infections (STIs). Sarah looked nervous as she sat down in the examination room, and Dr. Smith reassured her that everything would be okay.
During the examination, Dr. Smith asked Sarah about her sexual history and any potential exposure to STIs. Sarah hesitated at first, but eventually opened up to him about a recent sexual encounter with a new partner. Dr. Smith performed some tests and confirmed that Sarah had contracted chlamydia, a common bacterial STI.
Dr. Smith explained to Sarah the importance of reporting her infection to the health department, as required by law. He assured her that her name and personal information would remain confidential, but that it was necessary to notify her sexual partners to prevent the spread of the infection. Sarah was understandably upset, but Dr. Smith patiently explained the reasoning behind the mandatory reporting laws and the importance of breaking the cycle of infection.
As Dr. Smith was finishing up with Sarah, we heard a commotion outside in the waiting room. We rushed out to find a man shouting at the receptionist, demanding to know who had reported his STI to the health department. It turned out that he was one of Sarah’s recent sexual partners, and he was angry that he had been notified about his potential exposure.
Dr. Smith calmly intervened, explaining to the man the importance of reporting STIs and the potential consequences of not treating them. He also reminded the man that reporting was part of the patient-practitioner social contract and not a breach of confidentiality. The man eventually calmed down and agreed to seek treatment.
As we left the clinic that day, I couldn’t help but reflect on the complex nature of STIs and the ethical considerations involved in treating them. It was a delicate balancing act between respecting patient autonomy, maximizing patient and community benefits, and upholding the principles of beneficence and nonmaleficence. However, Dr. Smith’s expertise and patient-centered approach had shown me that it was possible to navigate these challenges with compassion and professionalism.
Little did we know that the next day, we would be faced with an even greater challenge. One of our patients had been found dead, and the cause of death was suspected to be an STI-related complication. As we investigated further, we uncovered a web of deceit and betrayal that led us down a path of intrigue and danger. But that, my friends, is a story for another day.
Abstract
There are distinguishing concepts that need to be understood regarding sexually transmitted diseases (STDs) and sexually transmitted infections (STIs). STIs can develop into STDs with visible symptoms, but STIs can also be asymptomatic. The term “venereal disease” carries a social stigma, leading to the use of the term “sexually transmitted infection” instead. STIs are usually transmitted through sexual contact, and can be caused by various bacteria, viruses, or protozoan. Mandatory reporting laws require practitioners to report STIs to the health department, but this is considered part of the patient-practitioner relationship, not a breach of confidentiality. The patient-practitioner relationship should involve informed consent for the patient and respect for the laws for the practitioner. The principles of beneficence and nonmaleficence apply in treating STIs, as it is important to not only treat the patient’s infections, but also their partner’s infections to break the cycle of contamination. The concept of expedited partner therapy (EPT) is also discussed, where a practitioner can treat the patient’s partner without seeing them in person. However, this raises concerns about informed consent, continuity of care, privacy, and other potential issues. If EPT is conducted, the practitioner should mitigate these concerns by initiating conversations with both the patient and the partner, documenting treatment, and making sure to comply with state laws.
**
Think
[48:1] All sexually transmitted diseases (STD) first start as a sexually transmitted infection (STI). Once a patient is infected by a foreign bacteria, virus, or protozoan, the infection can develop into a disease. A sexually transmitted infection (STI) can be asymptomatic, but a sexually transmitted disease (STD) usually manifests itself with signs and symptoms.
[48:2] Because the term venereal disease connotes undesirable symptoms, there has developed a social stigma associated with the term. Therefore, many practitioners now use the more accepted term, sexually transmitted infection.
[48:3] Sexually transmitted infections (STIs) are transferred from one person to the next usually through vaginal, anal, or oral sexual contact. Bacterial infections examples are chlamydia, gonorrhea, and syphilis. Examples of viral infections are hepatitis B, human immunodeficiency virus (HIV), herpes simplex virus, and human papillomavirus (HPV). Protozoal infections examples are trichomoniasis and parasites such as pubic lice.
