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Ethics OSCE Station Blueprint Station Name: HIV Infection Issue:Confidentiality Presenting Situation avid Plant requests results of HIV test which is positive. Mr. Plant does not want his wife to know his HIV status. Activities:Patient encounter. Time Required:10 minutes
This station was developed by Dr. Peter A. Singer (Centre for Bioethics and Department of Medicine, University of Toronto), and Anja Robb (Department of Family and Community Medicine, University of Toronto. It is part of the Ethics OSCE Project which is funded by Educating Future Physicians for Ontario (EFPO). There is an accompanying videotape. This material can be used for teaching or evaluation. It is not copyrighted and may be freely reproduced for educational purposes.
Instructions to Candidate:You started doing a locum for Dr. Lang a few days ago. Dr. Lang will be gone for several months. You are about to see David Plant, who has been Dr. Lang's patient for several years. Generally he has been very healthy and has not needed much medical care except for the occasional health check up. A few weeks ago he confided to Dr. Lang that he had unprotected anal intercourse with a homosexual lover on at least 5 occasions about 4 years ago. He expressed fear of having AIDS and requested an HIV test. Sandy, his wife of 3 years, is also a patient of Dr. Lang and has an appointment with you next week. She does not know about her husband's homosexual experience. Mr. Plant's test has come back HIV positive. A confirmatory test is also positive. Please inform Mr. Plant of the test results and deal with his concerns. Mr. Plant did not have an appointment. He walked in and insisted on seeing you today. You have a very busy office and only have 10 minutes to see him.
CHECKLIST ITEMS: ^^^^^^^^^^^^^^^^ 1. checks if patient talked with previous doctor about test, or implications of test. ----|----------------------------------------------------------- 2. assures patient he does not have AIDS. ----|------------------------------------------------------------ 3. states that prognosis is variable. ----|----------------------------------------------------------- 4. states that wife should be told/she has a right to know. ----|----------------------------------------------------------- 5. states that wife could be HIV positive and should be tested. ----|----------------------------------------------------------- 6. advises patient to use abstinence or safe sex with wife or other partners to prevent transmission of HIV. ----|----------------------------------------------------------- 7. encourages patient to tell wife. ----|----------------------------------------------------------- 8. offers to help tell wife. ----|----------------------------------------------------------- 9. advises patient that wife may find out through public health contact tracing. ----|----------------------------------------------------------- 10. offers follow up visit. ----|------------------------------------------------------------ ================================================================= RATE FROM 1-5: +------------------------------------------------------------+ | | | | VERY | | | POOR | FAIR | GOOD | GOOD | EXCELLENT | | 1 | 2 | 3 | 4 | 5 | +------------------------------------------------------------+ 1. How would you rate the candidate's communication skills? 1 2 3 4 5 2. How would you rate the candidate's ability to address the ethical issue in this case? 1 2 3 4 5
Instructions to Standardized Patients:Your name is David Plant. You are between 30 and 40 years of age. You are a high school English teacher. Very successful at your job. You have been very happily married for the last 3 years to Sandy, a teacher at another school. You have had some homosexual tendencies since adolescence, and have had a few brief homosexual relationships. You have had heterosexual relationships since adolescence also. About 4 years ago you met a man with whom you had a brief and intense affair. You had unprotected anal intercourse with him on at least 5 occasions. The affair ended when your lover left to live in California. Shortly after that affair, you met Sandy at a teachers' convention and fell in love. Your marriage has been a good one. You have recently talked about starting a family. Sandy has no suspicion that you have ever had a homosexual relationship. Physically you have been feeling fine. You have not experienced any symptoms of AIDS (e.g. weight loss, night sweats, diarrhea, etc.). Because of your past experiences you have been thinking more and more about the possibility of HIV infection. That's why you finally decided to have the test. When you spoke to Dr. Lang about the test, you were left with the impression that things would be OK - that the test would be negative. Because you've been feeling well and because you have not had any homosexual partners during the past 3 years, both you and Dr. Lang are hoping for the best. Now that the test has been done you are very anxious to get the result and possibly put your anxiety to rest. You phoned Dr. Lang's nurse and found out that Dr. Lang was away, but the test results were in your file. You were feeling so uneasy that you walked into the clinic and requested to see the doctor taking Dr. Lang's place. If candidate recommends that you tell your wife, you may say things like:
"How can you tell her something like this? She doesn't know anything about my homosexual experiences." "I really love her and I don't want to hurt her. I'm convinced that if she finds out she'll be devastated. It's going to blow her life apart. Why do we have to destroy her life?" "It'll be the end of us. She'll leave me. I don't want to lose her. I'll be left with nothing." "You won't tell her behind my back will you?" Prompts are used to standardize the scenario and give all candidates an opportunity to address releva
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