Dr Sue Ieraci: Should doctors report knife wounds?

Sometimes it seems as if the health care system is expected to manage all the ills of society.

In an effort to reduce knife crime, Victorian Opposition Leader Ted Baillieu is calling for mandatory reporting of knife wounds by doctors and hospitals.

AMA Victoria has opposed the suggestion on the grounds that it “could stop some people seeking medical treatment, causing them to bleed to death or risk serious infection”.

Here lies an ethical dilemma. How do we weigh up the rights of individual patients to non-judgemental care and confidentiality against the rights of society?

Doctors are generally urged to act in the individual patient’s best interests. Sometimes, however, legislation interferes with this relationship.

In New South Wales, for instance, the Road Transport (Safety and Traffic Management) Act 1999 requires doctors or nurses to collect blood samples for alcohol testing from all drivers and pedestrians involved in motor vehicle accidents.

That includes those who have attended hospital to seek medical care, not just those who are in custody or suspected to be intoxicated. (Exceptions are made where further blood sampling could be harmful such as in major trauma with significant blood loss.)

This procedure has become an accepted part of emergency department practice even though it is sometimes seen as an inconvenience in a busy clinical area.

Most of us would agree that measures to reduce drink driving are worth taking. How do we know, however, which measures work?

In a society that is becoming increasingly risk averse, this is a crucial point. If we are to accept yet another invasion of the doctor–patient relationship, we need some evidence of proven (or likely) benefit.

This is unlikely to be the case in Baillieu’s Victoria, where assault rates are actually decreasing, according to Victorian Police Minister Bob Cameron.

It is essential that we don’t get caught up in a political “race to the bottom”, where political leaders stir up fear in the hope of gaining community support.

We have already seen that happen in acute medicine. While health outcomes and longevity are better than ever, fear and risk aversion are rife.

Death in childhood from infectious disease, for example, is now vanishingly rare, but the whole community is terrified of it.

Fear campaigns have become the modus operandi in election campaigns, but let’s not have a situation where unrealistic fear determines health care policy.

Dr Ieraci is a specialist Emergency Physician with 25 years’ experience in the public hospital system. Her particular interests include policy development and health system design, and she has held roles in medical regulation and management. In addition to her emergency department work, Sue runs the health system consultancy SI-napse.

Posted 30 August 2010