| Finding a Doctor
Selecting a primary physician is one of the most important decisions
you make about your health care. Because the patient-physician relationship
is a crucial element in treatment, you'll want to take the time
to make the right choice. Remember: You have the right to feel secure
in your treatment; it's important that you ensure this right by
seeking as much information as necessary about your health care
providers.
What do People Look for in a Doctor?
Your doctor should have medical knowledge of and practical experience
with HIV/AIDS as well as a basic philosophy of healing that is similar
to yours. You want a doctor you can trust and with whom you share
mutual respect. Beyond that, every individual has his or her own
ideas about what is desirable or acceptable.
Whether you already have a doctor or you are shopping for one now,
consider the following points:
Medical Training
With a diagnosis of symptomatic HIV or AIDS, you'll want the care
of a physician who is Board certified in internal medicine, infectious
diseases, or a related specialty. Ask your current or prospective
physician what certifications he or she has received.
Experience Working with People with Symptomatic HIV or
AIDS
You'll want a doctor knowledgeable about AIDS and, preferably,
one with plenty of experience working with HIV-positive people.
Some physicians, particularly in New York and other metropolitan
areas, devote most of their practices to treating people with AIDS.
Ask your doctor how many AIDS patients he or she has treated.
A doctor knowledgeable about medical treatment for HIV illness
will be able to provide you with more information and options. Whether
you choose a doctor who works exclusively with AIDS, however, is
a personal decision.
Similar Philosophies and Attitudes
Like everyone else, doctors perform their jobs in many different
ways. While some follow a conservative, safe, by-the-book approach
to medicine, others are more willing to try new therapies, be more
proactive with patients, and be generally more receptive to their
patients' participation in treatment. Some doctors are more optimistic
than others in their outlook for people living with AIDS.
Are you interested in taking an aggressive approach to your illness?
Do you want to become as informed as possible about new drugs and
medical treatments? Do you intend to take an active part in the
decision making? If so, will the doctor be receptive to your wishes?
Do you want to be involved in new drug trials or new research protocols?
Will your doctor monitor you on such protocols? Will he or she work
to get a place for you in a research study? Are you interested in
exploring alternatives to established Western medicine, such as
homeopathy, vitamin therapies, and macrobiotics? If so, will your
doctor support you in these choices? Will your doctor respect your
wishes with regard to ending life support or creating a living will?
Who will be responsible for making medical decisions if you become
incapacitated?
These are all questions you'll want to ask your current or prospective
doctor. Follow your intuition. If you and the doctor are in conflict
on many of these issues, chances are you will want to continue your
search rather than find yourself shopping for a new physician later,
when changing may be more complicated.
Receptiveness to Your Input
Your doctor is someone you need to be able to talk with easily.
For those taking an active role in their treatment, a certain amount
of research and 'self-teaching' is involved. Because a tremendous
amount of documentation exists (articles, papers, anecdotal information)
you'll want to take responsibility for bringing this information
to your doctor's attention. Will your doctor listen to your suggestions,
complaints, or feelings about your treatment? If you are opposed
to trying something your doctor recommends or you are in favor of
trying something your doctor does not approve of, is your doctor
willing to take the time to listen to your comments and discuss
the issue?
Availability
It's a given: many doctors are overwhelmed by the number of patients
they see and the amount of work they do. Their time is extremely
limited. Some doctors make their patients suffer for their scheduling
problems and/or overloaded practices. Occasional delays of up to
an hour aren’t unusual, since every doctor is faced with emergencies;
but if you experience a lengthy wait every time you have a scheduled
appointment, then there's a problem. Your time is just as important
as your doctor’s. If you're already in treatment with a physician
and this situation exists, discuss it with him/her and see if something
can be done to shorten or eliminate the waiting period. If you're
interviewing a prospective physician, you might ask what the average
waiting time will be (particularly if you were kept waiting on your
initial visit).
Does the doctor return phone calls in a reasonable amount of time?
