Living Without HepC

Last week, Tuesday 26 April, Jeremy Laurence who writes a regular Health column in The Independent wrote a short piece about hepC which I found astounding on a number of different levels.

Although a bit longish, I reproduce it here so the full flavour of the piece can be seen:

It was a small scare with no one dead - so far. But it raised one of those intriguing questions about the balance of good and harm in health that remains endlessly fascinating. A gynaecologist infected with hepatitis C was thought to have passed the virus to a patient triggering an alert that led to 2000 women being offered tests last week. He had worked at 25 hospitals throughout England and Scotland for 23 years.

It caused hardly a ripple in the national media. But there was one puzzle about the case. A test for hepatitis C has existed since 1991. It is used to screen all blood donations for the virus. So why wasn’t it used on the gynaecologist, and for all other doctors involved in surgery where just a simple scratch or pin-prick could lead to transmission?

Well, routine testing of health workers has never been introduced because there is no vaccination against the infection.

Under new guidance, students intending to take up surgery will be screened. But the decision not to test existing health workers has divided the medial establishment. Public health specialists have argued that testing is necessary to protect patients. But surgeons have protested that routine testing would lead to a serious loss to the surgical workforce. One in 200 surgeons is thought to be infected and, once identified as a carrier of hepatitis C their career is over.

The official view, though not explicitly stated, is that the harm to patient care caused by the loss of surgeons from the workforce outweighs the harm caused by rare cases of viral transmission.

Five to 10 patients a year are estimated to contract hepatitis C from healthcare workers, and there is a tacit acceptance that this is the price we must pay to keep the NHS running. I think it is a reasonable balance, but I suspect many won’t. In case it is any comfort to those who don’t, the risk of dying as a result of hepatitis C is about equivalent to the risk of being killed by lightning.

From the article we can see that
* One in 200 surgeons are infected with the HepC virus; according to the Royal College of Surgeons website there are just under 50,000 surgeons in the country (my quick reccie shows a host of titles & types of surgeons so probably also includes Veterinary Surgeons).
* Based on these figures, there are currently about 250 surgeons infected with HepC performing operations every day.
* Surgeons take the view that if they are identified their career is over.
* The official view, though not explicitly stated, is that the harm to patient care caused by the loss of surgeons from the workforce outweighs the harm caused by rare cases of viral transmission
* Routine testing of health workers has never been introduced because there is no vaccination against the infection.
* Five to 10 patients a year are estimated to contract hepatitis C from healthcare workers, and there is a tacit acceptance that this is the price we must pay to keep the NHS running.
* The risk of dying as a result of hepatitis C is about equivalent to the risk of being killed by lightning

It leads me to wonder about a number of issues here:
* What information & statistics are being collected and what is being done with it?
* The ‘one in 200′ statistic must be based on data collected to form such an explicit ratio. So, data and information about HepC infection amongst the medical profession must exist. How much other such information is currently being collected and stored about other professionals? What is being done with it - and about it?
* Is it really sensible to decide not to screen health care professionals (or any other professionals as well) because no vaccine exists? We screen for cancer but there is no vaccine.
* Is it true that a surgeon’s career is over if they are identified having hepC? The gynaecologist mentioned in the first paragraph continues to work we are told (presumably on the same salary) on other duties but away from direct patient contact. Is the surgeons career really over if they are removed from risky activities such as operations? Don’t surgeons also teach, manage, do research, and other knowledge-related activities? Aren’t these careers?
* Does the threat of a shortage of surgeons mean that group are in a strong bargaining position for their preferences and views to hold sway in the debate about the balance of good and harm in health?
* Is that behind the ‘official view, not explicitly stated’, that the loss of surgeons from the workforce outweighs the harm caused by rare cases of viral transmission?

The General Medical Council tells us it is a doctor’s duty (amongst others) to
• make the care of your patient your first concern;
• recognise the limits of your professional competence;
• make sure that your personal beliefs do not prejudice your patients’ care;
• act quickly to protect patients from risk if you have good reason to believe that you or a colleague may not be fit to practise;
• avoid abusing your position as a doctor; and
• work with colleagues in the ways that best serve patients’ interests.

I cannot see how this commitment squares with that stance on protecting one’s career in medicine. Do they really plan to allow 5 or 10 people a year to contract a chronic disease as a result of this stance?

The risk of death from HepC may be similar to the chances of being hit by lightning, but the suffering caused by the disease and the treatment, as well as the cost of ‘late diagnoses’ is considerably significant - especially to those affected.

I am bemused by all this. I cannot find it in me to quietly accept that this is the way it is and should be.

This entry was posted on Wednesday, May 4th, 2005 at 3:34 pm and is filed under Journal. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.