[48:4] Mandatory reporting laws are government surveillance laws that require the practitioner, institution, and laboratories to report sexually transmitted infections (STIs), including the patient’s name and date of birth, to the health department. This gives the government the ability to implement mitigation measures to curb infectious outbreaks.
[48:5] Mandatory reporting laws are not a breach of the patient-practitioner relationship with its duty of patient confidentiality and privacy regarding the patient’s protected health information (PHI). Rather, the categories of mandated reporting are part of the patient-practitioner social contract, as that is what a reasonable person would consider just or fair public policy. The breach of the patient-practitioner relationship would be the practitioner not reporting a mandatory reporting incidence.
Assess
Patient: 1) Autonomy
[48:6] The patient-practitioner relationship is central for patients to trust their caregiver with confidential and private information. Without such trust, informed consent would not be possible as the patient would be fearful of providing honest disclosures, and the patient would not trust that the practitioner only had the patient’s best interests in mind. However, the patient-practitioner relationship, like every personal relationship, comes with specific boundaries and responsibilities. The practitioner is obligated to the patient and to the community to respect mandatory reporting laws regarding sexually transmitted infections (STIs) as part of the patient-practitioner relationship.
[48:7] Although all contact reporting will be done anonymously to respect the patient’s confidentiality and privacy, most patient partners will know immediately who their sexual partner(s) have been and who the patient is who reported them as a patient contact. If true, then the notion of keeping “patient anonymity,” although semantically true, is practically untrue.
[48:8] Therefore, it is imperative that the practitioner disclose such reporting mandates to the patient as soon as possible and explain the mandate’s purpose and justifications and how practitioner reporting is not a breach of the patient-practitioner relationship but rather a part of the social boundaries of that relationship. The goal for the practitioner should be to help the patient understand the importance of mandated reporting and, if possible, get the patient’s informed consent to report.
Practitioner: 2) Beneficence & 3) Nonmaleficence
[48:9] The professional principles of beneficence (do good) and nonmaleficence (do no harm) are patient-centered principles for the maximization of the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities. In the treating of sexually transmitted infections (STIs), it becomes imperative to treat not just the patient’s infections but also the infections of the patient’s sexual partner(s); otherwise, it will be impossible to maximize both the patient best interests which is to cure and society’s interest in halting the recycling of contagious infections.
[48:10] Mandatory reporting, plus effective treatments, is a professional patient obligation of beneficence (do good) that maximizes patients’ best interests by breaking the cycle of infection in accordance with the principle of nonmaleficence (do no harm).
[48:11] Expedited partner therapy (EPT) occurs when the practitioner provides sexually transmitted infection (STI) treatment to the patient’s partner without seeing the partner in person. Some, but not all states, approve of expedited partner therapy (EPT). The argument is that it would be futile to treat the patient without treating the patient’s sexual partner, who would only reinfect the patient if not treated. If the partner is unwilling or unable to come in for an appointment, then it would be better for the patient, partner, and the community to treat the partner from a distance rather than providing no treatment.
[48:12] The American Medical Association (AMA) Code of Medical Ethics 8.9 states:
Expedited partner therapy potentially abrogates the standard informed consent process, compromises continuity of care for patients’ partners, encroaches upon the privacy of patients and their partners, increases the possibility of harm by a medical or allergic reaction, leaves other diseases or complications undiagnosed, and may violate state practice law.
[48:13] If expedited partner therapy (EPT) is conducted by a practitioner in a state that allows it, then it is imperative that the practitioner try to mitigate each of those concerns by:
- 1. initiating a conversation with the partner by phone or by video conferencing,
- 2. going through all aspects of the informed consent protocol with the partner,
- 3. provide educational materials,
- 4. disclose that the expedited partner therapy (EPT) will not effectively treat other infections if present, and
- 5. encourage and refer the partner to an appropriate health care provider.
