Mandatory guidelines covering hospital tests of patients for AIDS virus infection are needed to stop doctors from ordering the tests without a patient's knowledge or consent, a new study concludes.
In an analysis of AIDS virus antibody testing at a medical center affiliated with the University of Minnesota, researchers found test misuse was rampant. In only 10 percent of the cases studied did medical records indicate that sound testing practices were followed.The study and an accompanying editorial in Friday's Journal of the American Medical Association say it is wrong for doctors to give patients the test unless they first provide counseling and the patients agree to be tested.
That counseling should include a warning that AIDS testing information could ruin a person's life if confidentiality is breached, suggests an editorial by Dr. Renslow Sherer, a founder of the AIDS service at Cook County (Ill.) Hospital.
"Confidentiality safeguards are essential," Dr. Sherer wrote, "But the physician's ability to guarantee them with certainty in hospitals and offices is limited and should be honestly portrayed as such to patients."
The Minnesota study focused on 275 patients who were tested between April 1985 and August 1986. It found that of those tested, 25 produced positive results, indicating infection with the AIDS virus, known as HIV, human immune deficiency virus.
In 44 percent of those tested, there was nothing listed in the medical records to indicate high-risk activities, such as homosexual practices or intravenous drug use that would raise any medical suspicion of HIV infection.
In another 44 percent of the cases, the study found that high-risk behaviors were noted in medical records, but that patient counseling and consent for testing were lacking.
Incidence of acquired immune deficiency syndrome in Minnesota is much lower than in other states such as New York, California or Florida. There are no legal restrictions on testing in Minnesota, such as a state law in Illinois that requires patient consent and counseling.
Many states lack such restrictions, so it is likely that the practices found in the study are widespread in the country, said study author Dr. Keith Henry and his colleagues at the University of Minnesota.
Besides the failure to counsel and inform patients about the tests, researchers also found a tendency for doctors to misunderstand or misinterpret test results.
In six cases where initial screening tests were positive for infection, but the confirmation follow-up tests were negative, doctors incorrectly interpreted the results.
In five other cases, doctors incorrectly recorded a diagnosis of AIDS on medical records even though the tests indicated HIV infection only, and no symptoms of the disease were apparent.