AIDS Center Director Offers Advice on Selecting a Physician

NEW YORK--When selecting a physician, the most important question anHIV patient can ask is, How many HIV/AIDS patients have you treated? RamonA. Gabriel Torres, MD, medical director, AIDS Center, St. Vincent's Hospital,NY, said at a teleconference sponsored by Cancer Care Inc. and the GayMen's Health Crisis.

"Credentials don't paint the entire picture," Dr. Torres said."They do not determine character, bedside manner, attitude, or thepractice setting."

Prospective patients, he said, should explore the doctor's attitudestoward HIV-positive patients, gays, bisexuals, and intravenous drug users."How does the doctor get along with these types of patients? Findout if other patients are content with the care they are receiving,"he suggested.

The patient should also look into the practice setting, he said. Theoffice should be "user-friendly" allowing patients to accessphysicians during off hours. "Does the physician belong to a group?If he is away, can the patient access covering physicians? Does he havean answering service or an intermediary to answer the phone?" Dr.Torres said.

These questions are extremely important for people with HIV/AIDS whomay need to contact someone at night or during weekends, he added.

The people who work in the office--the receptionist, nurse, phlebotomist,and others--should also reflect the physician's caring approach. Dr. Torressaid.

Questions HIV Patients Should Ask When Choosing a Physician

Prospective patients should find out the range of services a physicianoffers. Many who care for HIV/AIDS patients have personnel who complementstandard medical care such as nutritionists and acupuncturists, he said.

Also ask about the availability of special equipment in the office thatwill spare the patient from having to go elsewhere. "Often doctorswho treat HIV patients will do intravenous infusions and aero-solized treatments,and provide laboratory services in their offices," Dr. Torres said."This 'one-stop shopping' makes life a lot easier for patients withHIV."

The physician should keep abreast of rapidly changing treatment regimens,whether through involvement in research or association with a hospitalor community-based organization.

Patients should also inquire about a practitioner's affiliations withspecialists in dermatology, pulmonology, ophthalmology, psychiatry, andgastroenterology. Those with Kaposi's sarcoma will need a referral to anoncologist, and should find out which oncologist the doctor uses and theoncologist's hospital affiliations.

Many HIV/AIDS patients do not want to be treated in hospitals, Dr. Torressaid, and thus they should ask about the physician's attitude toward homecare. "We have been very successful in AIDS with providing patientswith comprehensive home care," Dr. Torres said, through the use ofvisiting nurse services and certified home care agencies that coordinatepharmaceutical services, laboratory tests, and relationships with vendors.

Patients may have significant practical concerns regarding the potentialfor disability determination, Dr. Torres pointed out. "Approval fordisability payments is based on the physician's findings in addition totest results and findings by specialists," he said, "and thedoctor-patient relationship often hinges on having a mutual understandingon the course to take on disability."

Good communication is a must in determining the level of care the patientdesires. "Physicians should share their own agenda, in terms of treatmentand terminal care, with people who are advancing quickly in their illness,"he said.

Physicians should also be involved in the prevention of HIV transmission."These issues need to be addressed up front, and patients should expecttheir doctor to question them about their sexual behavior," he noted.

Finally, he said, physicians who treat HIV patients need to listen aswell as talk. "They need to be educated about HIV, and patients shouldbe able to bring in questions and talk about things they hear in the media,"he said. "So in addition to all the other qualifications, there mustbe give and take, mutuality and trust in the doctor-patient relationship."