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Author Topic: When To Know Whether To Switch Docs?  (Read 2854 times)

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Offline tednlou2

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When To Know Whether To Switch Docs?
« on: December 08, 2009, 12:48:21 AM »
I have an HIV doc who has only been a doctor for 8 years.  He mainly focuses on geriatric patients and only works with HIV one day a week.  He just always seems to not know things.  It is like he is just winging it.  I realize every HIV expert had to learn and didn't know what they know now.

First, every time I see him he asks me what HIV meds I'm on.  I have to explain to him I'm not on HIV meds yet.  He doesn't review all my blood-work.  I have to ask him to look to see how my kidneys, liver, etc are doing.  I asked today about the new treatment guidelines.  He sited the WHO's (World Health Organization) new guidelines.  They made the increase from CD-4 200 to 350 last week.  I told him I realized that but a U.S. panel just raised it from 350 or less to 350-500 with over half suggesting starting above 500.  He didn't know what I was talking about. 

I asked him about testosterone possibly causing my energy loss and depression.  He said he had never heard that.  I told him low testosterone is a big problem with HIV men.  I asked him about a butt problem I have.  I asked him about anal cancer and anal dysplasia and how many think men should get anal pap smears.  He didn't know much about that.  He said I could just have hemmoroids or herpes.  He said he could give me medication for herpes.  I asked, "Wouldn't we want to test for herpes first, so we'd know for sure?" 

I think I'm answering my own question here.  He is very nice, but I worry about trusting my health to him.  If I can read about these things, he should too.  Both Dr. Gallant and Dr Young of thebody.com say we should all have HIV doc who regularly reads the latest news, takes refresher courses, and go to conferences.  My doc also won't give his patients a way of contacting him via e-mail if questions arise between visits. 

Also, when I asked him about starting a depression medication, he told me to find a primary care doctor.  I kinda think our HIV docs should become our primary care docs.  Everything to do with our health affects HIV and visa/versa.  Depression can cause CD-4 to drop.  I could see if he wanted a psychiatrist to prescribe the meds, however, most depression meds are prescribed by non-psychiatrists.  He also suggested I see a primary care doc for the butt issue.  With anal cancers being a big concern with HIV, I think he should be the one to refer me to specialist.  He finally said he would.

Just wondering what your experiences have been??  Are you HIV docs your primary care doc as well?  Does your doc seem very up-to-date on HIV?  Does your doc provide contact info, so you don't have to ask docs on websites?  I know websites like thebody.com and Dr. Gallant's are good resources to get 2nd opinions.  I'm just saying we shouldn't be forced to turn to them for info.     

Offline gonzo

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Re: When To Know Whether To Switch Docs?
« Reply #1 on: December 08, 2009, 02:19:08 AM »
Dude!, seriously, it's time to find yourself a new doc, forget him being nice this is your life we're talking about here, find yourself an informed doctor, someone you feel comfortable with.
I also feel our HIV Dr.s should be our primary Dr., I go see mine for whatever ails me, tho his specialty is ID's, and even tho he was not my first choice in Doctors( I sort of inherited him-my previous Doc passed away due to the disease-RIP Dr. K)
I been with him for the past 17 years, and he's been just wonderful and very supportive.
diagnosed in 1990, current Meds: Truvada/Reyataz/Norvir

Offline Buckmark

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Re: When To Know Whether To Switch Docs?
« Reply #2 on: December 08, 2009, 10:19:31 AM »

From what you describe below, it sounds like it is time for you to find a new doctor.  Not only does he sound rather inexperienced with HIV, but it doesn't sound like he takes your concerns seriously.

You've answered your own question.  Time to start shopping around for a new doc.  We in the US are being encouraged to become savvy consumers of healthcare, after all.

Personally, I wouldn't be so concerned about finding and HIV specialist who will also be your primary care physician.  You'll get differing opinion on this, I'm sure, but in my mind HIV specialists are just that -- specialists.  Primary care physicians have a broader range of knowledge and experience to apply.  And you're more than just an HIV+ patient, so I suggest taking a broader view of your health.  I see an HIV specialist in addition to my primary care physician, and it works out just fine.  In the end, it may just be a matter of personal preference.


