Should this surgeon be back in operation?

For a British doctor with the Aids virus, going back to the operating theatre would be a triumph. But not everybody is convinced, says Nick Harris

Professor George Browning is an internationally renowned ear, nose and throat surgeon based at Glasgow's Royal Infirmary, where he holds out-patient clinics and teaches students from Glasgow University. Last week, he became the first HIV-positive surgeon in Britain to be given the go-ahead to return to surgical practice.

An advisory body at the Department of Health, after lengthy consideration, has decided his condition does not prevent him from performing surgery. In theory, there is now nothing to keep Professor Browning out of the operating room. But he has had to overcome many obstacles and there may be more in the future.

It was in December 1994 that Professor Browning, 55, announced that he was HIV-positive. He took a three-month break from work, and when he returned he did so with the proviso in his contract that he would no longer perform surgery.

In October last year, Professor Browning wrote to the department's advisory body. Its job is to assess cases of ill health among medical workers and give advice to employers. Where necessary, it can seek specialist advice about potential danger to patients. "I like patient contact," Professor Browning says. "I like being in hospital. I like the aura that it gives. I like the intellectual side of it, and the academic and teaching sides." But there remained the desire to return to theatre and practice the work he is expert in.

For five months, Professor Browning waited for some guidance and became increasingly anxious that the decision was being stalled.

"I don't like indecision. I want to know," he says. "At the very least, one has got to try to work out who is going to operate on all the people on the waiting list."

Much of the surgery Professor Browning used to perform was keyhole surgery in the inner ear. Long-handled instruments are used in such procedures, and it is widely recognised to be low-risk in terms of patient safety.

"If you look at the medical facts, there is absolutely no reason, provided certain precautions are taken, why I shouldn't go back," he says.

The next stage in his return will involve a meeting with his personal physician, who will advise him on what operations he can perform, and a meeting with representatives of the local health trust. Beyond that, logistical details will have to be considered, such as a change in contract and arrangements for a theatre and anaesthetist.

Not everyone is convinced, however, that the role of an HIV-positive surgeon will be an easy one. Doubts about safety may take some time to dismiss. One medical worker says: "Mistakes can be made. You never know what can happen."

It may also take some time for old prejudices among the wider public to be dispelled. A recent Scottish television programme did a vox-pop on the subject of doctors with HIV and Aids. Six out of eight people interviewed said they would not feel comfortable being operated on by a surgeon they knew to be infected.

Professor Browning says: "I've got so many positive vibes back from patients. Nobody, as far as I know, has refused to see me at the clinic."

Nick Partridge, chief executive of the Terrence Higgins Trust, says: "We are delighted that Professor Browning is able to resume work. The importance of the decision is that it sends a strong message to people with HIV that working life doesn't have to stop."

He added that it also shows a growing maturity by health administrators towards those with Aids and HIV. He said that there has only ever been one case of a health worker infecting anyone worldwide - a Florida dentist whose precautionary measures were somewhat lax.

Professor Browning's case could be a landmark in the way in which employees with HIV and Aids are allowed to carry on with their work. "I think it's an important issue to raise," he says. "It's a pity that I have to be ill to do it. But I'm not ill at the moment."

By the end of 1995, there had been 25,635 reported cases of HIV infection in the UK. While less than a quarter of 1 per cent of the working population is infected, it is an issue that may have greater bearing in future.

A growing number of companies, including IBM and WH Smith, have guidelines regarding the employment of infected staff. One barrier to employment in future may be the insurance of employees, which is two to three times higher than normal when HIV cover is included. Employers willing to hire infected workers can only help to break down barriers.

In the US, nearly 70 per cent of large companies (2,500-5,000 employees), and nearly one in 12 small employers (those with fewer than 500 employees), have an employee with HIV or Aids. Prejudice against infection is gradually breaking down.

Last July, in a case viewed as a turning point for workers' rights, an American court found that the FBI had acted illegally in firing a San Francisco physician who had Aids. Unfortunately for the physician, who first sued the FBI in 1988, the decision was too late. He died in 1992.

"There are things that matter," muses Professor Browning, waving a hand at the file containing the correspondence relating to his case. "Obviously I wouldn't have taken this kind of thing up if I knew I was going to be dead by the time they answered my letter."

Professor Browning is a charming man with engaging eyes, and speaks with rhythmic, lilting tones that contrast booming exclamations with soft but positive assertions.

When asked if he felt that he had faced discrimination, he replies: "Do you mean discrimination because of my health or because of the reason why I probably got it?"

He is bisexual and says that it has been known for a long time. "It has become more open, obviously. I've not shied away from that and I wouldn't want to."

He has experienced a great deal of support, and in some ways has been surprised by the way people have reacted.

"One of the things I did not expect was the fact that people automatically knew I was infected, and my colleagues could then come up and say 'George, how are you?' They've been very good.

"If one of your colleagues develops a tumour, you're not really quite sure whether you're meant to know. When you see him the corridor, you don't really say 'How are you and how's your tumour?'

"The very openness about your ill health has actually been a helpful thing. There's no doubt about that. I think it's made it easier for people to communicate." Professor Browning is married with three grown-up children. In December 1994, the press found out that a Glasgow doctor had tested HIV positive and the wrong doctor was named.

Professor Browning came forward to identify himself to save further confusion - but was left with just 20 minutes to tell family members of his condition before it became public information.

His wife, who already knew, was, and has been, very supportive, he says. He is still unsure exactly what his children think. "I think they were surprised, but I didn't really have time to take that in because I myself was surprised."

For the moment, Professor Browning is in good health and is getting on with his life and his job. "Anybody who has an illness takes stock and says, 'What are the important things and what are the not important things to do?', but I really haven't stopped doing very much and I've not really taken on anything more.

"It's very interesting. I haven't really changed."