Physicians and the Acquired Immunodeficiency Syndrome

To the Editor.— The editorial in the October 13 issue of JAMA entitled "Physicians and Acquired Immunodeficiency Syndrome: A Reply to Patients" 1 proposes that physicians not be required to disclose their human immunodeficiency virus (HIV) status to their patients since the risk of transmitting the disease to patients is small. This statement fails to consider the impact of the subtle development of HIV-related encephalopathy on patient care and judgment problems related to the slow and common development of dementia in HIV-infected individuals. An error in judgment can be as lethal as HIV infection, yet no consideration has been given to the impact of HIV-related dementia on patient interaction and health care. What is the medicolegal obligation of an employer who employs a physician with an HIV infection who makes a judgmental error related to HIV encephalopathy? The employer or hospital certainly would have some degree of culpability and medicolegal