San Francisco Chronicle (SF); Wednesday, November 27, 1991
David Perlman, Chronicle Science Editor

The study's finding that so many physicians do not want to treat AIDS patients prompted a warning from the American Medical Association that doctors who refuse to do so could lose their medical licenses in many states.

"The practice of medicine is a privilege granted by society; it is not a right," warned Dr. Oscar W. Clarke and Dr. Robert B. Conley of the AMA's legal and ethics departments in an editorial commenting on the survey in this week's issue of the Journal of the American Medical Association. "If physicians fail to serve the public when called on to do so, society is justified in revoking that privilege," they said.

Doctors who persist in refusing to treat AIDS patients, Clarke and Conley warned, could face disciplinary action, including expulsion from their local medical societies, from professional associations and from the AMA itself.

In many states they could also be charged by their local licensing boards with unethical conduct for refusing to treat patients infected with HIV, the virus that causes acquired immune deficiency syndrome, the AMA officials warned.

Although California physicians have no legal obligation to treat everyone who comes to them, a doctor who is professionally competent to treat HIV-infected patients but who arbitrarily discriminates against them could face a hearing on charges of unprofessional conduct before the Medical Board of California.

The penalties could include license revocation, but it would take a pattern of complaints by many patients and that would be highly unlikely in this state, said a spokeswoman for the medical board.

The AIDS epidemic is so widespread in California -- particularly in San Francisco and Los Angeles -- that very few physicians reject HIV-infected patients, she said.

PROFESSIONAL DUTY

The medical profession's duty is to care for the sick, and "practitioners are not free to ignore that objective simply because it entails a small degree of personal risk or because they harbor negative attitudes toward the patients who are stricken by illness," the AMA officials said.

The new survey results were based on responses from more than 1,100 randomly selected physicians across the country who are in general practice, family practice or internal medicine. It was conducted by a research team led by Barbara Gerbert of the Center for AIDS Prevention Studies at the University of California in San Francisco.

Among its findings were these:

-- Three-quarters of the physicians said they have treated at least one patient infected with HIV, the human immunodeficiency virus, which causes AIDS, and 23 percent have treated more than 10 HIV-infected patients.

-- More than a quarter of the doctors who agreed they have a responsibility to care for infected patients still maintained that they would not treat them if they had any choice, and 48 percent said they prefer to refer HIV-infected patients to other physicians. Forty- two percent of the doctors said patients infected with the AIDS virus are "welcome" in their practice.

-- More than a third of the doctors in the survey conceded that they would feel "nervous among a group of homosexuals," and the same proportion said they believe that "homosexuality is a threat to many of our basic social institutions." More than half said they would also be uncomfortable having intravenous drug users as patients.

-- Despite the thousands of medical and scientific reports on the AIDS virus, on the nature of the disease and on the ways the virus is transmitted, nearly 85 percent of the physicians said they need to know more about HIV and the diseases it causes.

Gerbert, the survey leader, said in an interview yesterday: "It's a complex issue, because on the one hand physicians have their own attitudes about the patients who get the disease, and on the other they're no different from the general public in their perception of the risks involved in transmission. It's a kind of AIDS phobia that's widespread, and doctors are uncomfortable with it because they feel they need more information, although it's as though they'll never know enough."

Always watch for outdated information. This article first appeared in 1991. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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