Physicians and laboratories are mandated to report a number of medical illnesses. The
main purpose in reporting illnesses is both epidemiologic as well as to interrupt the spread of
certain communicable diseases. The illnesses that are always reportable include AIDS,
syphilis, tuberculosis, gonorrhea, and all of the childhood diseases such as measles, mumps,’
rubella, and pertussis. The list of other reportable diseases is extensive. These diseases are
reportable by somebody, not necessarily the physician.
Physicians are always legally protected for participating in partner notification. In
general, the health department performs the majority of contact-tracing events as well as
notifying those that have been in close contact of the possibility of infection. The name of the
source patient is always protected.
Partner notification exists for diseases such as HIV/AIDS, syphilis, gonorrhea, and
tuberculosis. In addition, the health department can incarcerate patients with tuberculosis to
prevent the spread of disease. If a patient won’t tell his or her partner, then you must answer
that you must follow your duty to report. If the source patient still won’t tell his or her
partner, you are within your legal right to tell the innocent third party. Partner notification
and reportable illnesses are an example of one of the few times that the patient’s autonomy
can be superseded because of the necessity of protecting others. My right to autonomy ends
where your safety begins. I have an absolute right to privacy, except when my restaurant
serves food infected with salmonella, and then the patient’s rights to autonomy become less
important than protecting others from harm.
Tuberculosis has special reporting and public-health issues. In addition to doing contact
tracing of the contacts in order to do PPD testing, there is the special issue of incarceration
for tuberculosis. Patients with tuberculosis should be isolated for about two weeks, which is
approximately the amount of time that is takes for sputum to become negative for acid-fast
bacilli. If a patient refuses to take antituberculosis therapy, physicians have the option of
incarcerating the patient to prevent them from spreading the disease. This is only for those
who still have positive stains of their sputum for acid-fast bacilli.
Incarceration for tuberculosis is not the same thing as being arrested. It has nothing to do
with the criminal-justice system. The incarceration occurs in a hospital not in a prison or jail.
You cannot force-feed tuberculosis medications, but you can prevent people from walking at
their leisure in the community to spread disease. Incarceration is a last resort and is only used
after all other options have been exhausted m terms of having discussions with the patient
and offering directly observed therapy at home.