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     One is that God loves you and you're going to burn in hell.
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Offline Miss Philicia

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Re: When To Know Whether To Switch Docs?
« Reply #3 on: December 08, 2009, 10:31:06 AM »
tednlou, I see you live in Louisville and as such living in a city you should be able to locate a clinic devoted entirely to HIV treatment at something like a local university, or at least I would think so.  Someone who treats HIV only one day per week (and I guess that doesn't even mean all of the patients on that day are HIV+, just that any HIV+ patient comes on that day) really isn't a great sign of competence with the issue.  It may be fine for a patient on auto-pilot, with their treatment very stable, but at the first sign of trouble that doctor will never be sufficient and personally that would make me very uncomfortable.
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Offline tommy246

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Re: When To Know Whether To Switch Docs?
« Reply #4 on: December 08, 2009, 10:47:17 AM »
Ted im not surprised your worry so much with a doc like that i would change tommorow you will find yourself feeling 100% better mentally when you know your in good hands i think its the most important thing and the sooner the better.
jan 06 neg
dec 08 pos cd4 505 ,16%, 1,500vl
april 09 cd4 635 ,16%,60,000
july 09 ,cd4 545,17%,80,000
aug 09,hosptal 18days pneumonia cd190,225,000,15%
1 week later cd4 415 20%
nov 09 cd4 591 ,vl 59,000,14%,started atripla
dec 09  cd4 787, vl 266, 16%
march 2010  cd4 720 vl non detectable -20  20%
june 2010  cd4  680, 21%, ND

Offline Inchlingblue

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Re: When To Know Whether To Switch Docs?
« Reply #5 on: December 08, 2009, 11:02:45 AM »
I think it's unanimous: based on what you are saying it's pretty obvious you need a new doctor!@ This guy sounds like Dr. Spaceman on 30 Rock.

You can maybe start a thread for anyone who might have firsthand experience with someone in your area and/or check the website www.aahivm.org and do a search by zip code and see what comes up. Find the best and most experienced HIV doctor in your area!

You are still not on meds and your numbers are good so you are still at a point that HIV can be a very manageable thing. If you are in the wrong hands it's not too hard for things to go wrong and things can get ugly. Not saying it to scare you, it's just that HIV treatment can be as easy as taking firstline meds with few if any side effects or as difficult as trying to figure out what to take for salvage therapy and the road from one to the other is not that long if one is not careful.

Having said that, even with an excellent doctor, it's still advidsable for all of us to be as informed as we possibly can about HIV and how it's treated.
« Last Edit: December 08, 2009, 12:29:48 PM by Inchlingblue »

Offline max123

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Re: When To Know Whether To Switch Docs?
« Reply #6 on: December 08, 2009, 12:26:05 PM »
i also agree with all that's been said, ted. time to let your fingers do the walking... ;)
1/86 - 6/08 (annually): neg elisa
7/09: pos elisa/pos wb
8/09: cd4 560, cd4% 35, vl 13,050
12/09: cd4 568, cd4% 33, vl 2,690
4/10: cd4 557, cd4% 29.3, vl 6,440
7/10: cd4 562, cd4% 29.6, vl 3,780

Offline randym431

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Re: When To Know Whether To Switch Docs?
« Reply #7 on: December 09, 2009, 10:42:40 AM »
I know your pain. The docs here where I am are terrible! A few good experienced docs had joined the staff a few years ago, then left for greener grass within two years. The bad ones are stuck here. As long as labs look good, they are happy. They show no concern about issues all hiv people deal with. I think my doc lives for the seminars out in california. Seems he is always going to, or just returned from some seminar. The draw must be the good food and the chance to look important.
What I really hate here are the docs only seen interested in two lab results, ch4 and vl. If you have other issues, like cholesterol issues or skin issues or sleep issues or energy issues, they want you to see yet another doctor to deal with those issues. At times Im seeing 4 doctors at once, one for this and one for that. The copays add up fast. And lately three of the doctors have been in some little war where they don't want to share labs, but insist on a set of labs for each doctor, duplicating labs. That is where I drew the line and just started canceling appointments.
I would love to have a one-stop hiv doctor, a doctor that knows a little something about everything.
Especially issues clearly hiv related.
« Last Edit: December 09, 2009, 10:47:29 AM by randym431 »

Offline allanq

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Re: When To Know Whether To Switch Docs?
« Reply #8 on: December 09, 2009, 11:58:18 AM »
You've given many reasons why you are not happy with your current doctor. Any one of them is reason enough to find another doctor. The fact that you have to educate your own doctor on basic HIV matters is a particularly compelling reason to change.

Have you tried the WINGS Clinic in Louisville? From what I've read, it seems like a very good place to receive your HIV care.


Good luck, and keep us posted.

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Offline pozniceguy

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Re: When To Know Whether To Switch Docs?
« Reply #9 on: December 09, 2009, 12:15:44 PM »
My own experience was more of a practical one.  my regular Dr( family Dr  GP.) was always having to give "referrals" in order to get the appointment with the ID Dr.  so both agreed I would  designate the ID DR as "primary"  to over come the nuisance of getting referrals...   and there is no issue nor do I need  "referral" to go to the Family Dr...

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