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Patient Education

The surgeon general's report on AIDS in 1986 emphasized the need for public education to control the spread of HIV infection in the United States. The full report, in a readable pamphlet form, is available from the CDC and many state and local health departments. One of the most controversial aspects of this report was the recommendation that frank sex education be provided to children who are not yet sexually active.

Patient education is an obvious adjunct to public education. Physicians who care for adolescent children must be knowledgeable about the risk of HIV and the safer sex practices that can limit its spread. Those who care for patients who are sexually active or are exposed to blood or tissue products must include information about the spread and prevention of HIV infection in routine patient counseling.

The duty to warn third parties is discussed in Chapter 21. There is also a duty to counsel the patient as to the prevention of harm to others. This duty has allowed persons injured by a patient whose driving was impaired by medication to sue the prescribing physician. If these third parties are able to prove that the physician did not warn the patient of the dangers of driving while on the medication, they may recover from the physician. It is clear that persons subsequently infected by an HIV carrier can recover if the treating physician did not properly instruct the patient in how to prevent the spread of the disease. There has been at least one large settlement by a physician who did not counsel a woman exposed to HIV by a blood transfusion to practice safer sex with her husband.

Physicians have a special responsibility to counsel women who seek medical advice on contraception. When physicians prescribe contraceptives, they imply that the prescribed contraceptive is safe to use. They may be held liable if the woman is injured by an undisclosed risk of the contraceptive. Thus, a woman who is prescribed oral contraceptives is given detailed information about the risks of smoking and vascular problems. The same woman should be warned about the risk of contracting HIV if she relies on oral contraceptives rather than condoms for contraception. As HIV spreads to the heterosexual population, forms of contraception that do not involve barriers and spermicides are increasingly inappropriate for women who are not in long-term, monogamous relationships. (See Chapter 25.)

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