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Ethical Question
Mar 18, 2008

Don't roll your eyes, I'm a chiropractic student and not all of us focus on the "innate." But I don't have a question of transmission, but more so of ethics. I just began rotations at this clinic and had the oppurtunity to treat this really nice patient (who was not osseously adjusted). I finished working on him and was cleaning the table, and my supervisor tells me to scrub it really well. I laughed, because he drooled on the paper on the headpiece - that means you did a good job on the soft tissue. She then informed me that he was HIV+ and that I really needed to "scrub it down." Now we learned about the spread of HIV in school, and it was my understanding that HIV is a delicate virus and cannot live for very long outside of the body. And we learned about "universal precautions." Apart from being a little sad about this man's diagnosis, I feel offended by her. What makes this patient so different? Or am I wrong? I understand procedure, but it seems weird to me for her to tell me to "really clean up" with one person rather than another because you just don't know who has disclosed their status. And I feel a little sick that this attitude exists in the healthcare field. I feel like I should say something, but I don't know what or how? But please, if I'm wrong, correct me. Thank you.

Response from Dr. Frascino

Hi Chiropractic-Guy-In-Training,

You are absolutely correct in your assessment and your indignation is completely justified. BRAVO! I strongly encourage you to say something to your clueless supervisor. Perhaps put it in the form of a series of questions. For example:

"Ms. Clueless Scumbag, can I ask you a question? Why did you want me to specially scrub down the whatchamacallit thingy just because the patient was HIV positive? Aren't our "universal precautions" adequate to prevent transmission of bloodborne pathogens like HIV and hepatitis? Or do we have extra-special universal precautions for HIVers? And, Ms. Scumbag, by the way I read that 25% of the over-1,000,000 HIV-positive Americans have absolutely no idea they are infected with the virus. So do you think we should surreptitiously test them all before cracking their backs so we'll know when the equipment needs one of those special scrub downs?"

That should do the trick. You seem like a bright, compassionate, insightful fellow. Are you sure you want to become a chiropractor? I don't think you're going to fit in with the rest of the group, especially if you have an appreciation of ethics!

Finally drooling doesn't necessarily mean you've done such a good job on the soft tissues. Manipulating and pushing on salivary glands will cause this to happen. In addition, like Pavlov's dogs, people can be programmed and conditioned to drool on exposure to a stimulus. I once had two Old English Sheepdogs named Dudley and Dexter who would impressively drool whenever I grilled steaks on the barbeque.

Good luck with Supervisor Scumbag. Stand back when you question her. She just may drool on you as she foams at the mouth in indignation.

Dr. Bob



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