Public health partner notification offers several options to people. The first is "self-referral", in which the person with the STI informs his/her partner directly. The second is "provider referral", in which the person with the STI voluntarily divulges partner information to a specially-trained public health worker. The public health worker locates and informs the partner of exposure, and does so without revealing the source of the information. A third mechanism is sometimes called "conditional referral", in which the person with the STI and the public health worker agree to allow a certain amount of time for self-referral. If it is not done, then the public health worker will do the notification.
There is another mechanism by which a partner may be informed, and that is by a physician or other clinician. When done with the consent and cooperation of the patient, this is equivalent to partner notification by other means. However, it is generally felt that physicians have a professional "duty to warn", without implicit consent, a known but unsuspecting partner of an infected person. Some states allow, but do not require, physicians to inform unsuspecting and exposed partners. Even if "Duty to Warn" motivated notification is allowed, many physicians will still ask the Health Department to do this task. This is not possible, since the voluntary consent of the infected person is required for public health partner notification.
"Duty to warn" motivation for informing partners is NOT a form of public health partner notification. Unfortunately, the two are often (and mistakenly) discussed together as "partner notification." This has only served to increase confusion and concern about public health partner notification.
The chart below illustrates the differences between public health partner notification and private clinicians' activities. It compares each according to the tenets of the partner notification policy in Massachusetts. As is obvious, there are important differences between the public health service of partner notification and a private clinician's sense of "duty to warn." Policy and practice elements designed to protect the infected person as well as the partner(s) are formally incorporated into public health partner notification. It is very important to be aware of distinctions in any discussion of partner services.
Table 1. Comparing the conduct of public health partner notification (PN) with private doctor's "duty to warn", according to the standards of PN policy and practice in Massachusetts.
|Policy Elements||PN||"Duty to Warn"|
|participation by the infected person is voluntary||Yes||No|
|notice to partner is face-to-face||Yes||not necessarily|
|notice is given in privacy||Yes||not necessarily|
|partners are notified of exposure||Yes||Yes|
|the source of information is not revealed||Yes||not necessarily|
|records of notification are kept||No||possibly|
|the safety of the infected person is paramount||Yes||not necessarily|
There are no laws in Massachusetts that mandate physicians to act on a sense of "duty to warn." The body of case law surrounding this issue nationally is not very large. Thus, there are few clear guidelines that one can offer a clinician seeking advice on the possible consequences of acting on a sense of "duty to warn." A clinician seeking assistance in such a situation can call the Division of STD Prevention at 866-749-7122.
This information is provided by Division of Sexually Transmitted Disease (STD) Prevention within the Department of Public Health.
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