His laboratory results came with the afternoon delivery. Judie, my receptionist, called Mark and he will be my last appointment tomorrow. He has been waiting two weeks since his bloodwork was drawn.
It is 1987 and I have a small practice with another doctor in a suburb of New Orleans. Word has spread in the gay community that my clinic will draw the bloodwork for HIV and send it to the lab with only a number identifier. That is not in compliance with Louisiana’s public health demand that all positive HIV patients must be identified and reported to the state Department of Health. I understand the public health concerns, the need to have reliable statistics and follow up of contacts but at what cost to my patients? The chances are that they will lose their jobs, their health insurance, perhaps their housing, and some colleagues, friends and even family may shun them . . . the list goes on. I hear of this happening over and over. Everyone is afraid and misinformation is everywhere. No, I took an oath to do no harm. I will not be party to harming my patients.
I had found a small independent lab willing to test for sexually transmitted infections, including HIV, on a cash basis with no questions asked about the number identifier. Back in those early days HIV testing took much longer due to the laboratory analysis process, the limitations in antibody detection technology, and the need for confirmation testing. The turn around time was often an agonizing two weeks for the patient.
For all patients being tested, I had a strict rule that results were only given in person, never over the phone or by letter. A negative HIV test would entail counselling on safer sex and because of the window period for detecting the virus antibodies, perhaps another blood sample would be needed. With negative tests there would be much relief and many thank yous, as if I had something to do with the results. But with the positive tests . . .
I have seen Mark’s results. He will be here tomorrow at five o’clock and probably won’t have slept. And I, I will put on my white coat and I will be the professional. He will not know that I did not sleep well either.
