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© 2008 American Public Health Association
DOI: 10.2105/AJPH.2008.142299
LETTER |
Janlori Goldman is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, and the Health Privacy Project, Center for Democracy and Technology, Washington, DC. Sydney Kinnear is with the Center on Medicine as a Profession (CMAP), College of Physicians and Surgeons, Co-lumbia University, New York, NY. Jeannie Chung is a first year law student at Brooklyn Law School, Brooklyn, NY. David J. Rothman is with the College of Physicians and Surgeons and the Institute on Medicine as a Profession, Columbia University, New York.
Correspondence: Requests for reprints should be sent to David J. Rothman, Institute on Medicine as a Profession, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, P&S Box 11, New York, NY 10032 (e-mail: djr5{at}colubmia.edu).
Regrettably, New York City Health Department Commissioner Thomas R. Frieden continues to misunderstand the points made in our article. We share with the New York City Department of Health and Mental Hygiene (DOHMH) a keen desire to promote access to comprehensive, effective care for people with diabetes and HIV/AIDS, as well as increased resources for prevention and community education. However, our overarching concern is that the DOHMH’s approaches will discourage patients from seeking and continuing care and will undermine medical professionalism. We respond to two particular issues raised by Frieden.
Regarding diabetes, we fear that the DOHMH’s direct intervention into the doctor–patient relationship will drive the most vulnerable patients away from health care. Letters from the DOHMH are likely to raise privacy concerns and alienate patients, and discourage them from using additional resources or returning to their doctor for follow-up care. Further, these letters may subvert the doctor’s authority and autonomy and disrupt the doctor–patient relationship. We believe that the program run by the New York City Health and Hospitals Corporation, which is led by medical professionals, is a more effective model and approach to reducing the incidence and severity of diabetes.
Second, written consent is not a barrier to routine testing but a safeguard that encourages patient trust and participation in the health care arena. A process that guarantees patient education about risks and benefits and allows them to make meaningful choices is the most responsible and effective way to proceed. Although Frieden and many Blacks, Latinos, and Whites believe HIV testing should be treated the same as screening for other diseases, a substantial minority (27% in 1 survey) believe that HIV testing should "require special procedures, such as written permission from the patient in order to perform the test."1(p21) Requiring written informed consent and a discussion of potential discrimination before HIV testing does not "deprive physicians of their autonomy to use judgment about how to counsel patients," as Frieden claims. On the contrary, it promotes an open and important dialogue between doctors and patients.
Our community will be better served if Frieden stays out of the examining room and doubles resources for prevention—promoting education, good nutrition, physical exercise, and other healthy habits.
Footnotes
Contributors
All authors conceptualized ideas, interpreted findings, and wrote and revised drafts of the letter.
Accepted for publication May 6, 2008.
References
1. Kaiser Family Foundation. Survey of Americans on HIV/AIDS. Washington, DC: Kaiser Family Foundation, 2006. Available at: http://www.kff.org/kaiserpolls/upload/7513.pdf. Accessed June 3, 2008.
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