NEW YORK--When selecting a physician, the most important question an HIV patient can ask is, How many HIV/AIDS patients have you treated? Ramon A. Gabriel Torres, MD, medical director, AIDS Center, St. Vincent's Hospital, NY, said at a teleconference sponsored by Cancer Care Inc. and the Gay Men's Health Crisis.
"Credentials don't paint the entire picture," Dr. Torres said. "They do not determine character, bedside manner, attitude, or the practice setting."
Prospective patients, he said, should explore the doctor's attitudes toward HIV-positive patients, gays, bisexuals, and intravenous drug users. "How does the doctor get along with these types of patients? Find out if other patients are content with the care they are receiving," he suggested.
The patient should also look into the practice setting, he said. The office should be "user-friendly" allowing patients to access physicians during off hours. "Does the physician belong to a group? If he is away, can the patient access covering physicians? Does he have an answering service or an intermediary to answer the phone?" Dr. Torres said.
These questions are extremely important for people with HIV/AIDS who may need to contact someone at night or during weekends, he added.
The people who work in the office--the receptionist, nurse, phlebotomist, and others--should also reflect the physician's caring approach. Dr. Torres said.
Questions HIV Patients Should Ask When Choosing a Physician
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Prospective patients should find out the range of services a physician offers. Many who care for HIV/AIDS patients have personnel who complement standard medical care such as nutritionists and acupuncturists, he said.
Also ask about the availability of special equipment in the office that will spare the patient from having to go elsewhere. "Often doctors who treat HIV patients will do intravenous infusions and aero-solized treatments, and provide laboratory services in their offices," Dr. Torres said. "This 'one-stop shopping' makes life a lot easier for patients with HIV."
The physician should keep abreast of rapidly changing treatment regimens, whether through involvement in research or association with a hospital or community-based organization.
Patients should also inquire about a practitioner's affiliations with specialists in dermatology, pulmonology, ophthalmology, psychiatry, and gastroenterology. Those with Kaposi's sarcoma will need a referral to an oncologist, and should find out which oncologist the doctor uses and the oncologist's hospital affiliations.
Many HIV/AIDS patients do not want to be treated in hospitals, Dr. Torres said, and thus they should ask about the physician's attitude toward home care. "We have been very successful in AIDS with providing patients with comprehensive home care," Dr. Torres said, through the use of visiting nurse services and certified home care agencies that coordinate pharmaceutical services, laboratory tests, and relationships with vendors.
Patients may have significant practical concerns regarding the potential for disability determination, Dr. Torres pointed out. "Approval for disability payments is based on the physician's findings in addition to test results and findings by specialists," he said, "and the doctor-patient relationship often hinges on having a mutual understanding on the course to take on disability."
Good communication is a must in determining the level of care the patient desires. "Physicians should share their own agenda, in terms of treatment and terminal care, with people who are advancing quickly in their illness," he said.
Physicians should also be involved in the prevention of HIV transmission. "These issues need to be addressed up front, and patients should expect their doctor to question them about their sexual behavior," he noted.
Finally, he said, physicians who treat HIV patients need to listen as well as talk. "They need to be educated about HIV, and patients should be able to bring in questions and talk about things they hear in the media," he said. "So in addition to all the other qualifications, there must be give and take, mutuality and trust in the doctor-patient relationship."
