Looking for opinions on a situation!!!

[txspadequeenRN]

im looking for opinions on a issue that occurred. now this is something that happened a while ago but it still irks me...

i was working in a ob/gyn clinic and we had a 8 month pregnant lady that was seen every month since the beginning of her pregnancy. one day her husband calls the doctor and tells him that he has had an affair and has contracted a std . he is scared for his wife and unborn baby that he will pass this to them. but he does not want her to know that he had this affair but she needs to be checked which requires a pelvic exam and he testing itself...in order to do this the doctor must lie to the patient ... now im just looking for opinions, the doctor ended up lying to the patient and she did not find out as far as i know...as the nurse i felt like climbing in a hole in the floor so i just backed out of the whole thing...this really has bothered me a lot. what do you think about all this mess

[nicunana]

How do you know the Dr. didn't tell the patient what test he was ordering? The scenario could have been "Now that you are so close to delivery, I want to run our standard STD panel on you so that all that will be taken care before your admission. That's one less thing we'll have to worry about at that time." I see no reason that he should have had to follow that up with "and besides your husband called & said he has an STD. " The Dr's resposibility was to identify any problems that might be present to affect Mom or the baby, not to become involved in marital issues. The fact that the STD test may not have been "standard" at this point in the pregnancy was to my way of thinking a kindness to the patient. Take it from one who knows, no one wants to find out near the end of her pregnancy that her husband is an unfaithful cad. If this is an isolated instance, they can get on with their marriage. If this is not an isolated instance, she will find out soon enough, without making what should be one of the happiest times of her life a nightmare. I think the Dr. showed great compassion.

[MIA-RN1, RN]

What kind of std? There is a huge difference between GC or CT and HIV. What if it were syphillis? By exposing her to one std, he's exposed her to many. Who says he doesn't have more than one std?

If it were something like say CT or GC, sure the doc can get a urine sample, send it for testing and be done with it. Is it ethical not to tell the patient? NO WAY. If it was an HIV test, it MUST be done under informed consent and with the proper counselling. So I doubt the doc did an HIV test or if he did and didn't tell her, what would he say if it came back positive????

Now we have a mother who was potentially exposed to HIV d/t her husband's unprotected sex with someone else.

Now we have a baby who should maybe not breastfeed since HIV transmission is possible.

Now we have a baby that is at risk for HIV, and a mother who maybe now needs to maybe think about prophylactic treatment.

BUT since the doctor said nothing to her...none of that will be done. So in 2 years when the kid is maybe diagnosed with HIV, what then?

[miracle1986]

A zillion cheers to Coopergrrlrn :cheers::cheers::cheers::cheers::cheers::cheers::cheers::cheers: and I mean a zillion..... (rootbeer in the mugs-not a drinker)....you are right on.

[EDValerieRN, ASN, RN]

What happens if the test comes back positive for an STD?

Mom asks how she could've got it... is the doc gonna lie to her then?

I think it's flat-out wrong. The clinic is providing healthcare to the woman, not to her cheating spouse, and has no obligation to keep such a thing a secret.

It's also flat-out wrong to assume that this woman wouldn't want to know if her spouse was cheating. Would you withhold the information from her because it may break up her marriage? Guess what? That marriage was already broken by her husband's infidelity.

By not telling her what happened, the healthcare provider is just enabling her husband to bring her home a worse disease next time.

[leslie :-D]

i would like to think the md told the husband, to tell his wife; and that he will if the husband does not....

as daytonite stated, we do not know all the information.

and no one is assuming the wife doesn't want to know.

just like no one is assuming she would want to know.

i can only hope the md gave the husband some beneficial advice re: husband's own follow-up care and the potential risks of all involved.

leslie

[bethin]

I think what the dr did was unethical and possibly illegal. Pts have to consent to be tested for HIV and I would think if the husband cheated he would also wanted to be tested for HIV as would the wife. When someone cheats you want to be tested for everything. What if the baby comes out and tests + for herpes or worse HIV? The woman deserves to know what she and her unborn child have been exposed to. Forget about saving the sancity of marriage - that ship has sailed. There's a child to think of. I know the risks of the fetus contracting HIV is minimal but it still exists.

What if the woman tests + for something? How is the dr going to explain that? The MD is setting himself up.

[SaderNurse05, BSN, RN]

I agree this was a case for the health department. Did the doctor test the husband or verify his results? I work in a public health STD/HIV setting and you would not believe some of the stuff our clients have come up with. For the doc to take this guy at his word and then perform tests on his patient under false pretenses seems to stick in my craw.:angryfire OP I can see why this still bothers you. I would also say that as a fellow health care professional you did the right thing by stewing on it but not telling the wife. Two wrongs don't make a right. I would just pray that the scumbag learns from this. Of course, he may have simply learned he does not have to take responsibilty for his actions and that a doctor no less will lie for him.:angryfire. The doc dropped the ball, the question is who should pick it up?

[Retired R.N.]

How do you know the Dr. didn't tell the patient what test he was ordering? The scenario could have been "Now that you are so close to delivery, I want to run our standard STD panel on you so that all that will be taken care before your admission. That's one less thing we'll have to worry about at that time." I see no reason that he should have had to follow that up with "and besides your husband called & said he has an STD. " The Dr's resposibility was to identify any problems that might be present to affect Mom or the baby, not to become involved in marital issues. The fact that the STD test may not have been "standard" at this point in the pregnancy was to my way of thinking a kindness to the patient. Take it from one who knows, no one wants to find out near the end of her pregnancy that her husband is an unfaithful cad. If this is an isolated instance, they can get on with their marriage. If this is not an isolated instance, she will find out soon enough, without making what should be one of the happiest times of her life a nightmare. I think the Dr. showed great compassion.

I agree with your opinion of this situation. If more doctors would run routine STD tests on all their patients, managing the patients' care would be much more focused and beneficial. When it comes to diseases that can cause such tragic effects to unborn babies and their mothers, I feel it would be malpractice NOT to test.

[chenoaspirit, ASN, RN]

No, the doc probably shouldnt tell the wife, the husband should. The doc is responsible for providing care and preserving good health for mom and baby, but ethically. As a nurse, no I would not deny treatment to the patient. The issue is how this situation made the nurse feel, and Im sure it would make me feel VERY uncomfortable. But even if this doc does test this mom/baby for HIV, who is to say that it wont show positive in 10 years from this episode. This is no short-term fix. The mom/baby need to be tested multiple times at intervals to ensure that no one was infected with something deadly. One test will not rule that out.