Is the doctor or an associate available, should an emergency arise?
Are they willing to take the time to explain medical procedures
and options to your satisfaction?
Bedside Manner
Make certain that your doctor's particular style is compatible
with your personality and needs. If you require plenty of reassurance,
don't depend on an unresponsive physician. Your doctor's personality,
attitude, and overall bedside manner will play a vital role in your
feelings about treatment, and you'll want to be sure that your doctor’s
style meets your needs.
Referral Base
A physician who is well connected with the medical community will
have a reasonably good referral base. If you require the care of
a specialist, your doctor should be able to refer you to another
physician who can handle the situation.
Affordability
If you have good medical insurance coverage, you will probably
have a wider range of doctors from which to choose. Ask if your
prospective doctor accepts delayed payment from insurance companies
or if you are required to pay up front and wait for the insurance
company reimbursement. If you have cash-flow problems, paying your
bill on the spot may be difficult. Try to work out an acceptable
arrangement with your physician. Let the doctor know if you do not
have insurance coverage; you may be billed at a lower rate.
If you have Medicaid you'll need to locate a doctor or a medical
clinic that accepts it. If you opt for a clinic and you are unfamiliar
with the facility, it's a good idea to be evaluated before you have
an acute medical problem. This will give you the opportunity to
see how the clinic works and give you an idea of the kind of treatment
you can expect.
Finding a Doctor
Perhaps you already have your own physician, a family physician
for example, with whom you think you want to remain in treatment
after developing an HIV-related illness. If you've been with the
doctor for a while, you're probably familiar with his or her style
and availability, but you may not be aware of his/her experience
with AIDS. Discuss these issues. Is your doctor equipped to provide
you with the level of support, both medical and emotional, that
you require? You will want to be assured that you can receive the
kind of medical treatment you need with an HIV or AIDS diagnosis.
If you do not have a primary physician, or if you want to change
doctors, there are several options to consider. Ask a trusted friend,
perhaps another person living with AIDS, for a recommendation. Although
experiences with doctors are subjective, this will give you a starting
point. Contact a local AIDS organization for the names of several
doctors, or, in the New York City area, contact the GMHC
Hotline. You may want to find a doctor close to your home, or
one who has admitting privileges at a hospital of your choice. If
possible, 'audition' several doctors.
You can expect to receive certain information over the phone:
- What are the doctor's Board certifications?
- Does the doctor treat people with AIDS?
- Does the doctor accept Medicaid?
- What other methods of payment are accepted?
- What is the cost of an initial visit?
Ask all the questions you think appropriate (write them down beforehand
if you're concerned about forgetting any important points). Your
gut reaction may be your most valuable tool in making the decision
to work with a doctor — do not ignore it.
If your medical care is dictated by an HMO or HIP, ask for a referral
to a doctor with AIDS experience. They may not have any referrals
but you can call doctors in the HMO to ask about their experience.
Although a referral is no guarantee of a doctor's abilities, it
is, at the very least, a starting point for finding a suitable doctor.
With an HMO, you may be able to switch clinics in order to gain
access to a different doctor.
Changing Doctors
Should you find it necessary to change doctors, you'll want your
complete medical records transferred to your new doctor, who will
review them carefully. If your new doctor has any outstanding questions,
it is his/her responsibility to contact your previous doctor for
clarification. It is reasonable to expect the transfer of your medical
records to take two to four weeks.
Experimental Drugs
If you are interested in trying an experimental drug, you will
want to do so with your physician's knowledge, so that he or she
can monitor the drug's effects and side effects. In some cases,
it will be your responsibility to obtain the medication and to provide
your physician with any literature pertaining to its use, side effects,
trial results, etc. Your doctor is not required to include any experimental
drug in your treatment plan, and if you wish to participate in such
protocols it is imperative that you discuss the issue with your
doctor prior to entering treatment.
© 2003 Gay Men's Health Crisis
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