LIFEMEDICINEPART 6:
FINDING DOCTOR
RIGHT
You may have to ‘kiss a lot of frogs’
to find the right HIV doctor. But, like any important relationship, it is
worth the effort
Words Dr Rupert Whitaker
Image Antonio Maggi
A good relationship with your physician is essential to thriving, or even
just surviving, with HIV. Your doctor is not your friend but they are there
to provide a good service: one that works for you and puts you in charge of
your health. After all, they are not the one living with your HIV.
Like any relationship, it can take time to find a good one. While there’s
no such thing as the perfect physician, a good one tries hard to become better
on all fronts. You don’t need a difficult doctor on top of being ill.
Try kissing several frogs but never, ever settle for a toad.
What to look for: the good and bad
People with long-term HIV (ie, experience) often acknowledge a need to be
in control of their health and trust their physician to help them do that.
Trust is created by consistency, support, respect, honesty and accountability.
A physician’s interpersonal skills and willingness to be your advocate
are most important. Beyond that, you need someone who is knowledgeable, flexible,
respectful, comfortable hearing about your sex life, your drug use, or your
spiritual or religious beliefs, and who understands that, over time, you’re
more likely than him/her to know what’s normal for your body. Your physician
needs to listen, be empathetic, seek your meaning and make relevant responses.
If you leave an appointment wondering why you bothered going, there’s
a problem.
When to move on
When it comes to living with HIV, you shouldn’t have to suffer second-rate
care. If your physician treats you like a problem, leave their care, complain
in writing and find a better physician, in the same clinic or elsewhere. If
you’re referred to ‘difficult’ consultants, a good physician
will acknowledge openly any problems that you’re having with his/her
colleagues and create, with you, a plan to work around such obstacles.
Getting the best care
Physicians are trained, and paid, to develop good clinical relationships.
You aren’t, but there’s a lot that you can do to help things go
more smoothly. Be involved in your care: do your best to follow treatment
plans you’ve developed together; always try to be pleasant, (but never
put up with bad behaviour); take a list of questions into the appointment;
be clear and brief when communicating what you want and why; learn negotiation
and assertiveness skills; be persistent, and insist on being treated as an
individual. You
can also join patient groups in clinics; ask about joining at your next visit.
A good
relationship with a physician is a solid start to living well with HIV.
Perfect physicians:
• Welcome information and questions.
• Are willing to learn things, look things up, or ask for guidance.
• Explain information well, in simple terms.
• Look and smile at you when talking.
• Acknowledge errors, apologise, and jointly create a plan to avoid
them in future.
• Advocate for consistent, quality care for you.
• Support patient groups to improve services.
• Get professional support to stay
emotionally well in their job.
Difficult doctors:
• Resist you taking charge of your health: ‘Doctor knows best’.
• Rely on test results more than listening to what you have to say:
“There’s no proof you’re sick, so you aren’t”.
• Evaluate you against a standardised ‘norm’ rather than
what is normal for you.
• Give the least possible treatment in spite of clear need, eg, under-treat
pain.
• Are pompous, abusive or lack empathy.
• Make excuses for bad behaviour: ‘I’m busy’
• Blame you for requiring quality care: “You’re expecting
too much of the NHS”.
• Label you as difficult rather than trying
to provide a better service.
• Protect their relationships with colleagues over the quality of your
care.
Dr Rupert Whitaker is co-founder of Terrence Higgins Trust and has a clinical
practice in psychological medicine.
• www.lifemedicine.co.uk
