The HIV-Positive Patient and Breach of Confidentiality
A 42-year-old male dentist was referred to the radiology department of a hospital for a CT-guided needle biopsy of a 1.5-cm lung nodule. Although the nodule was thought to be probably benign because of its appearance on CT scans, both the patient's family physician and a consulting radiologist believed that biopsy was indicated because the nodule contained eccentric calcification. On the day the biopsy was to be performed, the radiologist and the radiology nurse met with the patient to explain the procedure and obtain informed consent. The patient was told of the risk of bleeding, infection, and pneumothorax that sometimes requires treatment with a chest tube. Before signing the consent form, the dentist patient asked to speak privately with the radiologist. The patient then revealed to the radiologist that he was HIV-positive and was worried that his dental practice might suffer “dire financial consequences” if knowledge of his HIV status were to become public. The patient emphasized that he wanted his HIV status to be held in the strictest confidence. The radiologist, though somewhat startled by the patient's intensity, assured him that all medical records were confidential and that every precaution was routinely taken to maintain privacy of such information. After this discussion, the patient signed the consent form, and the biopsy procedure was begun. The radiologist performed a fine-needle aspiration of the lesion, but a cytopathologist present in the CT scanning suite found the sample insufficient to establish a diagnosis. Accordingly, the radiologist elected to obtain a small core biopsy using a spring-loaded device. A diagnostic specimen was obtained, but the patient complained of chest pain toward the end of the procedure. Chest radiographs taken immediately after the procedure disclosed a small pneumothorax. The patient was immediately...