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Is it time to change doctor?
Mar 20, 2006

I have been under a great deal of emotional stress for the past 2 weeks. I am 49 y/o, positive since 4/87; AIDS Dx 12/00. I have been unable to work since 12/00. I started high dose AZT in 9/87 and have been been given almost every drug as they came out of the pipeline. My current HAART Tx is Agenerase, Kaletra, Viramune, Viread. I have been on this combo since late 2001. I have a multitude of nasty side-effects but have made the choice to endure them as phenotypic and genotypic resistance tests showed multiple mutations to all drug classes. I have made the decision to stick with this regimen until Tx failure occurs. I am 99.9% adherent. I have not missed a dose since having surgery in 2004. My CD4 is 320 and VL is <70. I called my HIV doctor's office yeserday because I have been feeling much worse than I ususally do. I have no appetite, markedly decreased energy levels, temp between 99.5-100.5 daily, chills, body pain. I mentioned that I am under a lot strss at the moment. The doctor's nurse called me the following day and left a message telling me that it sounded as if my symptoms were stress related and I should find a way to reduce and manage my stress level. I am being treated by a psychistrist and clinical social worker for Major Depression and Panic Disorder. My concern is, if there really is something going on physically, how do they know without examining me? I've never been exactly thrilled with my current HIV doc's bedside manner. I am older than he and have a similar education level. I have always been somewhat putoff by his attitude and demeanor which at time is "his way or no way". Is it time for me to consider looking for a new HIV doctor? I have been with this doctor since 5/2001.

Response from Dr. Horwath

There is no way to tell whether your symptoms were due to a physical cause without examining you. I agree with you that you should have been examined. If nothing was found on physical examination, then it would make sense to search for emotional and stress-related causes.

Whether or not you stay with this doctor depends on many things, including your prior hisotry with him and your other options. Even though you don't like his bedside manner, if he is an experienced HIV specialist, you might be better off staying with him if no other specialists are available in your area. People seeing experienced HIV specialists generally have better treatment outcomes than those who see general medical practitioners. However, if you do have other specialists available to you, then you are free to explore other options. It's a difficult decision to change doctors, but it is your option to choose.



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