THE PUBLIC'S ATTITUDE TOWARD PHYSICIANS AND THE CARE OF AIDS PATIENTS IN THE STATE OF MARYLAND Edward G. Grace, DDS, MA, Leonard A. Cohen, DDS, MPH, MS, and Michael A. Ward, DDS, MPH Baltimore, Maryland
A telephone survey of 1477 households in Maryland examined the public's attitudes toward physicians and the treatment of AIDS patients. The results indicated that most respondents (86%) want to know their physician's human immunodeficiency virus (HIV) status and that 65% would change physicians if that physician had acquired immunodeficiency syndrome (AIDS). Approximately 50% did not know if their doctor treated AIDS patients, but the majority (68%) responded they would not change doctors because they treated AIDS patients. Significant differences were found in respondents' opinions related to age and education. It was also found that the majority of respondents (57%) received their information about AIDS from the mass media and that very few received their information from medical or other health sources. (J Nati Med Assoc. 1 992;84:681 -684.) Key words* acquired immunodeficiency syndrome (AIDS) * AIDS attitudes * Maryland patients
From the Department of Oral Health Care Delivery, Baltimore College of Dental Surgery, University of Maryland, and the Department of Health and Mental Hygiene, AIDS Administration, State of Maryland, Baltimore, Maryland. This research was supported by the AIDS Administration, Department of Health and Mental Hygiene, State of Maryland, and the Centers for Disease Control, United States Public Health Service. Requests for reprints should be addressed to Dr Edward G. Grace, Dept of Oral Health Care Delivery, Baltimore College of Dental Surgery, Dental School, University of Maryland, 666 W Baltimore St, Baltimore, MD 21201. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 8
Acquired immunodeficiency syndrome (AIDS) is one of the most publicized health problems of this century. The public is inundated daily with news stories concerning this disease. Unfortunately, this plethora of publicity often contains misleading information and has resulted in misconceptions in the general public. Public confusion, in conjunction with remaining uncertainties about the etiology and treatment of AIDS, has sometimes resulted in a distancing between patients and their health-care providers. Health-care workers are also subject to both uncertainty and concerns about their personal safety. There are more than 350 known cases of physicians with AIDS in the United States.1 Fineberg stated that, "No disease in modern times has engendered such frustration, resentment and anxiety or demanded more compassion, intelligence, selflessness and integrity on the part of health professionals."2 Health-care providers must struggle with their own prejudices concerning high-risk groups and the social behaviors associated with human immunodeficiency virus (HIV) infection.3'4 The effects of AIDS on health care impacts society as a whole as well as each of us individually. Health policy and health planning activities in the United States have had to be adjusted, and every person has had to make personal and health behavior decisions because of the
disease.5 Recent publicity regarding the apparent infection of a patient by a dentist6'7 and concerns about the treatment of AIDS patients in medical and dental officesl"8-10 as well as providers' fears about patient attitudes toward being treated in offices that also have AIDS victims as patients' 1-13 have created tension in the doctor-patient relationship. The hesitancy on the part of 681
PUBLIC ATTITUDES & AIDS PATIENTS
many health-care providers to treat AIDS patients has a complex etiology. It stems not only from the fear of the transmission of the disease to medical personnel, medical staff and other patients, but there is also the fear of the potential economic consequences of treating AIDS patients, ie, other patients may be reluctant to continue in the provider's care. To assess the public's attitudes toward health providers and the care of AIDS patients, a comprehensive survey of Maryland residents was conducted. This article reports the findings regarding medical doctors. Findings related to dentists have been presented elsewhere. 14
METHODS A telephone survey was conducted for which the target population was adults ages 18 or older who resided in Maryland. A sample of 2688 telephone numbers were generated randomly. Of this sample, 1477 were identified as households, as opposed to businesses or offices. Participants were selected by asking to speak to the adult living in the household who was 18 or older and had the most recent birthday. This method provided a random respondent without asking any intrusive questions about household composition. If the selected participant was not at home, up to 20 callbacks were made at different times and on different days. The questionnaire was pretested by experienced interviewers and supervisors prior to the survey. After revisions, the final version was programmed into the computer-assisted telephone interviewing system and checked for correct logic and administration. All interviewers were trained in both general survey procedures and in the particular questionnaires used for this study. In each household contacted, the telephone number and Maryland location were verified. The interviewers identified themselves, stated the general study purpose, and obtained verbal consent. No addresses or last names of respondents were obtained, and all responses were treated confidentially. To reduce the response burden, participants were randomly assigned to one of two versions of the questionnaire. The questionnaires contained 27 and 28 questions, respectively, and each took approximately 8 to 10 minutes to complete. Many of the questions were identical with those used in previous published research.1 Based on the data analysis plan, the questionnaires contained questions that appeared on both versions as well as questions that were unique to each 682
version. Data were analyzed based on the total number of individuals responding to each question. Chi square and point biserial correlation coefficients were used to examine significance in bivariate analyses.
