One of the people who nominated him called him "my patron saint." Another person wrote, "His dedication and yearning to learn more in order to best serve his community is endless. He has been a great help to me, even though I am living on the other side of the continent." Meet Dr. Hana, one of the up and coming HIV physicians who is bringing new energy and ideas to HIV.
How long have you been practicing?
I have been in practice for almost five years.
What kind of patients do you generally see at Kaiser? Do they generally have private insurance or get ADAP or Medicaid?
As a general practitioner, I see patients with primary care needs. I see mostly patients with private insurance, but I also see patients on ADAP, Medi-Cal and Medicare.
Are they dealing with other diseases? If so, what are they dealing with?
Patients with HIV are living longer because of HAART. Thus, for example, I see patients dealing with chronic liver disease from hepatitis C and B co-infection, as well as common adult onset diseases like heart disease, cancer and diabetes
Is there anything particularly challenging or different about working in HIV care in an HMO (i.e., can you give resistance tests when you'd like)?
One of the reasons I chose to work at Kaiser was the plethora of services available for my patients. I work in a unit that is specialized in HIV care. I count myself lucky to be within a caring and experienced team of HIV specialists, HIV case managers, HIV pharmacists, an HIV nutritionist, a health educator and a behavioral therapist. Resistance testing is available to patients at provider discretion. Patients have access to the newest experimental drugs via our research programs. Team members stay on the cutting edge of developments in the field. We hold a provider meeting every week to discuss hospitalized cases and share new HIV knowledge. At Kaiser, we care deeply about our patients. For example, because of concern about using a different formulation of amprenavir (Agenerase) when using dual protease inhibitors on some of our patients, we went the extra mile and checked drug levels on these patients to ensure that their drug levels were adequate.
Are you seeing more women in your clinic lately? What are the particular needs for women with HIV?
I have few women in my practice, but I always wish to care for more. There are many HIV-related issues that impact women, including concerns about gynecological problems, pregnancy and care for children.
What kind of adherence support do you provide for your patients?
As I mentioned earlier, I have a large support through my team. Additionally, our behavioral therapist runs a weekly HIV support group.
What percentage of your clinic are immigrants?
A few of my patients are immigrants. They are from all over the world. It is hard to categorize the behavior of the immigrant community as a whole. Occasionally extra support is needed and, fortunately, there are a variety of non-profit organizations in the bay area to support HIV patients.
Can you tell me specifically how crystal meth has impacted patients already infected? Anecdotes would be great.
Unfortunately, I have seen a fair amount of crystal meth use in my practice. Crystal meth seems to go hand in hand with increased risk for sexually transmitted diseases, including new HIV infections. Not only are people jeopardizing their health, but some of my meth-addicted patients have lost their jobs and their health care. People who have pre-existing depression and anxiety disorders are especially at risk for abusive use of crystal meth,
I understand that you are lead principal investigator on a preventive behavioral study. Can you provide more details about the study?
I am proud to lead as a principal investigator an interventional preventive behavioral study with the University of California, San Francisco. The study which called "Positive Choice: Prevention for Positive Health" is a randomized, controlled trial to determine whether Positive Choice, which is an interactive multimedia computer program that delivers a brief motivational intervention before HIV-infected patients' health care appointments and cues health care providers can do the following things:
What's the biggest thing you have learned practicing during the last five years?
I have learned to recognize the value of earning patients' trust.
Can you describe how your work has changed since you first started?
Over the last five years, I grew to know my patients better. I learned from them, gained more experience and recently expanded my interests by getting involved in clinical research.
Why did you choose to specialize in HIV?
There is almost no one in the world who has not been touched by the HIV epidemic in one way or another. There is a lot still to learn about this virus. Physicians have a responsibility to help people who got infected and prevent others from getting infected.
What's the best thing about your job?
I like interactions with patients. It is a constant challenge and reward.
What's the worst thing about your job?
Delivering bad news.
What have been your greatest successes in your work? What is the biggest challenge you face as a clinician?
My greatest success has been building up a large panel of patients that trust and recommend me to their friends and partners.
Gaining patients' trust is the biggest challenge for any clinician.
