Three minutes into the appointment he handed me a stack of prescriptions for HIV medications and told me to go to the pharmacy and get them filled. I asked a few questions about what was being prescribed when he abruptly told me to "just take the pills and you'll be on cruise control."
"What are you talking about?" I asked. His response was a simple, "Like I said, just take your pills and you'll be on cruise control for the rest of your life." Once again, I started to ask some questions about his prescribed course of treatment. His irritation with me became obvious and he got up to leave the exam room.
Newly diagnosed, out of the hospital for just three days, and my first appointment with my new doctor lasted less than five minutes. Actions really do speak louder than words and it was apparent from his actions that Dr. Cruise Control was dismissing my concerns and questions as irrelevant. After all, it seemed, I was just the patient; he was the doctor.
After telling me to make a follow-up appointment in three months (three months!), he left me sitting there in the exam room. I was dumbfounded. I sat there and started to cry.
Needless to say, that was the last time I saw that doctor. Cruise control is meant for automobiles -- not for someone recently diagnosed with HIV or who's still getting used to the words "you have AIDS."
I look back at that experience and realize that even though my relationship with Dr. Cruise Control was short-lived, he provided a valuable lesson. In that brief encounter, it became clear that I needed to become a wise consumer of healthcare services; I needed to set in place a process that would help me to make a well thought-out decision as to who I would trust to be an integral part of my healthcare team.
After my encounter with Dr. Cruise Control I set out to find a doctor that would work with me as a partner in my care. The most important factor in my search was coming to the realization that any doctor that I would work with from this point forward also had to be a healer.
What do I mean by "healer"? It's simple: I will not entrust my care to someone who does not care for me in a holistic manner -- he or she has to treat me as a whole person, not simply as a virus who happens to be living within a human being.
A healer is as concerned about how I am feeling as he or she is with the numbers on my quarterly blood work. A healer works with me as an equal partner in my care. A healer talks with me rather than talking at me. Healers encourage me to be an active part of my care and are not threatened by the fact that I may want to explore complementary therapies as a part of my health care. They are willing to admit that they do not have all of the answers and don't expect me to put them on a pedestal and accept every word as gospel.
I realized that I needed to be able to ask questions and bring thoughts, suggestions, and questions to my appointments. I needed to be able to have any concerns or questions addressed without being made to feel like a fool. I also decided after my experience with Dr. Cruise Control that any doctor I worked with had to have specialized knowledge and experience in the treatment of HIV/AIDS. While there are many talented doctors, I wanted a provider who was at the forefront of treating HIV. I decided that I wouldn't consider any provider who did not have a significant HIV practice.
Once I tentatively decided who was going to replace Dr. Cruise Control, I had a conversation with the prospective new doctor about what his expectations were of me as a patient. Interestingly, his expectations of me were very similar to the expectations I had of him.
He asked that I be open-minded to suggestions and come to my appointments willing to discuss various treatment options. He asked for my continuing honesty about issues going on in my life and with my health, and he asked that I make a commitment to continue my education on issues related to living with HIV.
The thing that really made me realize that it was going to be a good match was when he told me that he approached his relationship with patients as a partnership -- with both patient and doctor having a shared responsibility. He shared his belief that patients, when given the opportunity to work with their doctors as equal partners in their care can, in many ways, become their own doctors.
At that moment I remembered a quote I had read the day before that was written many years ago by Albert Schweitzer. He said, "Each patient carries his own doctor inside him. They come to us not knowing that truth. We are at our best when we give the doctor who resides within each patient a chance to go to work." It was clear that my new doctor was empowering me -- the patient -- to be an active participant in my care and to awaken the "doctor" that resides within me.
The final question I asked him was whether he saw any parallels between living with HIV and being on cruise control. He laughed. He said he wished it was that simple, but it was clear that cruise control was meant for automobiles and had no place in a philosophy of HIV care.
I knew I had made the right decision.
Greg Milward recently returned to his birthplace of Madison, Wisconsin, after 20 years in Tucson, Santa Fe and Washington, D.C. He shares his life with his partner of 24 years and the two best Labrador Retrievers in the world. He is happy to report that his approach to finding a good health care provider led him to the University of Wisconsin HIV Care Program and Dr. Frank Graziano, with whom he shares "a wonderful doctor/patient relationship." He can be reached at firstname.lastname@example.org.
Tip Sheet for Finding a Good HIV Care Provider
If you can, get yourself to a computer and check out the following resources:
American Academy of HIV Medicine
On this site you can find a physician in your area who is an HIV specialist according to the American Academy of HIV Medicine (AAHIVM). The AAHIVM has established a definition for "credentialed HIV Specialist" using industry-standard criteria to measure knowledge -- experience, education, and external validation. To receive and maintain credentials, a provider (physician, osteopath, physician assistant, or nurse practitioner) must continuously fulfill the requirements of the AAHIVM. Requirements include being licensed, passing a credentialing exam, taking regular courses, and maintaining a patient caseload of at least 20 every two years. Visit www.aahivm.org.
The Body has organized a variety of information from various sources on the topic of "Choosing and Working with a Provider." The collection includes basic information, personal accounts, research, and resources. Visit www.thebody.com/choosing.html.