Four researchers of Indore have set out on a task to find answers to a question - which has been bothering surgeons for the past few years - with the increasing HIV prevalence and consumer practice/legalities involved in medical practice, should HIV testing be done as mandatory test before operative or any invasive procedure?
Initial reports have revealed startling facts about the nature of patients, of practice and of attitudes among the medical practitioners. The findings have stumbled upon another aspect of the issue that whether the patient is entitled to know the HIV status of the surgeon operating on him.
Initial investigations by these researchers reveal that `special' universal precautions would cost the patient twice as that of the HIV screening.
Out of the 50 hospitals contacted by the researchers - Choithram Hospital and Research Centre (CHRC) Medical Director, Dr Ravi Kant, Dr S P Jaiswal, Dr V S Chitnis and Maninder Singh Bhatia - only one institute has rejected the proposition as `extraneous'. All the rest of them have expressed dire need for pre-operative screening.
According to Dr Ravi Kant, the findings point out that the additional burden of the universal precautions falls on the patient amounting to the tune of Rs 600, as a base amount. The screening costs would amount to only Rs 200-300.
This significance of this factor is more in places like Indore where most of the patients come from rural platforms and have little money to spend on medical needs. In addition to that, the concept of medical insurance is yet to kick-start here.
In Indore, around 25 per cent of the patients were screened for HIV (in the targeted hospitals) during the year 2002. Among those who were found HIV positive, only 50 per cent of patients could get enter the operation theatre. (The data on follow-up of HIV positive patients were inaccessible).
This fact reveals the massive stigma attached with the disease - even among the medical fraternity. More than 30 per cent of the doctors confirmed that HIV status does affect the treating doctors' attitude towards the patient.
Dr S P Jaiswal was of the view that the screening of patients with informed consent and with pre and post counseling sessions, before invasive procedures would solve four purposes. It will ensure universal precautions are taken, would reduce the time consumed for administering Post-Exposure Prophylaxis (PEP) in case of contact with HIV source, would allow proper disease management in case patients turns out to be positive and would supplement the World Health Organisation (WHO's) database (which is desperately needed in view of gross under-reporting of HIV cases).
The consumer laws also play a vital role here. The patient can always claim later on that he was exposed during surgeries performed, before he was tested for HIV. This could lend the hospital or the doctor into trouble, he added.
When asked about whether a cross-examination of the patients was carried out to confirm whether they want to know the status of surgeons operating on them, Dr Jaiswal said that the patient has every right to do so. But, the study is too premature and needs further work.
The researchers plan to conduct a collaborative study exploring several aspects of the issue with the WHO. A proposal is being prepared, he said.