I have the best doctor on earth -- caring, compassionate, knowledgeable, funny, and, possibly, a liberal. But this hasn't always been the case. Having spent several years as a health educator, talking to both patients and healthcare providers, I thought of myself as confident and savvy enough to choose and have a relationship with a good, new doctor when the time came. Was I wrong. I had moved to a new city in 2000 and, being new in town and having a rather small pool of doctors in my health plan to choose from, I just went down the list and randomly selected a doctor for an annual physical and to check a minor pain I had.
Things started off badly from the moment my new doctor and I met. As I had always told clients, talking to your doctor should always be as frank and informed a conversation as possible regarding one's health history -- especially with a new provider. I informed my doctor that I was gay, single, sexually active, approaching my forties (okay, this was a while ago), and offered many other details that I considered pertinent. This should have triggered a series of questions from her regarding my health, such as HIV status, hepatitis A, B, and C (including vaccinations), and STDs. But no such questions were asked. Given my age, I also should have been asked about and checked for testicular cancer, and a conversation regarding colon and rectal cancers should have taken place. No such luck. During our brief -- very brief -- "conversation" we did talk about my occupation. "HIV heath educator," I said. "Ah!" she exclaimed. "In that case, we need to do a TB test." I asked whether she suggested the test because I'm from a third world country. "No, 'those' people you work with are at higher risk for TB than the rest of the population," she explained. I should have walked away at this point. But I didn't, partly because I was caught off guard and partly because, in the ten minutes of our interaction, I had been reduced to a semi-naked dummy sitting on a cold chair answering questions as if I were back in the principal's office.
I explained that I was there for my annual physical, a minor itch, and chronic back pain. I requested a basic lab work up and a referral to a specialist for my back. I was informed that I was too demanding and possibly a difficult patient, too, which I suspect was noted on my chart. The doctor left the room and I waited for about ten minutes, which seems like an hour when you're sitting on a cold chair wearing nothing but a thin hospital gown. Finally, a nurse came into the room, ordered me to dress, gave me several prescription forms and the referral for the lab work, and then left. I waited some more and then decided to investigate. I left the examination room and asked at the front desk about my doctor. I was told that she was with a patient. But she was with me, I explained. No, I was told. She's finished with you.
At this point, many things had gone wrong, but I was still dumbstruck by the events that had taken place in less than 20 minutes. I dropped off the prescriptions at the pharmacy, made the appointments for the specialist, lab tests, and follow-up visit, and went home. Once at home, I realized that I had left the doctor's office with a year's worth of pain killers (the doctor had prescribed 11 refills), sleeping pills, and antidepressants. I decided to wait until my next visit to ask some questions regarding this course of treatment.
In the meantime, I concluded that this was probably not the best choice of healthcare provider. For starters, she didn't seem very sensitive to my sexual orientation, which I consider paramount to my health. I should have been offered HIV, STD, and hepatitis screening. I should have been asked about my sexual behaviors and/or partners. I should have been checked for testicular cancer. Attention should have been paid to my family's disease history, which I had written down. I should have been told what tests I was getting and, more importantly, we -- the doctor and I -- should have discussed the drugs she was prescribing, the side effects I might expect, and any interactions I should be aware of. Since there wasn't a single sentence devoted to my mental health, I should have been told the reasons for prescribing antidepressants. And since we talked very little about my back pain, there was no clear explanation as to why I was given a year's worth of refills of a very addictive pain killer. And the itch? I forgot about the whole thing.
My next and last visit to my new doctor was better for me. I had prepared myself to be assertive and firm, and I was. My doctor, on the other hand, did not find this amusing. When I asked about the course of treatment she had prescribed, she impatiently explained that she was the doctor, that's what doctors do, and that I, the patient, should be more cooperative and trusting. I agreed with her on this one -- patients should be cooperative and trusting. But this doesn't mean giving up the right to know and understand, the right to ask and question. Cooperation and trust must go both ways.
The lesson? I should have shopped around more; I should have asked my friends and colleagues for referrals; I should have researched my health plan better; and I should have left the office the minute I got a hint that this doctor and I were incompatible from the beginning. Now I'm back with my old doctor and I couldn't be happier.
Carlos H. Arboleda is a freelance consultant who has done HIV treatment education and advocacy work for over ten years for organizations such as Gay Men's Health Crisis, the National Minority AIDS Council, and, yes, Abbott Laboratories.
This article was provided by AIDS Community Research Initiative of America. It is a part of the publication ACRIA Update. Visit ACRIA's website to find out more about their activities, publications and services.