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Thursday, July 5, 2007

I was not a threat to anyone: Tuberculosis miscommunication

Andrew Speaker, a young, newly married personal injury lawyer, had just found out he had a form of tuberculosis that is resistant to multiple drugs that are usually effective. He felt fine – but he knew he’d need a lobe of one lung removed, and would need IV medicine almost every day for two years or so. But he thought at the time, "I was not a threat to anyone – that was the impression I was under."

The Centers for Disease Control told him they preferred that he not leave the country. He may have been told he was contagious or slightly contagious, but not highly contagious.

Andrew flew on a plane to Italy, and then returned to the U.S., later to go to an isolation room in a Denver hospital.

Now this has become the subject of intense publicity and formal investigation about the role of CDC, the Department of Homeland Security and patients about quarantining tuberculosis patients.

It seems from an interview transcript that Andrew had been told of his disease and contagiousness, but downplayed its significance, perhaps from wishful thinking. He is a highly educated person, and his father-in-law is a TB researcher at CDC. Even bright and well-informed people like Andrew sometimes don’t listen well when the stakes are so high and so personal.

Such miscommunication between patients and health care workers and providers often occurs. Perhaps the CDC staff spoke too indirectly, trying to be polite, rather than prescriptive, in saying they “prefer” Andrew should not get on a plane. Their indirect communication may have muddied their message. Or maybe Andrew just didn’t hear them.

Tape-record your doctor’s appointments so you can be sure to hear everything clearly.

Thanks, Dr. Vicki Rackner.

Read one of our patient compliance stories, or read more from the CNN transcript of an interview from an isolation room in a Denver hospital.

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