GMS's advice in Serious Communicable Diseases. Is consent to testing necessary for tuberculosis in the same way as for HIV infection?

Editor—The General Medical Council recently sent all medical practitioners in the United Kingdom its booklet Serious Communicable Diseases,1 which replaces the earlier HIV Infection and AIDS.2 In this the council broadens its earlier advice on consent to testing to include investigation of tuberculosis and hepatitis as well as HIV infection. We completely agree that tuberculosis should be regarded as a serious communicable disease, but treating it in the same way as HIV infection in the context of obtaining consent to investigation and treatment potentially presents major problems, which we wish to draw to the attention of readers of the BMJ. Clearly, when the suspicion of tuberculosis is high it is appropriate to explain this to patients at the time of collecting sputum or other specimens for investigation. However, sputum is commonly tested for tuberculosis in patients being investigated for common respiratory symptoms, when the likelihood of having the disease is low. In our view, obtaining consent to specific testing for tuberculosis in such patients may create needless anxiety. Alternatively, it may even mean that appropriate specimens are not examined because of the concerns this might raise. We suggest that asking for general permission to test samples to exclude infection is appropriate without necessarily specifically naming tuberculosis when the probability of the patient having the disease is comparatively low. We have raised our concerns about this advice with the GMC but it sees no need to modify its guidance.