RESULTS Subjects were asked if they would continue to see their physician if he or she had AIDS but was well enough to stay in practice. The majority (66.8%) responded that they would change doctors, 10.3% were not sure, and 22.9% would continue under their doctor's care. Respondents were next asked if infected physicians should reveal their HIV status. An overwhelming 86% of the respondents reported that physicians should tell their patients if they have AIDS, while 6.2% believed physicians should reveal their status only if asked and 4.8% thought infected doctors should keep this information to themselves. There was a significant difference between the desire of patients to have the doctor reveal their HIV status and the respondent's willingness to remain in the care of an infected doctor (x234.9; df 6; P
A telephone survey of 1477 households in Maryland examined the public's attitudes toward physicians and the treatment of AIDS patients. The results indicated that most respondents (86%) want to know their physician's human immunodeficiency virus (HIV) status and that 65% would change physicians if that physician had acquired immunodeficiency syndrome (AIDS). Approximately 50% did not know if their doctor treated AIDS patients, but the majority (68%) responded they would not change doctors because they treated AIDS patients. Significant differences were found in respondents' opinions related to age and education. It was also found that the majority of respondents (57%) received their information about AIDS from the mass media and that very few received their information from medical or other health sources. (J Nati Med Assoc. 1 992;84:681 -684.) Key words* acquired immunodeficiency syndrome (AIDS) * AIDS attitudes * Maryland patients
From the Department of Oral Health Care Delivery, Baltimore College of Dental Surgery, University of Maryland, and the Department of Health and Mental Hygiene, AIDS Administration, State of Maryland, Baltimore, Maryland. This research was supported by the AIDS Administration, Department of Health and Mental Hygiene, State of Maryland, and the Centers for Disease Control, United States Public Health Service. Requests for reprints should be addressed to Dr Edward G. Grace, Dept of Oral Health Care Delivery, Baltimore College of Dental Surgery, Dental School, University of Maryland, 666 W Baltimore St, Baltimore, MD 21201. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 84, NO. 8
Acquired immunodeficiency syndrome (AIDS) is one of the most publicized health problems of this century. The public is inundated daily with news stories concerning this disease. Unfortunately, this plethora of publicity often contains misleading information and has resulted in misconceptions in the general public. Public confusion, in conjunction with remaining uncertainties about the etiology and treatment of AIDS, has sometimes resulted in a distancing between patients and their health-care providers. Health-care workers are also subject to both uncertainty and concerns about their personal safety. There are more than 350 known cases of physicians with AIDS in the United States.1 Fineberg stated that, "No disease in modern times has engendered such frustration, resentment and anxiety or demanded more compassion, intelligence, selflessness and integrity on the part of health professionals."2 Health-care providers must struggle with their own prejudices concerning high-risk groups and the social behaviors associated with human immunodeficiency virus (HIV) infection.3'4 The effects of AIDS on health care impacts society as a whole as well as each of us individually. Health policy and health planning activities in the United States have had to be adjusted, and every person has had to make personal and health behavior decisions because of the
disease.5 Recent publicity regarding the apparent infection of a patient by a dentist6'7 and concerns about the treatment of AIDS patients in medical and dental officesl"8-10 as well as providers' fears about patient attitudes toward being treated in offices that also have AIDS victims as patients' 1-13 have created tension in the doctor-patient relationship. The hesitancy on the part of 681
PUBLIC ATTITUDES & AIDS PATIENTS
many health-care providers to treat AIDS patients has a complex etiology. It stems not only from the fear of the transmission of the disease to medical personnel, medical staff and other patients, but there is also the fear of the potential economic consequences of treating AIDS patients, ie, other patients may be reluctant to continue in the provider's care. To assess the public's attitudes toward health providers and the care of AIDS patients, a comprehensive survey of Maryland residents was conducted. This article reports the findings regarding medical doctors. Findings related to dentists have been presented elsewhere. 14
METHODS A telephone survey was conducted for which the target population was adults ages 18 or older who resided in Maryland. A sample of 2688 telephone numbers were generated randomly. Of this sample, 1477 were identified as households, as opposed to businesses or offices. Participants were selected by asking to speak to the adult living in the household who was 18 or older and had the most recent birthday. This method provided a random respondent without asking any intrusive questions about household composition. If the selected participant was not at home, up to 20 callbacks were made at different times and on different days. The questionnaire was pretested by experienced interviewers and supervisors prior to the survey. After revisions, the final version was programmed into the computer-assisted telephone interviewing system and checked for correct logic and administration. All interviewers were trained in both general survey procedures and in the particular questionnaires used for this study. In each household contacted, the telephone number and Maryland location were verified. The interviewers identified themselves, stated the general study purpose, and obtained verbal consent. No addresses or last names of respondents were obtained, and all responses were treated confidentially. To reduce the response burden, participants were randomly assigned to one of two versions of the questionnaire. The questionnaires contained 27 and 28 questions, respectively, and each took approximately 8 to 10 minutes to complete. Many of the questions were identical with those used in previous published research.1 Based on the data analysis plan, the questionnaires contained questions that appeared on both versions as well as questions that were unique to each 682
version. Data were analyzed based on the total number of individuals responding to each question. Chi square and point biserial correlation coefficients were used to examine significance in bivariate analyses.
RESULTS Subjects were asked if they would continue to see their physician if he or she had AIDS but was well enough to stay in practice. The majority (66.8%) responded that they would change doctors, 10.3% were not sure, and 22.9% would continue under their doctor's care. Respondents were next asked if infected physicians should reveal their HIV status. An overwhelming 86% of the respondents reported that physicians should tell their patients if they have AIDS, while 6.2% believed physicians should reveal their status only if asked and 4.8% thought infected doctors should keep this information to themselves. There was a significant difference between the desire of patients to have the doctor reveal their HIV status and the respondent's willingness to remain in the care of an infected doctor (x234.9; df 6; P
