Infectious Diseases: An Ethical Challenge for Physicians
By Edward J Sherwood Texas Medicine February 2017

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Symposium on Infectious Diseases ­— February 2017

Tex Med. 2017;113(2):30.

By Edward J. Sherwood, MD 

Infectious diseases are different. Not only are there more of them than other types of disease, but also more is known about them. Of all human afflictions, those that can be cured are, for the most part, infectious diseases. 

Infectious diseases afford physicians a great opportunity to relieve suffering and save lives. On the other hand, failure to diagnose timely and treat appropriately can place others at risk, including the physician and health care team, because many infectious diseases are communicable. Furthermore, our interventions and treatments for noninfectious diseases frequently impair local and/or systemic host defenses, and the cunning microbes find a way to exploit every weakness. Finally, infectious diseases are rapidly evolving, with entirely new ones emerging more frequently than is true for any other type of disease.  All of these characteristics of infectious diseases present a huge intellectual and ethical challenge for practicing physicians. 

The Texas Medicine Editorial Board should be commended for devoting this symposium issue to infectious diseases. The outstanding authors contributing to this issue of Texas Medicine provide a big-picture perspective relevant to physicians practicing in every specialty of medicine. Regrettably, some important topics, such as immunizations and intrauterine infections, have been left out due to space limitations. 

The opening paper by one of the nation's most distinguished clinical investigators provides a broad perspective on what Mother Nature has done to us with predictions of what she is likely to do in the years ahead. It is followed by a true detective story of an outbreak investigation. At least two important lessons emerge from these papers. First, protecting the public from communicable diseases requires a close and effective working relationship between clinicians and public health. Second, our food supply is highly vulnerable to human bioterrorism in addition to whatever Mother Nature may throw at us.

The next two papers are derived from the words of Walt Kelly's Pogo: "We have met the enemy and he is us." These papers address health care-associated infections and the growing problem of antimicrobial resistance. To be clear, physicians are not the enemy. However, physicians do have the potential to aid and abet the enemy through imprudent use of invasive devices and antimicrobial agents.

The review of the hygiene hypothesis reminds us how much is yet to be learned about the interactions of humans and microbes. The issue concludes with the thoughts of a distinguished infectious disease physician educator on how to assure the physician workforce is appropriately trained to diagnose and treat infectious diseases.

Among the ethical duties conveyed by the authors of this issue of Texas Medicine are the following:  

  • To report timely. Public health authorities cannot investigate an outbreak until someone brings the situation to their attention. Physicians may review the Texas Department of State Health Services' disease reporting requirements online
  • To prescribe prudently. Invasive devices and antimicrobial agents are two-edged swords. We must thoughtfully weigh their risks and benefits before prescribing.
  • To learn continuously. Infectious diseases present a moving target. The relevance of what we learned in medical school diminishes daily.  

One might add to this list of moral imperatives: to appreciate our Texas Medical Association, which helps physicians cope with the daunting challenge of infectious diseases through the work of various councils, continuing medical education offerings, and Texas Medicine.  

On a personal note, I am deeply grateful for the privilege of serving as guest editor and wish to extend a sincere thank-you to each of the authors who have made this symposium issue possible.

Edward J. Sherwood, MD, serves on the clinical faculty of Texas A&M College of Medicine. He is the guest editor of this symposium issue.

For detailed information about the authors of this symposium, visit www.texmed.org/Feb17SymposiumAuthors.

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Last Updated On

February 01, 2017

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