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Residents' Experiences in, and Attitudes Toward, the Care of Persons With AIDS in Canada, France, and the United States

Martin F. Shapiro, MD; Rodney A. Hayward, MD; Didier Guillemot, DES; Didier Jayle, MD
JAMA. 1992;268(4):510-515. doi:10.1001/jama.1992.03490040086030.
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Objective.  —To evaluate resident physicians' experiences in, and attitudes toward, the care of persons with the acquired immunodeficiency syndrome (AIDS) in Canada, France, and the United States.

Design.  —Cross-sectional survey, using a self-administered, mailed questionnaire to residents in 10 American states, three French regions, and all 10 Canadian provinces, with follow-up surveys of nonresponders in France and the United States.

Subjects.  —Systematic samples of residents in the last year of internal medicine or family medicine residencies prior to subspecialization or entry into medical practice.

Results.  —While the majority of residents had provided inpatient and outpatient care to persons with AIDS, most believed that their training in ambulatory care of persons with AIDS had been deficient. The rate of blood-contaminated needle-sticks from human immunodeficiency virus—infected patients ranged from 4% for internal medicine residents in Canada to 14% in the United States (P<.05). The majority recognized an ethical obligation to treat AIDS, but 4% in France, 14% in Canada, and 23% in the United States indicated that they would not care for persons with AIDS if they had a choice (P<.001). A substantial minority of US physicians reported that a patient of theirs had been refused care by a medical specialist (19%) or a surgeon (39%), but less than 10% of French physicians reported such refusals (P<.001).

Conclusion.  —Concerns about caring for AIDS patients were common and many physicians reported that patients were refused care. While most residents acknowledged an obligation to treat human immunodeficiency virus infection, many did not, and viewpoints varied considerably across the countries studied. The lower level of reluctance to treat AIDS patients in France and Canada makes it clear that the higher rate in the United States is far from optimal and needs to be addressed.(JAMA. 1992;268:510-515)


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