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Your patient tested positive for gonorrhoea. What's next?

19 September 2019 | Ruanne Brell, BA, LLB(Hons), Senior Solicitor, Medico-legal Advisory Service and Dr Hayley Legrand, MBBS, BMedSc, DCH, FRACGP, Medical Adviser and Claims Manager, Avant, VIC

You’ve finished all your appointments for the morning, and while looking over test results from the lab, you see there’s a positive diagnosis for gonorrhoea.

It’s been a while since one of your patients has had a positive gonorrhoea result. What are your obligations?

Notifiable conditions broadly include communicable diseases that raise public health concerns. This includes STIs, blood-borne diseases, vaccine-preventable diseases and a number of other infectious diseases.

Whether a disease is notifiable, how diseases are notified and by whom are dealt with by state and territory legislation. There is a national framework for sharing information about communicable diseases and public health risks.

However, the actual list of diseases and obligations varies depending on where you practise. Measles, for example, generally requires an urgent phone notification by doctors on the basis of a reasonable clinical suspicion. Requirements also change periodically, so it is important to check your state or territory health department guidelines at the time the condition is diagnosed. Currently, gonorrhoea is a notifiable condition in all states and territories.

More information for specific state and territory requirements

State / territory

What kind of information is covered

Link

ACT  

List of notifiable conditions under ACT regulations, code of practice for notifiable conditions, reporting forms

ACT Health

NSW

Notification guidelines for medical practitioners, hospital CEOs and pathology laboratories, and notification forms

NSW Health

NT

Schedule of notifiable conditions and notification forms

Department of Health

Queensland

List of notifiable conditions and reporting forms

Queensland Health

SA

List of notifiable conditions, notification forms and fact sheet for health professionals

SA Health

Tasmania

Guidelines for notifiable diseases and fact sheets

Department of Health and Human Services

Victoria

List of notifiable conditions and notification procedures

Health Vic

WA

List of notifiable conditions and notification forms

Department of Health

 

In some jurisdictions, the obligation to notify is with the pathology laboratory, while others also require doctors to notify.

In the case of an STI, doctors may have a legal obligation to provide certain information to patients about infection control and treatment.

Diagnosing clinicians are also responsible for initiating contact tracing. It is important that you, and your practice where relevant, make appropriate attempts to follow up and document any discussions regarding results and contact tracing.

Talking about notifiable conditions with patients

Patients may be uneasy or upset about a condition being reported. While it is important to be sensitive to their concerns, it is not a matter of discretion. There are legal as well as professional obligations to report these conditions and penalties for failure to report.

It may help to explain that the notification system exists to assist with monitoring and preventing communicable diseases and aims to protect the health and safety of the community.

Data collection is largely looking at communicable disease trends to allow for better planning. But patients should be advised that in some cases public health staff may contact them directly for further information.

Sometimes patients may ask you not to record sensitive results in their notes, but where results are clinically significant and require treatment, you must record them.

However, most software has a way of dealing with sensitive records. If patients raise privacy concerns, you can be reassured that providing personal information to the public health unit for purposes of national communicable disease monitoring is permitted under the Privacy Act 1988. It is held confidentially, in accordance with national and state privacy principles.

What information is required in the notification?

The extent of personal information required differs according to states and to some conditions. For instance, notifications relating to some STIs, including HIV, require only the first two letters of the patient’s first and last name and date of birth.

Check your state-specific provisions to understand what to include in the notification, the method and the relevant time frames (see table above for links for each state and territory). While the notification to the local public health body may require personal and identifiable information, that data is then collated into a de-identified dataset to send to the Nat­ional Notifiable Disease Surveillance System.

Key tips and resources

Notifiable conditions can present a number of challenges for doctors. Discussion of results, such as in the case of STIs, can be difficult due to the sensitive nature of the information.

Focusing on the larger public health and safety issue may be helpful. State health departments generally have useful resources explaining the latest guidelines, processes, and many also have information you can share with patients.

This article was originally published in AusDoc.PLUS on 8 August 2019.

More information

The RACGP’s Red Book  has helpful information or read our article, Tracking clinically significant tests.

For expert advice on your obligations to notify certain diseases, contact us at nca@avant.org.au or on 1800 128 268, 24/7 in emergencies.

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