[48:14] As telemedicine is adopted by the medical profession, institutions, and patients as an accepted alternative for specific check-ups and treatments, expedited partner therapy (EPT), as implemented by telemedicine will also become more adopted as a medical standard of care. Expedited partner therapy (EPT) could be modified to include an online telemedicine visit by the partner before obtaining medical treatment. This would effectively address the American Medical Association (AMA) 8.9 concerns about expedited partner therapy (EPT).
Public Policy: 4) Justice
[48:15] Classical liberalism purports that the maximization of each citizen’s individual rights and liberties will result in the maximization of all citizens’ individual good. Since the community is composed of groups of individuals, it logically follows that the community’s good will then also be maximized. However, if individual rights and liberties of others are being harmed by the inappropriate exercise of individual rights and liberties, then mitigation measures must be mandated as a matter of justice. When sexually transmitted infections (STIs) fit these social conditions, it becomes necessary for public health authorities to implement mandatory reporting laws to protect other individuals rights and liberties that make up the community’s good.
[48:16] Ethically, there is no difference between an act of omission and an act of commission when the consequences of harm are equivalent. Justice (be fair) recognizes this, giving governments and social institutions authority to mandate the reporting of sexually transmitted infections (STI) and to inform the patient’s partner(s) of communicable exposure risks, as an act of omission by not having mandatory reporting laws, would have the negative social consequence of an act of commission— a contagious infection epidemic.
[48:17] Epidemiologists, the scientific experts on the mitigation of sexually transmitted infections, have incontrovertible empirical evidence that mandatory reporting of sexually transmitted infections (STIs) is required to keep contagious infections from becoming a community epidemic. The role of government is to prevent and mitigate such contagious harms, as a principle of upholding the citizen’s constitutional right and liberty to assemble and interact safely.
[48:18] A practitioner's failure to report a communicable disease is a misdemeanor punishable with a fine of between $50-$1,000 and up to 90 days imprisonment.
Conclude
[48:19] Mandatory reporting compliance for sexually transmitted infections (STIs) is a necessary duty as a medical practitioner. The practitioner’s goal should always be to get the patient’s informed consent to report by helping the patient understand how mandatory reporting maximizes the patient's best interests. Although expedited partner therapy (EPT) is not yet an accepted practice for all states, it behooves the practitioner to think through and assess the strengths and weaknesses of expedited partner therapy (EPT) and know what actions can be taken to mitigate the ethical and practical concerns.
[48:20] In summary, mandatory reporting of STIs is an essential responsibility for medical practitioners in order to protect public health and prevent the spread of infections. Practitioners must strive to obtain the patient’s informed consent for reporting and help them understand the importance of these measures. Although expedited partner therapy (EPT) is a controversial practice and not accepted in all states, it is important for practitioners to consider the ethical implications and potential benefits of this approach. Ultimately, the medical community must continue to explore innovative and ethical solutions to effectively manage and treat sexually transmitted infections.
**
[48:19] Mandatory reporting compliance for sexually transmitted infections (STIs) is a necessary duty as a medical practitioner. The practitioner’s goal should always be to get the patient’s informed consent to report by helping the patient understand how mandatory reporting maximizes the patient’s best interests. Although expedited partner therapy (EPT) is not yet an accepted practice for all states, expedited partner therapy (EPT) it behooves the student to think through and assess the strengths and weaknesses of expedited partner therapy (EPT) and know what actions can be taken to mitigate the ethical and practical concerns.
48. Review Questions
1. Categories of mandated reporting are part of the patient-practitioner social contract, as that is what a reasonable person would consider just or fair public policy. The breach of the patient-practitioner relationship would be the practitioner not reporting a mandatory reporting incidence.
2. The goal for the practitioner should be to help the patient understand the importance of mandated reporting and, if possible, get the patient’s informed consent to report.
