Mistakes: An Ethics Perspective

I did everything by the book – wore gloves, had a supervisor over my shoulder watching my every move, consented the patient, drew up the needle, had my syringe disposal bin by my side, positioned the patient appropriately and got the perfect blood draw – and then it happened. I pricked my finger. At first it seemed like nothing, my hands were dry from the antiseptic wipe anyway, it was probably just that. But as the tiny bubble of blood arose out of my thumb, my heart sank. It had happened.

A million thoughts ran through my mind – I’m young, fit, healthy, I don’t smoke, drink only on occasion, and don’t do drugs. I’m nice to my patients, love medicine and revel in ethics.  Above all, I’m a lawyer and hyper vigilant about infection control, consent and procedural process. I document everything. How could this be true?

Walking back to my supervisor I blushed with embarrassment – what reaction would he have – would I be disciplined, had I lost his respect, would I be criticised for incompetence, did I have AIDS? To my relief, the support I received from the staff was unfaultable. ‘Don’t worry’ they said – ‘You’ll be fine’, it’s bound to happen – everyone knew someone who’d been affected or exposed at some point, and they had all been fine. The reality was clear, estimated risk of transmission from exposure via contaminated hollow-bore needle puncture was 1:3.3 for Hepatitis B, 1:55 for Hepatitis C, and 1:313 for HIV.1 Indeed, further analysis of the statistics told the story; parenteral exposure carries a risk of transmission of HIV 0.3%, Hepatitis B, 30% and Hepatitis C, 2%.2 Transmission rate for Syphilis was lower unless the area was considered highly endemic. I was immune to Hep B thanks to vaccination – but LFTs needed to be checked again. And then there was the question of the patient – this is where my ethics began to fade. For years I have prided myself on being objective and equitable. I don’t discriminate between patients, I don’t prejudice my mind, and I act in fairness to all parties, wholeheartedly believing medicine should be accessible and applicable to all regardless of socioeconomic circumstances, religious affiliation or personal belief. But the minute I was exposed I started to question these values…

1 Bowden, FJ. Needlestick Injuries in Primary Care. Australian Prescriber (2001); Vol. 24, No. 4, p. 98.
2 Gerberding JL. Management of occupational exposures to blood borne viruses. New England Journal of Medicine (1995); 332: 444-451
US Public Health Service. Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis. MMWR Recommended Rep. 2001; 50: 1-52.

ADF Newsletter Editorial, June 2016
Observations of the US healthcare system from an Australian doctor who worked there