What do you think is the biggest problem people with HIV face today?
Patients must cope with a disease that we still do not have a cure for. Thousands of lives are lost daily to the disease. Also, patients on HAART occasionally suffer unfortunate side effects and complications from the treatment. Finally, I wish I could say that our society has completely eliminated the stigma associated with HIV.
What single change would you like to see in HIV care?
From a global point of view, I would like to see treatment available to everyone in need and more funding for programs that deliver HIV care. For example, Brazil has been successful in cutting down numbers of new infection and numbers of deaths.
What do you provide in terms of education or counsel for a patient who is just diagnosed?
There is a lot for anyone who recently got diagnosed to digest and deal with. I make sure that my patient has a good support network, sometimes offering help from resources like a behavioral therapist. I explain what the viral load and the T-cells mean and offer the appropriate vaccinations. I encourage my patient to write down all questions they have and contact me later if they need to. Finally, I encourage them to go to web sites like TheBody and AIDSmeds.com and read some enriching books like The First Year by Brett Grodeck. I also have the patient follow up in two to three weeks.
What do you provide in terms of education or counsel for a patient who is about to begin treatment?
It is essential that patients are ready to commit to a long-term treatment plan. I explain the important of compliance and the risk of resistance with missing doses. Then I go into the dosing and what to expect as possible side effects and arrange a visit with my pharmacist to discuss the regimen in more detail. Finally, I arrange a follow up and encourage contact for any concerns.
If you were infected with HIV today, at what T-cell count would you begin treatment?
Between 250-300. Recent studies do not favor treatment above 350 cells except for symptomatic patients and do show a better outcome if patients start treatment before the T-cell count drops below 200.
What treatment regimen would you choose if you had to begin treatment today?
I would suggest an NNRTI with either Truvada or Epzicom, because of the simplicity of the regimen and the minimal side effects.
What's the key to a great healthcare provider/patient relationship?
Good communication. It is always a two-way road.
How do you feel about patients who take a proactive role in their own treatment? Do you have many patients who are proactive?
I encourage all my patients to be proactive in their care. I encourage them to ask questions and mention their concerns.
Who was your all-time favorite patient and why?
I tend to avoid favoritism in my work. Every patient is unique.
What is the most important, memorable or useful thing you have learned from your patients?
I have learned to listen to my patients. They taught me more about HIV than everything I have learned from books.
How do you maintain a positive outlook and avoid burning out?
I try to exercise regularly and enjoy my free time. I am also fortunate enough to have support from friends and family.
If you weren't a clinician what would you be? Why?
I would probably be a computer engineer since I have always been interested in science.
Who would you dedicate this award to if you could?
My patients first, then the team with which I work.
Where did you grow up?
I was born and raised in Damascus, Syria.
What did you want to be when you were a kid? When did you decide on medical school?
I always wanted to become a physician. Childhood trips to the hospital with my aunt, a pediatrician, inspired me to go to medical school.
What kind of work do your parents do?
My father is a businessman and my mother is an accountant.
Who were the most influential people in your life, both professionally and personally?
My family and teachers are behind my success.
What do you do in your spare time?
I like traveling, cooking, reading, exercising and dining out.
Do you have a partner?
For the last year and half, I have had a wonderful partner, who is going to law school. We are planning on having a kid in a few years.
Where do you live? What kind of community is it?
I live in San Francisco, in a colorful neighborhood filled with life and activities.
If you had anyplace to live besides where you live now, where would you live?
New York City or Chicago.
What's the best vacation you ever had?
Going to Hawaii. It is a piece of heaven on earth.
What's the biggest adventure you ever had?
Walking across an active volcano as lava flowed past me into the ocean.
What's currently on your bedside table for reading? What book would you say has had the most impact on you?
I try to balance between reading medical journals and non-fiction novels. Recently, I have been reading an interesting book about the Iraqi war called Generation Kill.
What kind of music do you like to listen to?
I like listening to Arabic music the most, but I also like classical, Hindustani, classic rock and pop music.
Anything else you think it would be important that people reading this interview know about you?
I am grateful for the opportunity to participate in the fight against HIV.