3. Mandatory reporting, with effective treatments, is a professional patient obligation of beneficence (do good) that maximizes patients’ best interests by breaking the cycle of infection in accordance with the principle of nonmaleficence (do no harm).
4. Expedited partner therapy (EPT) is when the practitioner puts as a top priority a face-to-face clinical appointment expediting the patient’s partner therapy.
5. When the consequences of harm are equivalent, there is ethically a significant difference between an act of omission and an act of commission
**
Wrong 😕
[48:5] Mandatory reporting laws are not a breach of the patient-practitioner relationship with its duty of patient confidentiality and privacy regarding the patient’s protected health information (PHI). Rather, the categories of mandated reporting are part of the patient-practitioner social contract, as that is what a reasonable person would consider just or fair public policy. The breach of the patient-practitioner relationship would be the practitioner not reporting a mandatory reporting incidence.
CORRECT! 🙂
[48:5] Mandatory reporting laws are not a breach of the patient-practitioner relationship with its duty of patient confidentiality and privacy regarding the patient’s protected health information (PHI). Rather, the categories of mandated reporting are part of the patient-practitioner social contract, as that is what a reasonable person would consider just or fair public policy. The breach of the patient-practitioner relationship would be the practitioner not reporting a mandatory reporting incidence.
Wrong 😕
[48:8] Therefore, it is imperative that the practitioner disclose such reporting mandates to the patient as soon as possible and explain the mandate’s purpose and justifications and how practitioner reporting is not a breach of the patient-practitioner relationship but rather a part of the social boundaries of that relationship. The goal for the practitioner should be to help the patient understand the importance of mandated reporting and, if possible, get the patient’s informed consent to report.
CORRECT! 🙂
[48:8] Therefore, it is imperative that the practitioner disclose such reporting mandates to the patient as soon as possible and explain the mandate’s purpose and justifications and how practitioner reporting is not a breach of the patient-practitioner relationship but rather a part of the social boundaries of that relationship. The goal for the practitioner should be to help the patient understand the importance of mandated reporting and, if possible, get the patient’s informed consent to report.
Wrong 😕
[48:10] Mandatory reporting, with effective treatments, is a professional patient obligation of beneficence (do good) that maximizes patients’ best interests by breaking the cycle of infection in accordance with the principle of nonmaleficence (do no harm).
CORRECT! 🙂
[48:10] Mandatory reporting, with effective treatments, is a professional patient obligation of beneficence (do good) that maximizes patients’ best interests by breaking the cycle of infection in accordance with the principle of nonmaleficence (do no harm).
Wrong 😕
[48:11] Expedited partner therapy (EPT) is when the practitioner provides sexually transmitted infection (STI) treatment to the patient’s partner without seeing the partner in person. Some, but not all states, approve of expedited partner therapy (EPT). The argument is that it would be futile to treat the patient without treating the patient’s sexual partner, who will only reinfect the patient if not treated. If the partner is unwilling or unable to come in for an appointment, then it would be better for the patient, partner, and the community to treat the partner from a distance rather than providing no treatment.
CORRECT! 🙂
[48:16] Ethically, there is no difference between an act of omission and an act of commission when the consequences of harm are equivalent. Justice (be fair) recognizes this, giving governments and social institutions authority to mandate the reporting of sexually transmitted infections (STI) and to inform the patient’s partner(s) of communicable exposure risks, as an act of omission by not having mandatory reporting laws, would have the negative social consequence of an act of commission of a contagious infection epidemic.
CORRECT! 🙂
[48:11] Expedited partner therapy (EPT) is when the practitioner provides sexually transmitted infection (STI) treatment to the patient’s partner without seeing the partner in person. Some, but not all states, approve of expedited partner therapy (EPT). The argument is that it would be futile to treat the patient without treating the patient’s sexual partner, who will only reinfect the patient if not treated. If the partner is unwilling or unable to come in for an appointment, then it would be better for the patient, partner, and the community to treat the partner from a distance rather than providing no treatment.
