MEETINGS * RENCONTRES

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Use discretion 'in teat'ing HIV patients, FPs told

Bill Trent C all the man any name you like to protect his anonymity, but don't call him a pervert because his sexual preferences led him to test positive for antibodies to the human immunodeficiency virus (HIV). "John", an intense young man who is HIV positive, brought that message to more than 300 doctors attending a recent refresher course for family physicians sponsored by the Postgraduate Board of Montreal's Royal Victoria Hospital. The 3-day course covered medical and surgical subjects and various psychosocial issues. "Physicians must realize in dealing with HIV patients that most of them are gay men", he said. "I've encountered a lot of homophobia out there. I've talked to physicians whose attitude basically was that I was a perverted slut and I was getting what I deserved. I don't know if those men and women realized that they felt that way but it was certainly there." John, whose infection was diagnosed early in 1986, was invited to join a panel discussing controBill Trent is a freelance writer living in Lanark, Ont. 660

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"In the past 3 years I've seen about 2 dozen GPs, 10 specialists, 3 naturopaths, 2 homeopaths, a psychiatrist, 3 psychologists, 3 massage therapists, an astrologer and a

fortune-teller." HIV-positive patient versial aspects of the AIDS epidemic and provided a first-hand view of one man's life with the virus. Copanelists were Dr. Norbert Gilmore of the Royal Victoria's Division of Clinical Immunology, and Dr. Michael Kaye, director of the Division of Nephrology at Montreal General Hospital and chairman of its ethics committee. "In the past 3 years I've seen about 2 dozen GPs, 10 specialists, 3 naturopaths, 2 homeopaths, a psychiatrist, 3 psychologists, 3 massage therapists, an astrologer and a fortune-teller", said John. "I suppose in giving you this information I take the risk of looking a bit neurotic but, in retrospect, I don't think I was being neurotic." He said he had been looking for a physician, or healer, with

whom he could have "some kind of equal relationship" and it had taken him a long time to find one. The first unhappy event occurred when he was admitted to hospital with shingles: "The specialist came into the room to say I was HIV-positive and, given his experience, I could be dead in about a year and a half. Then, he asked if I had any questions. I didn't react to that very well at all." Another unhappy episode involved a general practitioner. "I'd go into his office and he'd spend the first 15 minutes telling me how his patients were dropping like flies, and how depressing it was to deal with my situation." John could sympathize with the doctor. "I understand it was very hard for him to care for a young man who was sick and dying, but he needed to become

"It's like looking at somebody with some chronic failure, someone with diabetes, an old person who is wearing down." -

Dr. Norbert Gilmore, on treating AIDS patients

part of some kind of support group where he could deal with his anxieties and not tell me about them." Doctors, he argued, have a responsibility to look after their own health, especially when they are dealing with numerous cases involving major illness and death. "Find some kind of outlet for your guilt, so that you don't burn out, so you don't get depressed", he urged. He recalled another physician who kept assuring him that "everything was wonderful". When the physician suggested he take zidovudine (AZT), he began to suspect he wasn't being kept fully informed about the state of his health. The doctor confirmed this, saying he was afraid his patient wouldn't be able to handle bad news. John finally found a physician he feels comfortable with. "He wants me to have a relationship with him in which we're equals", he said. "That's what I want because if I'm going to have equal standing with a doctor, I need certain things. Number one, I need facts. If I don't know exactly what my condition is, if I don't know what the test results are, if I don't know what certain treatments are, I can't participate in decisions made about my health." The doctor's compassion is a major component of their doctorpatient relationship, he said. 662

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"He's not afraid to be my friend, even though we both know that chances are I won't be here X amount of time down the road. He hasn't been afraid to become close to me." John's final comments drew a rousing round of applause. "One of the most important things is to know exactly what's going on and to know that you can count on your physician to be honest with you. The relationship between doctor and patient is very, very

important." Gilmore told the family physicians they had a key role in the care of HIV patients. US studies show there is a need for general practitioners to take over the dayto-day treatment of such patients, and he said this is true for Canada, too. "There are complicated illnesses that crop up and some of the infections and tumours require a lot of specialty involvement", Gilmore said, "but in general I see it as a primary care disease in which patients are followed regularly in a physician's office and where they are looked at as whole patients, and not considered simply in terms of a particular illness or infection." HIV is now regarded as a chronic illness, he said: "It's like looking at somebody with some chronic failure, someone with diabetes, an old person who is wearing down." He thinks the medical

office lends itself more readily to total care of patients than does a hospital. For one thing, confidential issues are a little easier to discuss in the privacy of a doctor's office. Caring for HIV-infected patients can be a lengthy procedure, he pointed out. There can be a 10-year lapse between the start of an infection and the time immune deficiency occurs, and life can go on for years after that. "So, we're talking of a total time of maybe 10 or 12 years", he said. "Now, we don't always see people the minute they're infected. It could be several years down the line because they've been quite healthy, coming in for checkups and being tested." Gilmore said optimistic and pessimistic are not definitive words when dealing with HIV patients - a more appropriate word is realistic. "We say to ourselves, 'this is the information we have and let's get on with it. We have to deal with it'. " Patients must be followed closely from the moment the problem is detected. "If somebody's immune system starts to fall apart, he has to be cared for", Gilmore said. "People may die from their illnesses but we have to manage them all the way to the terminal phase. We watch them carefully, their general and mental health, the social issues and how they're dealing with them."-

Use discretion in treating HIV patients, FPs told.

MEETINGS * RENCONTRES 0~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Use discretion 'in teat'ing HIV patients, FPs told Bill Trent C all the man...
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