A Medical Economics Web Exclusive

Did my patient give me AIDS?

Fear for his own life taught the author valuable lessons in patience and compassion.

By Joshua M. Usen, DO
Family Physician/Getzville, NY

Chuck, a young machinist, had been a patient of mine for several years. He'd been in two car accidents while under my care, injuring his shoulder and back. He was only 35, a couple of years older than me, but, unkempt, with bloodshot eyes, and cigarette-stained teeth, he looked far older.

Chuck's care had been fragmented. He'd had short courses of physical therapy and a couple of visits with orthopedists, but there was little continuity. I enrolled him in a physical therapy group, and referred him to an orthopedist and a pain management specialist.

He often missed his appointments—with me as well as with the orthopedist and physical therapist—due to court dates, arrests, and other personal issues.

Whenever I saw Chuck for routine medical problems, he claimed he didn't have any money to pay for care that wasn't directly related to his car accidents. So I wrote off his charges and gave him samples of medications whenever possible.

One day, he arrived at my office with a splinter lodged deeply in a now-infected finger. Using lidocaine and the appropriate instruments, I easily removed the splinter; Chuck gratefully accepted some free sample antibiotics and was on his way.

As I cleaned the instruments, I accidentally stuck myself with a bloody sharp. I cleansed the area immediately, but my heart sank and my suspicious, paranoid mind took over: "Of all the patients! He's got a lot of tattoos. What other 'questionable' things has he done? IV drugs?!"

After I'd calmed down and reviewed the risks associated with blood-borne pathogens, I began a regimen of anti-HIV drugs. This would at least give me some small measure of comfort until I could ask Chuck to get tested.

The next morning, I called him at home and explained that I'd had an accident after he left the office. He seemed genuinely apologetic, even though it wasn't his fault. I explained to him that, because of his tattoo art, he might have been exposed to risk factors for HIV, hepatitis B and C, and other diseases—and that now I may be at risk, too.

I asked him if he'd get tested for my own peace of mind; I'd pay the lab fees. He reluctantly agreed, because I'd gone out of my way for him over the past year. However, he said he didn't want to know the results, good or bad.

Chuck promised to get tested the next day, a Saturday. An hour after the lab closed, I phoned to see if he'd gone. I wasn't surprised to hear that he hadn't. The lab wouldn't reopen until Monday, leaving me the weekend to wait and continue to feel nauseous from the anti-HIV drugs.

On Monday morning, I dialed Chuck's cell phone and asked him what had happened. "Doc, I'm sorry," he replied. "I was in court and the hearing wasn't even for me. I'm at the lab now."

I felt relieved. The tests would be run the next morning.

Tuesday afternoon, I called the lab. The technician informed me that Chuck's name and results weren't in the computer. Apparently, he hadn't showed—again. I figured that he was lying to me because he had something to hide. That made me feel really queasy.

I called Chuck at home and got his girlfriend. She was very involved with his medical care, having accompanied him to all of his appointments.

"Did he go for his blood work?" I asked.

"Gee, I don't know." An obvious lie, I surmised.

"Please have him call me when he gets in."

Days passed, and I debated calling again. The notion of shaming Chuck into having a test done seemed unethical, and unlikely to work. Obviously, I'd overestimated his appreciation. All I could hope for was that he would consent at some point. But for all I knew, he might never come back to see me. Badgering wouldn't help.

Another three weeks went by, and still no word. My GI malaise continued.

Finally, Chuck called to ask me to refill one of his pain medications. Part of me wanted to be petty and refuse, but that would violate my personal and professional ethics. Plus, if I didn't continue his care, I'd lose any chance of ever getting him tested. When he came to the office for his prescription, he sheepishly asked my receptionist if he could speak to me "about his test results."

Puzzled, I asked him to come into my office. "Doc," he began, "I know I told you that I didn't want to know. But I've changed my mind."

"What are you talking about? Your blood test?"

"Yes," he replied. "That day you talked to my girlfriend, I was at the lab." He rolled up his sleeve to show a nearly healed bruise. "They had to stick me five times!"

I sat silently, pondering the ramifications of what I was about to say. "I never got the results," I said flatly.

A long pause followed. Before he could say anything, I dialed the lab. After a brief delay, a technician found the results. I motioned Chuck to remain in my office while I spoke with the tech's supervisor and the lab's director. Neither of them could explain why I hadn't received the results—and why previously there had been no record of my patient in the system.

I hung up the phone, and gave Chuck a smile and a thumbs-up. "Negative!" I said. "We're both fine. No HIV, no hepatitis."

A spontaneous hug followed. "But I really don't know what happened to the results."

Chuck gave me a quizzical look. "You mean I haven't slept in a month because the lab screwed up?!" he asked. "The reason I never called you back is because I was afraid you were going to give me bad news."

"And I've been puking for a month, taking HIV-prevention pills, because I was worried about what you might be hiding from me."

For three weeks, I'd been cursing Chuck as another ungrateful abuser of the medical system. I'd portrayed him as someone who allowed himself to wallow in his own self-pity with respect to the blows that life had dealt him, so much so that he lacked common decency. Moreover, I felt I had gone out of my way to help him and he had lied to me in return.

Of course, when I finally got Chuck's test results, I was relieved that I wouldn't have to worry about HIV. Equally important, though, the incident taught me never to judge someone by appearance alone or based on something in his or her past. In this case, I felt heartened knowing that I'd formed a bond with a person I might otherwise never be able to connect with. That made the news we got even sweeter.

Joshua Usen. Did my patient give me AIDS?.

Medical Economics

2003;6.