AMA Journal of Ethics^®

Case 

After Mr. Daar left Exam 2, Dr. Macklin began a physical examination. Upon discovering localized symmetric mucocutaneous lesions, generalized nontender lymphadenopathy and red papular lesions 4-5 mm in diameter, Dr. Macklin confirmed Mr. Jonsen's complaints of sore throat, fever, and headache.

"Have you had any unprotected sex or used any intravenous drugs in the last year?"

"No drugs, but I've had unprotected sex, why?"

"Well, I'd like to run a few tests because I'd guess that you have secondary syphilis, but I want to confirm that diagnosis before we go any further."

"Is syphilis treatable?"

"Yes, but first I need to confirm the diagnosis. Just in case, I'd also like to test you for other common STDs, including HIV, that may be latent in your system."

After a pause, Mr. Jonsen mutters, "Alright, go ahead."

Mr. Jonsen does test positive for syphilis, and he also tests positive for HIV. Dr. Macklin returns to Exam 2 to deliver the news.

"As we expected, you've got secondary syphilis. The good news is that penicillin is a highly effective treatment and so we should be able to clear this up pretty quickly. Unfortunately, Mr. Jonsen, you've also tested positive for HIV." Dr. Macklin hands Mr. Jonsen a couple of slips of paper. "Here's the name of a nearby HIV clinic and a prescription for penicillin." Dr. Macklin pauses for a moment while Mr. Jonsen stares at the floor. "Obviously you shouldn't have unprotected sex because you put any partner at risk for infection as well."

Mr. Jonsen looks up, "I think I'm entitled to make my own decisions, but thanks for the input." As he starts putting his clothes back on he says, "I expect you to keep this information confidential."

"I'm afraid I can't do that Mr. Jonsen. State law requires me to report all cases of sexually transmitted diseases. I also need your assurance that you won't have unprotected sex."

"I guess you don't always get what you need." Mr. Jonsen retorts as he gathers his things.

What should Dr. Macklin do? (select an option)

A. Inform the appropriate authorities about the STDs and that Mr. Jonsen is likely to put others at risk for infection.

B. Ask Mr. Jonsen to stay so they can plan therapy, counseling, and referral for Mr. Jonsen's follow-up care.

C. Record the diagnosis in Mr. Jonsen's medical chart and take no other action.