My Patient Has Hepatitis C. He Tested Positive Five Years Ago And Nobody Told Him

Dylan didn’t have a family doctor when he ended up hospitalized one weekend five years ago. He was a drug addict with a bad infection in his arm, probably from injecting heroin.

I’ve known him for a while now, and he’s been sober pretty much since that hospitalization. During a physical a few weeks ago, I asked him if he had ever been tested for hepatitis since he got clean. He didn’t think so.

I checked his account in Maine Health InfoNet, just to see what kinds of testing he had gone through. Sure enough, five years ago there was an entry for a hepatitis C screening. The name of the test was displayed in yellow instead of black. That means abnormal.

I clicked on the test. It was a positive antibody test, not followed up with a viral load test.

Dylan’s arm felt better and he was discharged. He didn’t have a family doctor and he didn’t join any Suboxone or methadone clinic. So nothing happened. Nobody asked him until I did. I ordered a viral load and it is up there. I personally don’t treat Hep C, but I referred him to a local colleague who is board certified in infectious diseases and does a great job.

Dylan took the news well. He suspected something was going on when the result hadn’t gone up in the portal. His partner went and got tested. A negative result often comes back quicker than a positive one. So only he needs treatment.

But I feel bad in situations like this. People get discharged so quickly from the hospital these days. The workup isn’t always finished. And the business model of having the primary care physician wrap things up after a hospitalization doesn’t work for people with no PCP – like most twenty somethings.

My old adage “if you find it, you own it” is not universally accepted. Maybe it should be.

If You Find It, You Own It

3 Responses to “My Patient Has Hepatitis C. He Tested Positive Five Years Ago And Nobody Told Him”

  1. 1 Tony Glaser November 1, 2021 at 2:14 pm

    I had a similar but worse experience – a man in his early 50s who was losing weight and becoming jaundiced. I managed to get his old military records – and there it was, a positive hepatitis C test about 25 years earlier, which nobody had told him about and was never mentioned in his chart again. He died of hepatocellular carcinoma within a few months leaving a wife and children. No point trying to sue the military I guess

  2. 3 wayne Fuller November 5, 2021 at 8:48 pm

    Have to say. I spent 24 yrs in 3 branches of the US Armed forces (11 yrs USAF, 3 yrs USA reserve and 10 yrs USN reserve) as well as many years interspersed in private practice and academic medicine on faculty at Duke University. These “results”are often not available to the “treating” physician and “invisible” to the next provider which is, unfortunately, an issue when physicians rotate into and out of service areas or out of service altogether ( leave the military). Encountered the same when I worked for many years at IHS site with physicians, all of whom are well intentioned, but were only on site temporarily at the locations and those sites could not keep permanent providers. i do not believe these issues are easily remediated.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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