간염보균 의사 지망생들이 한번읽어볼 기사

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죄송합니다 번역해서 올리지못해서요. 

Physician with HBV Denied Professional Choice

In July of 2005, a physician who recently graduated from an excellent medical school began a surgical residency with the intention of specializing in orthopedics. Shortly after beginning the residency, the doctor was informed by the hospital that “orthopedics is not a good specialty for you” and that he could not continue in the surgery program. He was asked to pick a different specialty. Here is his story, which was submitted anonymously to B Informed.

The physician (hereafter called Dr. X) had learned that he was chronically infected with HBV in 1995 after donating blood to the Red Cross. On further examination, he was found to not have active HBV (HBeAg negative) and his liver enzymes were within normal limits. When Dr. X applied to medical school, he disclosed his HBV status on the school’s health forms, but was not restricted from participating in any activities or procedures. In June 2005, prior to beginning the surgical residency, Dr. X had tests to monitor his HBV status, which after 10 years, showed again he did not have active HBV (HBeAg negative, very low viral load) and his liver function was normal. After being told that he would not be allowed in the orthopedic residency program in July, Dr. X immediately began contacting experts in liver disease and HBV for advice.

Three experts provided oral and written statements confirm‎ing Dr. X had an inactive hepatitis B infection that had been stable for more than 10 years and that he was, therefore, very unlikely to have any health problems from hepatitis B during his residency. Furthermore, these experts were of the opinion that the usual precautions taken by all physicians during invasive procedures including wearing gloves, mask, and protective clothing would essentially eliminate Dr. X’s exceedingly low risk of transmitting HBV to a patient.

The hospital hired a fourth expert, who took an opposing view. He raised the possibility that Dr. X’s HBV might not be stable; his viral load might rise making him highly infectious; and that he might suffer a tissue-penetrating wound in the operating room, which might then expose a patient to his infected blood. The other three experts considered these risks to be greatly exaggerated and highly unlikely, but not impossible. In November 2005, the hospital finally held committee hearings in response to Dr. X’s appeal. Even though federal and organizational guidelines supported Dr. X’s right to pursue a residency in orthopedics, the hospital’s education committee voted to deny him the orthopedic residency.

Editor’s Note: Today Dr. X is a resident in the same hospital, but not in surgery. This story, unfortunately, highlights that even those medical professionals responsible for educating future physicians need to be better educated themselves about hepatitis B.

If You have Hepatitis B and want to Pursue A Medical Career, Read this Article First….

What are U.S. medical school and hospital guidelines for students, residents or doctors who have chronic HBV? “There are no federal guidelines. Each state, each school, each hospital has its own policy,” says Anna Lok, M.D., a highly respected liver specialist and professor of Internal Medicine, University of Michigan Health System (Ann Arbor). “The Centers for Disease Control (CDC) recommends that health care workers who are positive for HBsAg and HBeAg [considered to be infectious] should not engage in exposure-prone procedures, such as operations, unless they have discussed their situation with the hospital, gone through counseling regarding precautionary measures, and informed their patients of their HBV status. This is not law, merely a recommendation.

” There are no recommendations, however, for health care professionals with HBV who are considered to be low risk or “non-infectious” (HBsAg+ and HBeAg-); although in Europe many countries use HBV DNA to determine if such workers can carry out “exposure-prone procedures”.

The good news is that students with HBV can be admitted to medical schools. Although “some medical schools have raised questions on how to train students if they cannot go through the entire surgical rotations,” Dr. Lok adds.

Residents with HBV are restricted as to the specialty they can choose, emphasizes Dr. Lok. “I generally advise medical students, who know they have HBV, early on in medical school of the CDC recommendations so they can plan career choices appropriately.

” Dr. Lok notes that there is no CDC recommendation that restricts doctors with HBV from working. “There is a need to inform patients if a physician is HBsAg- and HBeAg-positive and plans to perform exposure prone procedures. However, even if the physician is successful in getting hospital privileges to operate, in reality, if one were to inform patients of the risk, the surgeon’s career would probably be ended.

” The bottom line is that it is possible to go to medical school and practice as a physician with HBV. The key to success is to get early counseling about appropriate career choices (i.e. surgical specialties may not be possible) and to know the CDC guidelines regarding HBV prevention.

— Elizabeth Lipp, science writer, Oreland, PA

[리치맨]

먼지 몰라도 조은 기사 ㅋㅋㅋㅋ , 준성님 잘 계시지요? 늘 행복하시고 대구나 대구근처 오시면 연ㄹ락 주세요.

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꼭 기억 하고 있겠읍니다.

[윤구현]

출처를 알려주시면 좋겠습니다.... ^^*

[준성]

Source reported by Science reporter to Liver Treatment Algorithm.