Wrong 😕
[48:16] Ethically, there is no difference between an act of omission and an act of commission when the consequences of harm are equivalent. Justice (be fair) recognizes this, giving governments and social institutions authority to mandate the reporting of sexually transmitted infections (STI) and to inform the patient’s partner(s) of communicable exposure risks, as an act of omission by not having mandatory reporting laws, would have the negative social consequence of an act of commission of a contagious infection epidemic.
48. Clinical Vignettes
1. Mr. James Brown is a 25-year-old graphic designer who comes to the clinic with complaints of burning urination and a rash on his genitals. Upon further questioning, he admits to having unprotected sex with multiple partners in the past month. He denies any fever, chills, or swollen lymph nodes. The differential diagnosis includes gonorrhea, chlamydia, syphilis, and genital herpes. An ethical question arises about whether to inform his sexual partners of his condition.
2. Ms. Sarah Lee is a 30-year-old accountant who comes to the clinic with a diagnosis of chlamydia. She reports having unprotected sex with her boyfriend who lives in a different state. She is concerned about informing him of the diagnosis, as he cannot come to the clinic for testing and treatment due to work commitments. The practitioner discusses expedited partner therapy (EPT) as a potential option and explains the process to Ms. Lee.
3. Ms. Sarah Lee is a 26-year-old nurse who visits the clinic with a complaint of genital warts. She reports having unprotected sex with multiple partners over the past year. The practitioner performs an examination and confirms a diagnosis of human papillomavirus (HPV). As mandated by law, the practitioner explains the mandatory reporting laws and the importance of reporting the case to the health department. Ms. Lee is concerned about the consequences of reporting, as she is afraid of losing her job and reputation as a nurse.
4. Mr. David Johnson is a 35-year-old man who presents to the clinic with a complaint of painful urination and discharge from the penis. He reports having unprotected sex with a sex worker while on a business trip to a neighboring state two weeks ago. The practitioner examines him and diagnoses him with gonorrhea, a sexually transmitted infection. As mandated by law, the practitioner explains the mandatory reporting laws and the importance of reporting the case to the health department. Mr. Johnson expresses his concern about being reported to his employer, as he works for a large government agency and is required to obtain a security clearance.
5. Ms. Lisa Rodriguez is a 28-year-old woman who presents to the clinic with a complaint of vaginal itching and a burning sensation during urination. She reports having unprotected sex with her new boyfriend two weeks ago. The practitioner examines her and diagnoses her with a chlamydia infection, a sexually transmitted infection. As mandated by law, the practitioner explains the mandatory reporting laws and the importance of reporting the case to the health department. Ms. Rodriguez expresses her concern about her immigration status, as she is currently undocumented and fears that reporting the case may lead to deportation.
CORRECT! 🙂
Explanation: The practitioner must balance the respect for Mr. Brown's autonomy and the community's interest. The patient-practitioner relationship is based on informed consent and confidentiality [48:6]. Mandatory reporting laws are not a breach of the patient-practitioner relationship as it is part of the social contract [48:5]. However, the practitioner should explain to Mr. Brown the purpose of mandated reporting and get his informed consent to report [48:8]. Therefore, the practitioner should only inform Mr. Brown's sexual partners with his consent [48:13]. It is incorrect to inform Mr. Brown's sexual partners without his consent as that would breach his confidentiality and autonomy; it is incorrect to just leave the responsibility to inform his sexual partners to Mr. Brown because it does not address the community's interest in preventing the spread of STIs.; and it is incorrect to put the responsibility for informing his contacts solely on Mr. Brown, as the practitioner has an obligation to respect the patient-practitioner relationship and protect the community's interest.
