HIV, a Partner Who Does Not Know, and a Curious Colleague
A 29-year-old man is newly diagnosed with HIV and syphilis at a county hospital. He asks the physician not to tell his girlfriend of two years; he says he will tell her himself "soon" but has not. He is a well-known local footballer, and a journalist telephones the ward asking whether he is a patient. Separately, the IT audit shows that a nurse from another ward opened his electronic record twice, at 22:40 and 23:05, when she was not on duty for him. She later tells a colleague she "wanted to see who it was".
1. What is the physician's position on informing the girlfriend, and what steps come before any disclosure?
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Confidentiality is the default, but it is not absolute and it is not the only duty in play.
Public health duties. HIV and syphilis are notifiable; notification goes to the epidemiology service, and partner notification is a recognised function of that service, which can contact partners without disclosing the index patient's identity wherever possible.
The patient's own duty. An infected person is required to inform sexual partners and to take precautions to prevent transmission. The physician should state this clearly, offer supported disclosure (in the room, with a plan and a date), and record the advice.
Disclosure without consent. This is a last resort, justified only by necessity and proportionality: a real and imminent risk to an identifiable person, no less intrusive route, and legal advice where time permits. The physician should first involve the epidemiology service and the institution's legal service, and document the reasoning.
"Soon" is not a plan; the answer is a dated, supported disclosure, not silence and not a unilateral phone call.
2. How should the journalist's call and the nurse's record access be handled?
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Journalist. No confirmation that the man is a patient, no comment on his health, no "no comment" that functions as confirmation. Take the caller's details, say the institution does not discuss individual patients, and inform the duty manager and the patient. If the man wishes to speak publicly, that is his decision and should be arranged properly.
The nurse. Access without a care relationship is a breach of the confidentiality duty and of data protection law, regardless of whether she told anyone. The steps are: preserve the audit log; report to the director and the data protection officer; conduct a disciplinary procedure with the right to be heard; consider whether the conduct meets the threshold for a criminal report concerning unauthorised access. The patient should be informed that his record was accessed without authorisation, because he has a right to know and may need to take steps of his own. "Curiosity" is not a lawful purpose.
3. What should the record contain by the end of the admission?
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A record that would withstand scrutiny by the patient, the chamber and a court should show:
- the diagnosis and the treatment plan, in factual, non-stigmatising language;
- that the duty to inform partners was explained, with the patient's response and any agreed date for disclosure;
- the referral to the epidemiology service for partner notification;
- advice on precautions and on adherence, and the follow-up appointments;
- the journalist's call, what was and was not said, and who was informed;
- the unauthorised access, the audit reference, the notifications made and the patient being told.
What it should not contain is speculation, moral comment or identifying detail beyond clinical need. The record is the institution's memory and the patient's evidence; both are served by precision.