Section I
Case Studies
The Reality of Disability Insurance
Andy is a third-year medical student. His wife is a third-year law student who will be entering the workforce next year. They have talked about having a family but have decided to wait until they are more established in their careers. Andy has gone to many information sessions about various types of insurance he should look into, but didn’t really think he needed any of it. Andy decides he’d rather not obtain any disability insurance because he is young and healthy and thinks the chances of him becoming disabled are small. Andy does an internal medicine rotation and unfortunately sticks himself with a needle that he used to inject an HIV positive patient. What should he do?
First, Andy should immediately speak to the doctor in charge and explain what happened. He should tell the doctor the patient’s name so the doctor can proceed with getting consent for a blood sample to determine HIV and hepatitis serology. The doctor will also consult an Infectious Disease physician.
Within two hours of the needlestick, Andy should go to occupational health (if the event occurred during the work day) or the emergency room if the event occurred after hours. Blood will be drawn to test for HIV or hepatitis serology.
Infectious disease will perform a risk analysis to determine the likelihood of infection transmission, taking into account such factors as the depth of the needlestick, the bore of the needle and patient characteristics. If there is a high risk of HIV infection, Infectious Disease may recommend a post-exposure prophylaxis cocktail; however, it is up Andy to decide whether or not to take it. The cost of the cocktail is covered by Worker’s Compensation. Common side effects include nausea, vomiting and diarrhea which may make it necessary to take one to three weeks off work. If the patient is known to have HIV/AIDS, the Infectious Disease physician may prescribe their treatment regimen to Andy.
Blood will be drawn over the next six months to ensure Andy does not seroconvert.
If the patient has Hepatitis B, Andy should be protected through Hepatitis B immunizations. To ensure Andy has an appropriate immune response, antibody titers may be drawn. A booster immunization may be given to prime the immune response if the titre is low.
The time following a needle-stick injury can often be an emotional one. Andy may receive support from Occupational Health or the Education Assistance Program. A referral to an immuno-comprimised clinic is another potential source of support.
Andy will be able to work; however, in some provinces he has an ethical obligation to inform the Provincial College of his status if he performs high-risk procedures. These include digital palpation of a needle tip or sharp object in a body cavity (e.g., major abdominal, vaginal, cardiothoracic or orthopedic operations), repair of major traumatic injuries or cutting/manipulation in the oral cavity. The college would then review whether any practice modifications are necessary. Failure to notify the college would be considered unprofessional. In most cases, the physician will decide to practise a different area of medicine. Further information can be found at http://www.cpso.on.ca/policies/policies/default.aspx?ID=1474.
After being stuck with a needle, there may be a waiting period prior to Andy’s being approved for coverage. The insurer will also need reassurance that he is not HIV positive.
If the insurance was purchased prior to becoming ill (and prior to the needle incident), he could pay off his student debt under the RBC Insurance “student limits”. Critical illness insurance would provide a lump sum benefit if Andy is diagnosed with a serious illness; this is paid regardless of whether or not Andy can work/earn an income. Disability insurance would provide a percentage of income replacement if the serious illness prevented Andy from working.
Again, if Andy had purchased life insurance prior to the needle incident, his wife and child would receive the benefits.
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