Wrong 😕
Explanation: The practitioner must balance the respect for Mr. Brown's autonomy and the community's interest. The patient-practitioner relationship is based on informed consent and confidentiality [48:6]. Mandatory reporting laws are not a breach of the patient-practitioner relationship as it is part of the social contract [48:5]. However, the practitioner should explain to Mr. Brown the purpose of mandated reporting and get his informed consent to report [48:8]. Therefore, the practitioner should only inform Mr. Brown's sexual partners with his consent [48:13]. It is incorrect to inform Mr. Brown's sexual partners without his consent as that would breach his confidentiality and autonomy; it is incorrect to just leave the responsibility to inform his sexual partners to Mr. Brown because it does not address the community's interest in preventing the spread of STIs.; and it is incorrect to put the responsibility for informing his contacts solely on Mr. Brown, as the practitioner has an obligation to respect the patient-practitioner relationship and protect the community's interest.
CORRECT! 🙂
Explanation: The American Medical Association (AMA) Code of Medical Ethics states that EPT may violate state practice law and compromise continuity of care for patients' partners [48:12]. Therefore, the practitioner should arrange a telemedicine appointment for the boyfriend to consult with the practitioner and obtain a prescription, which addresses the concerns of informed consent and continuity of care [48:13]. The other options are incorrect because they either do not involve informed consent or a consultation with the practitioner, assumes the boyfriend will follow the instructions and may not address any questions or concerns he may have, or because the option puts the burden on Ms. Lee and does not involve the practitioner in the process and having the boyfriend go to a local clinic, may not be feasible for the boyfriend due to work commitments. EPT is a potential option for patients who cannot bring their partner to the clinic or when partner notification is not sufficient or feasible [48:11]. However, it is important for the practitioner to follow ethical and legal guidelines to ensure patient safety and privacy [48:12]. Telemedicine is an emerging field that offers opportunities for providing EPT services while mitigating the ethical concerns associated with it [48:14]. Overall, EPT can be a valuable tool in preventing the spread of STIs, and practitioners should consider it as an option when appropriate.
Wrong 😕
Explanation: The American Medical Association (AMA) Code of Medical Ethics states that EPT may violate state practice law and compromise continuity of care for patients' partners [48:12]. Therefore, the practitioner should arrange a telemedicine appointment for the boyfriend to consult with the practitioner and obtain a prescription, which addresses the concerns of informed consent and continuity of care [48:13]. The other options are incorrect because they either do not involve informed consent or a consultation with the practitioner, assumes the boyfriend will follow the instructions and may not address any questions or concerns he may have, or because the option puts the burden on Ms. Lee and does not involve the practitioner in the process and having the boyfriend go to a local clinic, may not be feasible for the boyfriend due to work commitments. EPT is a potential option for patients who cannot bring their partner to the clinic or when partner notification is not sufficient or feasible [48:11]. However, it is important for the practitioner to follow ethical and legal guidelines to ensure patient safety and privacy [48:12]. Telemedicine is an emerging field that offers opportunities for providing EPT services while mitigating the ethical concerns associated with it [48:14]. Overall, EPT can be a valuable tool in preventing the spread of STIs, and practitioners should consider it as an option when appropriate.
CORRECT! 🙂
Explanation: The correct answer is C because the practitioner is obligated by law to report the case to the health department [48:4]. Mandatory reporting laws require the practitioner to report the case, including the patient's name and date of birth, to the health department [48:4]. This gives the government the ability to implement mitigation measures to curb infectious outbreaks. The other options are incorrect because they either do not address the community's interest in preventing the spread of STIs, are in noncompliance with the mandatory reporting laws to provide the patient’s name and date of birth, or does not specifically address the practitioner's obligation to report the case to the health department. While it is important to respect patient confidentiality and privacy, mandatory reporting laws exist to protect public health and prevent the spread of STIs [48:15-18]. Practitioners must balance patient autonomy and confidentiality with their obligations under the law. It is important for practitioners to inform patients about mandatory reporting laws and the consequences of non-compliance [48:8]. In conclusion, the practitioner should report the case to the health department, including Ms. Lee's name as required by law. The practitioner should also work with Ms. Lee to provide resources to deal with the consequences of mandatory reporting.
