Should Health Care Provider Convenience Trump Patient Protections?

by Alison Mehlman
CHLP Director of Planning & Policy Research

It appears as if some physicians in New York State feel that their time and convenience should be a primary determinant of HIV testing policy. But what has happened to patient-centered care? Should the perceived inconvenience of a health care provider trump the enforcement of necessary patient protections?

It appears as if some physicians in New York State feel that their time and convenience should be a primary determinant of HIV testing policy. But what has happened to patient-centered care? Should the perceived inconvenience of a health care provider trump the enforcement of necessary patient protections?

In an article published recently by pressconnects.com, the Westchester County health commissioner responded to a proposed amendment to existing New York law that would eliminate documentation of a patient’s informed consent to HIV testing by remarking that physicians are very busy and do not have time to get a patient’s signature for an HIV test. He went on to assert that physicians would sooner defer the test than take the time to explain the test and get the patient’s signature on a piece of paper. Seriously?

Current New York law requires that testing of any person for HIV be conducted only with that person’s written, informed consent. This means that the person being tested must be counseled about what the test is for, and must agree to it by signing a form. There are many good reasons for this requirement. First, it ensures that patients are active participants in the decisions that affect their own health care. Second, it affirms the basic tenet of medical care—and is consistent with New York State’s Patients’ Bill of Rights—that requires a patient’s consent for any treatment. Third, it prevents testing for a highly stigmatized medical condition without the patient’s full understanding of what the test is and what the results might mean. And fourth, it underscores the need for health care providers to have open and honest conversations with their patients about what leads to HIV transmission, i.e., sex and drug use, and whether patients might be at risk.

Doing away with the requirement for informed, written consent in favor of the so-called “opt-out” testing model being promoted by the CDC and many medical and service providers—which would mean that nearly everyone in New York would be tested for HIV, regardless of their risk, unless they affirmatively object to the test—will only lead to people being tested for HIV without their knowledge or consent. Some physicians see this as a positive thing because they would be able to avoid uncomfortable conversations about sex and drug use and, if informed consent is not required, more people would be tested for HIV and know their HIV status. In New York, however, with its already streamlined counseling and documented informed consent process, HIV testing rates have continued to increase, all the while patients have been involved in the process. What these providers don’t seem to realize is that sidestepping a patient’s rights will only exacerbate a growing mistrust of the health care system and, potentially, lead to some patients’ choice to forego health care altogether.

Is it really that difficult and time consuming to explain an HIV test and obtain a patient’s signature? Current law requires only that the patient be counseled about the test, including what it involves and what the results might mean, and then sign a form to that effect. The requirement does not create more work for physicians because, in just about every health care setting imaginable, it is the nursing or other staff, not the physician, who draw bloods and make sure that patients sign forms. Why is it acceptable to have patients sign a form indicating that they have been advised about the office’s privacy practices, but too much of a hassle to have patients sign a form indicating that they understand and agree to a test that is going to be performed on them and that may have serious consequences? The written consent requirement for HIV testing is about patient-centered care, and even a very busy provider could find time for that.