Physicians Who Have AIDS

I am sometimes asked to recommend a physician. In my experience, physicians tend to recommend physicians who are in their peer group (similar age, training, medical school attended, residency or fellowship), and these recommendations are not always well-informed, current or appropriate. Sometimes they are downright dangerous.

My primary criterion for making a recommendation is whether the physician has good medical judgment. "Good hands" for a surgeon, an encyclopedic knowledge of disease for an internist, or good bedside manners for a family practitioner just don't make much of an impression on me. I have seen surgeons with good hands and technical ability operate inappropriately because of poor judgment. I have seen internists who could recite chapter and verse from the textbook who just didn't have the judgment to make important medical decisions, and I have seen good bedside manner cover up mistakes in judgmentwhich resulted in patient injury.

A physician's judgment may be difficult for a lay person or even a colleague to assess. Not only may it be affected by human frailties such as family problems, financial problems, lack of sleep, overwork and momentary distraction, it may be affected by disease. Physicians, with significant illnesses, including (but not limited to) Alzheimer's disease may become subtly demented so that even their working associates are not alerted to their dimished professional capacity. As I described in my chapter, "The HIV-Infected Health Care Worker" in West/The American Health Lawyers Association's) Health Law Practice Guide," there is increasing evidence that physicians who are infected with the HIV virus are at risk of having brain function impairment. They may have impaired neuropsychologic scores before treatment and after treatment with drugs which did not have maximum effectiveness. An excellent update on this subject can be found in Letendre,McCutchan et al. "Neurologic Complications of HIV Disease and Their Treatment" in Topics in HIV Medicine 16:15-22, 2008, a publication of the Intenational AIDS Society-USA.

Physicians and other health care workers have generally enjoyed confidentiality about their HIV status, primarily because there is no current significant evidence that they risk transmitting the disease to patients. Their practices may be restricted, with respect to certain invasive surgeries, but in general they practice without hindrance. It is time apply principles of public health to HIV-infected physicians and, because HIV-infected physicians may develop subtle dementia during the course of their disease, require routine periodic neuropsychologic testing. If significant impairment is found, practice should be restricted.

And it may be time to revisit the issue of notice to patients, since a physician who has significant neuropsychologic damage is not what the patient generally bargains for as a health care provider.