 Valerie has come to Dr. Green's office after being referred by her general dentist. Valerie? Valerie Cole? That's me. Hopefully this won't take too long. Dr. Kimberly Green is a periodontist who has been practicing in the city for a number of years. Valerie's dentist referred her to Dr. Green due to gingival recession that may require grafting. Hi, Valerie. I'm Dr. Green. Great to meet you. So Dr. Fields sent you my way. Yeah, he said my gums have receded as badly as his hairline. I hope it's not that bad. Before we talk about treatment options, let's go through your medical history. Okay? After reviewing other aspects of Valerie's medical history, Dr. Green asks her about her HIV status. I see you've indicated your HIV positive. Tell me more. What do you want to know? Well, why don't we start with when you were first diagnosed and when you last saw your physician? I was diagnosed about a year ago. And I saw my doctor about three months ago. I don't see that you have any medications listed here. Let's talk about your treatment regimen and your most recent viral load and CD4 counts. I want to keep this private between me and my physician. Why do you need to know these things? You're only treating my mouth. I understand your concerns about privacy. It's my obligation as your periodontist to keep your health information private just like any other doctor. I need to know in case we need to make any modifications to your treatment. Right. I just, I just, I don't like to talk about my status with anyone. Look, I'm feeling healthy when I saw my doctor. He said my CD4 count was, I think around 280 and my viral load was undetectable. I'm doing really well. That's great news. It's important for me to be in contact with your physician so we can coordinate your care. Okay. I did write down the name of my infectious disease doctor on the form I filled out for you. It's all there. During the phone consultation with Valerie's physician, Dr. Green learns that Valerie's most recent CD4 count was actually 180 copies per milliliter and the viral load measured greater than 80,000 copies per milliliter at her most recent visit three months ago. And the physician also indicated that she had not shown up for a more recent appointment. What are the ethical and professional issues raised by this scenario? You may pause the video to consider this question. Consider these possible options for addressing this situation. You may pause the video after each possible solution to consider the implications of each option. Should Dr. Green continue with treatment without further addressing Valerie's HIV status, discuss Valerie's HIV status with her general dentist, discuss with Valerie the discrepancy in the CD4 counts and the viral load she reported, share with her physician the disparity in information received from Valerie, dismiss Valerie as a patient citing her inaccuracies in describing her condition. Now let's look at potential contributing factors as you weigh what's important in your decision about an appropriate course of action, a health practitioner's legal obligation to report a patient's HIV status, the absolute right of an individual to confidentiality with regard to health information, the possibility of co-morbidities in the patient, the potential of the patient experiencing stigma and discrimination if her status were to be disclosed, the risk to others posed by a patient who may not adequately understand the implications of their HIV status. Many dental practitioners face ethical dilemmas such as this one on any given day. Anticipating how you might deliberate to find a suitable resolution to any such dilemma is good preparation and can aid each practitioner to find appropriate solutions to the challenges they sometimes must face.