Wrong 😕
Explanation: The correct answer is C because the practitioner is obligated by law to report the case to the health department [48:4]. Mandatory reporting laws require the practitioner to report the case, including the patient's name and date of birth, to the health department [48:4]. This gives the government the ability to implement mitigation measures to curb infectious outbreaks. The other options are incorrect because they either do not address the community's interest in preventing the spread of STIs, are in noncompliance with the mandatory reporting laws to provide the patient’s name and date of birth, or does not specifically address the practitioner's obligation to report the case to the health department. While it is important to respect patient confidentiality and privacy, mandatory reporting laws exist to protect public health and prevent the spread of STIs [48:15-18]. Practitioners must balance patient autonomy and confidentiality with their obligations under the law. It is important for practitioners to inform patients about mandatory reporting laws and the consequences of non-compliance [48:8]. In conclusion, the practitioner should report the case to the health department, including Ms. Lee's name as required by law. The practitioner should also work with Ms. Lee to provide resources to deal with the consequences of mandatory reporting.
Wrong 😕
Explanation: The practitioner is obligated by law to report the case to the health department, including Mr. Johnson's name and other identifying information [48:4]. Mandatory reporting laws require the practitioner to report the case, which is necessary to prevent the spread of the STI and protect public health. The other options are wrong because they either do not address the community's interest in preventing the spread of STIs, violates the mandatory reporting laws requirement to disclose the patient’s name, or because it puts the responsibility on Mr. Johnson to self-report, which may not be effective in preventing the spread of the STI. While it is important to respect patient confidentiality and privacy, mandatory reporting laws exist to protect public health and prevent the spread of STIs [48:15-18]. Practitioners must balance patient autonomy and confidentiality with their obligations under the law. It is important for practitioners to inform patients about mandatory reporting laws and the consequences of non-compliance [48:8]. In this case, Mr. Johnson is concerned about the potential consequences of mandatory reporting, but the practitioner must comply with the law and report the case to the health department. The practitioner should explain the importance of reporting to Mr. Johnson and provide resources to deal with the consequences of mandatory reporting. It is important for practitioners to be aware of the potential consequences of mandatory reporting, such as the impact on employment and security clearances, and to work with patients to mitigate these risks while complying with the law.
CORRECT! 🙂
Explanation: The practitioner is obligated by law to report the case to the health department, including Mr. Johnson's name and other identifying information [48:4]. Mandatory reporting laws require the practitioner to report the case, which is necessary to prevent the spread of the STI and protect public health. The other options are wrong because they either do not address the community's interest in preventing the spread of STIs, violates the mandatory reporting laws requirement to disclose the patient’s name, or because it puts the responsibility on Mr. Johnson to self-report, which may not be effective in preventing the spread of the STI. While it is important to respect patient confidentiality and privacy, mandatory reporting laws exist to protect public health and prevent the spread of STIs [48:15-18]. Practitioners must balance patient autonomy and confidentiality with their obligations under the law. It is important for practitioners to inform patients about mandatory reporting laws and the consequences of non-compliance [48:8]. In this case, Mr. Johnson is concerned about the potential consequences of mandatory reporting, but the practitioner must comply with the law and report the case to the health department. The practitioner should explain the importance of reporting to Mr. Johnson and provide resources to deal with the consequences of mandatory reporting. It is important for practitioners to be aware of the potential consequences of mandatory reporting, such as the impact on employment and security clearances, and to work with patients to mitigate these risks while complying with the law.
