Doctor, You're Fired

Dr. Joel Gallant, chair of the HIV Medicine Association and author of the book "100 Questions and Answers about HIV and AIDS," tells about an interaction that could have ended up with the patient "firing" him.

"I recently saw a new patient on a day when I was running behind and feeling overwhelmed by the pressures of time schedules and incomplete documentation," Gallant told EDGE. "It obviously showed, because after about 15 minutes, he smiled and said, 'Doc, you need to lighten up!'

"We both laughed, and I apologized for being so businesslike and rushed. The rest of the visit went well, but if he hadn't said anything, nothing would have changed and he might not have come back.

In that case, humor diffused an awkward situation and cleared up what a simple misunderstanding.

But there are times when you should weigh the pros and cons of your primary physician. If your "con" side is a lot longer, you should consider a switch. Knowing when to walk away from this all-important relationship can be just as wrenching as leaving a partner -- but it could be one of the most important decisions you'll ever make.

If your provider seems like he is disconnected, or you don't feel he's taking enough of an active role in your treatment process, that "can be a sign that your concerns are not being considered," said Dr. Joseph Olivieri, a virology physician at New York University Medical Center, said.

"All treatments do not work the same and can vary greatly depending on the individual," he added. "If your doctor is very quick or eager to recommend a particular brand or product without discussing different treatment plans with you it may be a good sign to speak with another medical professional."

"If your viral load and CD4 count are more important to your provider than how you're feeling, that's another problem," Gallant sais. "It's not easy to change a provider's behavior, especially within the constraints of the medical system he or she works for.

Gallant suggested "addressing this head-on with a polite but clear statement: 'Sometimes I feel like you're distracted and aren't really listening to what I'm saying.' That approach might work for many providers, who really want to communicate with their patients but have become overwhelmed by the demands of our healthcare system."

"If you are legitimately concerned about some aspect of your health, start with that health complaint at the beginning of the visit," Cheri Joce, a San Diego HIV healthcare provider added. "This way, your provider is likely to focus on that issue and move onto other items later in the visit which may not be as important."

Sex & Drugs: Definitely Not Off Topic

"Any provider taking care of patients with HIV infection should be very comfortable talking about sex and drugs, subjects that should be brought up during the very first visit," Gallant noted.

"Be completely honest," Joce said. "Nothing you say or do will shock your healthcare provider. Most providers have been around long enough to be well seasoned on a variety of topics and they shouldn't be uncomfortable talking about drug use or your sexual activities."

"If your provider doesn't bring them up, that's a red flag, but try raising the issue yourself anyway" Gallant warned. "If your provider seems uncomfortable, judgmental, or just plain clueless, you've got a problem that you're probably not going to be able to fix -- though you're welcome to try!"

If your doctor doesn't suggest testing for STDs, Joce said that should be another large red flag: "If you are living with HIV, you are sexually active, and your doctor is not suggesting you be tested for syphilis, gonorrhea, and chlamydia, it may be time to find another doctor.

"Sexually active gay men are supposed to get regular throat and rectal swabs for gonorrhea and chlamydia," Gallant added. "If that's not happening, or if your provider has never looked at your 'junk,' it may be time to move on."

Disengaged Doctors Don’t Cut It

If for any reason you just aren't feeling it, find someone else.

It's nothing personal, Joce pointed out: "If you don't connect with your healthcare provider, ask for someone else. You can discreetly do this with the office staff and usually the provider isn't offended. Your health is a greater concern than offending someone. Sometimes personalities don't jive or you don't feel comfortable enough to be open with an individual. If this is the case, move on and don't look back."

Sometimes you may not be getting the information you feel you need or the services you believe you need. Sometimes, the problem may be endemic in your principle healthcare facility. If so, said Gallant, you need to figure that out and move on.

"Changing providers is easier than changing the way a clinic operates," Gallant explained. "But if you have serious concerns, you should discuss them with your provider and the manager or director of the clinic. If the situation can't be changed, you may have to consider going elsewhere, if that's an option."

The most important key to your health is always to remind yourself that you and your provider share responsibility for keeping you healthy. Your provider has the responsibility to present you with all of the information you need to make the best decisions you can make for your own health. You have the responsibility to supply all of the information your provider needs to make those recommendations as well as following through with your treatment.

"I've been fortunate enough to find a great doctor," Gerry Salazar, a woman living with HIV, told EDGE. "But it didn't happen overnight. It was a process and it took me more than a year to get someone I was comfortable with. But it was all worth it.

"You only have one life and there are few things more important than finding someone you would entrust it to."

This story is part of our special report: "Ask the Doc: Special HIV Edition". Want to read more? Here's the full list.

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