Warn patients of specific risks

ED physicians should not disclose a patient's HIV status, except when there is a legal mandate to do so and even in this case, this is preferably done through a third party, such as a public health official, advises Matthew Rice, MD, JD, FACEP, an ED physician with Northwest Emergency Physicians of TEAMHealth in Federal Way, WA.

When there is a person at specific risk of harm, then an exception might be considered, he says. "But this would be a highly unusual case," says Rice. If your patient is aware of their HIV-positive status, but indicates that he or she is going to continue to have unprotected sexual contacts with a specific person without appropriate protections, then there is a specific risk to a specific person and, thus, a potential duty for the ED physician to take action to protect this individual.

Even if this is not the case, however, clinicians should clearly document instructing the HIV-positive patient to avoid risky behaviors that could infect others, such as sharing needles and exchange of bodily fluids. Also, it should be documented that you have explicitly informed them about ways to prevent exchanges of bodily fluids. "I would be specific about this, so there is no doubt the patient has been warned of what to be careful about," adds Rice.