Dr Phil Hammond

There's nothing quite like an ill-judged, overblown medical scare story for wrecking doctor-patient relations

Moral outrage is the very lifeblood of the media, especially in health issues. This is beautifully encapsulated in one of the classic media scare stories that never was; the danger posed to women by an HIV- positive obstetrician. This particular saga first unfolded in Australia.

The story starts in mid-1994, when a junior male obstetrician jabbed himself with a dirty needle used for taking blood from a female patient while working in King George V hospital, Sydney. When this happens, blood samples for hepatitis and HIV are taken (with mutual consent) from both parties. On 3 June the doctor was found to be HIV positive, and the patient HIV negative. The doctor had thus been HIV positive before the accident occurred, and it was estimated that this had happened around mid-1992. What to do now? During that time, 8,000 women had given birth at the hospital but only 149 had been operated on by the doctor. What's more, in worldwide studies of 19,000 operations done by an HIV-positive doctor on a patient, there had been no documented case of transmission of the virus from doctor to patient. The known risk was therefore immeasurably small.

In these days of consumerism and defensive medicine, doing nothing is no longer an option. The New South Wales Health Department assembled 10 expert teams to trace and counsel the 149 contacts. An HIV test "with results back in two hours" was offered, to minimise anxiety. In the first three days, 110 women were successfully traced and tested (all HIV negative) and things were going well - until the husband of one of the women tested phoned a tabloid current affairs programme. Cue hastily convened press conference.

The Health Department were used to these. Eight months previously, four patients of a Sydney doctor who attended his rooms for minor surgery on one particular morning had subsequently been found to be HIV positive. The doctor had operated on an HIV-positive patient that morning, before the others arrived. This was patient-to-patient transmission, probably via contaminated medical instruments. The department received a lot of criticism at the time - the news media described it as "a public relations disaster" - was no doubt keen to avoid another pasting.

This time around, news coverage started with the 39 mothers ("mums with babies") still to be sought. One TV bulletin built the suspense (and public anxiety) by quoting 8,000 as the number of women "who could feel at risk tonight". Papers that had quoted the risk as minimal moved into "disaster that could have happened" mode and even the respectable Sydney Morning Herald fuelled the panic with the headline "Battle to contain HIV may be lost: 17 women still sought". More than 4,000 women called the Health Department's telephone hot line - only 10 of whom had been operated on by the doctor.

Chief health officer Dr George Rubin kept emphasising the "infinitesimal risk", but was repeatedly countered with "so why bother to investigate, then?" Then the heat turned on the doctor himself. If he had acquired HIV from a patient (far more likely than the inverse), he would have been hailed as "an innocent hero". But if he had acquired it through sex or drugs, he would be a villain. George Rubin tried to keep the doctor's private life private, but was no doubt mindful of the criticism he had faced in the previous case. The whistle-blowing husband had told the media the name of the hospital, and the Health Department allowed them to close in on his identity. Rubin, under heavy questioning, revealed that the doctor "had risk factors for HIV" and had not acquired HIV from a dirty needle. The next day, Channel 7 news pronounced that the doctor was "believed to be gay".

Rubin's next attack came from HIV workers, who accused him of revealing unnecessary details about the doctor's private life. Meanwhile, the current affairs programme Real Life interviewed a woman who had been tested. Wife: "I thought that if I've been infected and my little girl's been infected and I've infected my husband Keith, then that's the end of my life." "Were you reassured by the results of the blood test?" "No. I'd like to be tested again." Husband: "I'm pretty shocked. These are medical people ... you put your life in their hands." True. But only 1 out of the 149 women had tested positive, and that had nothing to do with the doctor. Without the leak, the post-tracing headline would have been "None contract HIV from doctor". Not much of a headline, reallyn

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