Case and Commentary
Jan 2005
Extending the ER visit so that Dr. Macklin can discuss follow-up care and convince Mr. Jonsen to avoid unprotected sex and other at-risk activities (option B) is the preferable option. Mr. Jonsen's disease must be reported, regardless, to the appropriate authorities and, if Dr. Macklin fails to convince Mr. Jonsen that he should avoid putting others at risk, it may also be necessary to inform public health authorities that Mr. Jonsen's behavior is endangering others (option A).
Option C—noting the diagnosis and taking no other action—should be avoided for the 2 reasons mentioned above: physicians must report certain types of diseases and diagnoses to the health authorities, and HIV seropositive status is one such diagnosis; the risk of harm that Mr. Jonsen places others in by continued unprotected sex argues that Dr. Macklin cannot just record the diagnosis in Mr. Jonsen's chart and take no further action.
Preferable: B
Acceptable: A
Avoid: C
Additional discussion and information
