Switching doctors, not meds
Jan 13, 2014
It might be disingenuous to ask this question to a panel of individuals with "MD" after their names, but here I go; The current doctor delivers a standard questionaire type exam at every vistit consisting of him reviewing the labs (hint, I have had HIV for years and I can read those too) and a single question; "Have you missed any doses?" No, I have not. He then dismisses me for the next several months. Is it wrong to want a more holistic approach applied here and questions about other medical issues I am experiencing (facial cellulitis, awful fatigue, osteoporosis, plummeting WBC, surviving to menopause which that last one is almost unbearable at this point)? Am I expecting too much? Do most physicians look at practicing in this specialty with a more integrated approach? Do I need an internal medicine doctor instead of an infectious disease specialist?
Response from Mr. Vergel
No, you are not expecting too much from your doctor.
I do not blame most doctors who do not expand on basics, specially the ones in free clinics funded by governments in which they see many patients in one day. Most have little time and expect the patient to bring up issues if they have them. We have to be educated, empowered and know how to politely ask for what we need. Expecting to get certain care without asking for it is just unrealistic.
If you are fully insured and your doctor does not address your questions, then it is time to divorce him or her and look for someone who can address your issues. Sometimes that is not easy to do and requires a lot of networking with people in your city to find out who are the best local doctors. Some of the best doctors are not longer accepting patients or Medicare. Also, many of the good "old-timers" have retired from HIV and have been replaced with doctors who treat HIV in a less comprehensive way. Calling the local AIDS Service Organizations and asking them about doctors in your area are ways to get to the best medical practices.
I find that most HIV doctors are very comprehensive in their approach. Mine is a family medicine doctor. I really think we do not have to see an internal medicine or infectious disease doctor. But it is important that the doctor you chose has at least 25 HIV+ patients and keeps updated yearly with at least 15 hours of medical education. Unfortunately, many doctors get their HIV information from pharmaceutical sales alone and that is not enough to keep up with HIV treatment guideline changes. You can find doctors who meet this criteria here: American Academy of HIV Medicine
I have a few friends who work as pharmaceutical reps. They all agree that they would rather work calling on HIV doctors than any other specialty. They say these doctors are usually friendly, more open to new things, and more comprehensive in their treatment of patients. Of course, we are losing those doctors to retirement or to the fact that their practices are full.
If you want to address facial wasting, read the info on this site and write down questions for your doctor: www.facialwasting.org
If you want to find out if you have bone loss, ask to get an order to get a DEXA scan.
If you are suffering from menopause related issues, ask to be referred to a gynecologist to run a full hormone panel and physical OBGYN exam.
I hope this helps. As we age with HIV, we have to remain educated and self-reliant to ask for what we need in an environment in which less and less time is spent with patients as 30 million new people enter the health care market in the United States.
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