CORRECT! 🙂
Explanation: Mandatory reporting laws for STIs require the practitioner to report the patient's name and date of birth to the health department [48:4]. This information is necessary to identify and notify the patient's sexual partners and to prevent the spread of STIs. The other options are incorrect because they either ignore the community's interest in preventing the spread of STIs, puts Ms. Rodriguez's privacy at risk, or puts the responsibility on Ms. Rodriguez to self-report, which may not be effective in preventing the spread of the STI. It is important for practitioners to balance patient autonomy and confidentiality with their obligations under the law. In this case, Ms. Rodriguez's fear of deportation is a valid concern, and the practitioner should provide her with resources to deal with this issue. The practitioner should explain the importance of reporting the case to the health department and provide Ms. Rodriguez with information about the consequences of non-compliance. Mandatory reporting laws exist to protect public health and prevent the spread of STIs [48:15-18]. However, it is important for practitioners to be aware of the potential consequences of reporting, such as the impact on patients' privacy and immigration status, and to work with patients to mitigate these risks while complying with the law. In cases where patients are undocumented, practitioners can still report the case to the health department while taking steps to protect their privacy and minimize the risk of deportation.
Wrong 😕
Explanation: Mandatory reporting laws for STIs require the practitioner to report the patient's name and date of birth to the health department [48:4]. This information is necessary to identify and notify the patient's sexual partners and to prevent the spread of STIs. The other options are incorrect because they either ignore the community's interest in preventing the spread of STIs, puts Ms. Rodriguez's privacy at risk, or puts the responsibility on Ms. Rodriguez to self-report, which may not be effective in preventing the spread of the STI. It is important for practitioners to balance patient autonomy and confidentiality with their obligations under the law. In this case, Ms. Rodriguez's fear of deportation is a valid concern, and the practitioner should provide her with resources to deal with this issue. The practitioner should explain the importance of reporting the case to the health department and provide Ms. Rodriguez with information about the consequences of non-compliance. Mandatory reporting laws exist to protect public health and prevent the spread of STIs [48:15-18]. However, it is important for practitioners to be aware of the potential consequences of reporting, such as the impact on patients' privacy and immigration status, and to work with patients to mitigate these risks while complying with the law. In cases where patients are undocumented, practitioners can still report the case to the health department while taking steps to protect their privacy and minimize the risk of deportation.
**
48. Reflection Vignettes
1. Ms. Daisy Burke is a 25-year-old receptionist who comes to the clinic complaining of genital itching and burning during urination. During her physical exam, the medical practitioner observes genital ulcers and bumps, leading to the diagnosis of genital herpes. The practitioner is mandated by law to report the STI to the state health department and to inform Ms. Burke’s sexual partner to ensure proper treatment and prevent further spread of the disease. However, Ms. Burke becomes agitated and anxious upon learning that her partner will be informed, even though the practitioner assures her that the information will be kept confidential and her identity will be protected. Ms. Burke expresses concerns about the negative impact on her personal and professional life if her partner finds out, and worries about the stigma associated with having an STI. The practitioner explains the importance of contact tracing and partner notification to prevent the spread of STIs and the importance of proper treatment for her own health. The practitioner also discusses the available resources and support systems to help Ms. Burke deal with the emotional and psychological impact of the diagnosis and the disclosure to her partner.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
**
2. Ms. Isabel Jensen is a 27-year-old nurse who presents to the clinic with symptoms suggestive of a sexually transmitted infection (STI). Following an examination, the medical practitioner diagnoses Ms. Jensen with chlamydia, and she provides informed consent for treatment. The practitioner advises Ms. Jensen's partner to seek medical attention for treatment, but the partner refuses due to various reasons. The patient requests expedited partner therapy (EPT), a practice where a medical practitioner provides a prescription for medication to a patient's sexual partner without examining them. As per the practice guidelines, the practitioner provides EPT to Ms. Jensen and instructs her on how to deliver the medication to her partner. However, the practitioner ensures that Ms. Jensen understands the potential risks associated with EPT, such as the possibility of medication allergies or adverse reactions, and that it is not a replacement for a full STI evaluation by a healthcare provider.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
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