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January 2010
Building a cooperative
patient/doctor relationship
A positive HIV antibody test or an AIDS diagnosis changes many aspects of a per-
son’s life, including the kind of relationship they have with their doctor. Many peo-
ple develop a more assertive attitude about their health and well-being when they
find out they have HIV. Because HIV disease and its treatment is complicated, mak-
ing decisions about when, how and whether to start therapy isn’t always easy. Choose a
One great step to take is to become an active participant in your health care relationship style
and treatment decisions. This means that both you and your doctor need to learn Choose a relationship style and discuss
how to work and communicate with each other. it with your doctor. People have dif-
This publication’s intention is to help both patient and doctor establish reason- ferent styles of relating to doctors, and
those styles may change at different
able expectations of each other and to set up a climate of cooperation and joint
times or for different illnesses. In the
responsibility for healing. Just as there isn’t a “one size fits all” approach to HIV “traditional” doctor-patient relation-
care, there’s no one doctor-patient relationship that suits everyone. ship, the doctor leads and the patient
follows. For some, this is effective be-
cause they feel secure and cared for.
For the patient ... Others may view their relationship
as more of a partnership, where both
contribute to the decision-making
Share your point of properly monitoring through exams process. Some prefer to make decisions
view with your doctor and lab tests should be routine. In turn, and use a doctor primarily as a consul-
Share your point of view. If something is you should agree to heed reasonable tant. This style requires diplomacy by
or isn’t working for you, it’s important warnings suggested by this process. the patient as many doctors have not
to let your doctor know. Being hon- If you want certain prescriptions, adjusted to the role of consultant.
est about your viewpoint is especially asking in a friendly tone is likely to None of these styles is right or
important if you want to enroll in a work best. If the doctor opposes it, wrong, but they all make different de-
study or use experimental treatments. you’re entitled to know why, in clear mands upon the relationship. It’s im-
Explain why you’re considering a terms. His or her concerns and knowl- portant that you let your doctor know
particular decision and listen to what edge should be given due respect, which style you prefer. As you become
your doctor has to say. Many doctors whether or not you agree with them. more familiar with HIV and
are willing to work with and support
patients who have clearly put some
thought and time into their decisions.
Facing new decisions? Wondering what’s the next step?
Whether or not agreement is
reached on particular treatments, National HIV Treatment Hotline: 1-800-822-7422 (toll-free)
10a–4p, Monday–Friday, Pacific Time
© project inform 1375 Mission Street san francisco, ca 94103-2621 415-558-8669 www.projectinform.org
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toll-free national hiv/aids treatment hotline 1-800-822-7422 local & international 415-558-9051 monday–Friday 10–4 pacific time
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January 2010
Support your patient’s many sides of medical issues that confront patients, and
interests in their health care do not feel insulted if your patient chooses something you
Support your patient’s interest in monitoring and treat- don’t recommend.
ment. While not every treatment is appropriate, every Today, many people take a strong role in the decision-
patient’s opinions and health are. The more uncertainties making process. Of course, that empowerment doesn’t
a given treatment raises, the more important it is that you automatically make your patient right. Doctors should help
monitor its use. Patients may be willing to follow your rec- persuade patients to do what makes sense. Use of well-
ommendations if you’re willing to monitor your patient’s phrased questions, reasoning, shared information, respect
other choices simultaneously. and patience on both sides best achieve mutually satisfying
When someone asks to be monitored in a course of choices.
treatment, it doesn’t imply you agree with it—only support
for your patient’s well-being. There are no legal precedents
Respond medically
in AIDS in which a doctor has been accused of malpractice
for taking blood counts while a patient used a drug against Patients may use a treatment anyway if they’re determined
his or her recommendation. to and you may not be able to sway them against it. Refus-
ing to monitor diminishes your patient’s confidence and
may increase the risk of harm.
Be flexible with your responses Respond in a medical fashion to the uncertainties of un-
Recognize that the uncertainties of the epidemic demand a approved treatments or strategies. Perhaps this means more
flexible response. The expectation that patients will passively frequent visits, other diagnostic tests, or more cautious
follow orders simply doesn’t work with everyone, certainly reading of lab markers. Added expense may be the price
not when doctors may not have answers for every question. and the patient must be prepared to heed the outcome of
HIV has changed forever the way many people relate to the monitoring process.
their doctors. The new assertiveness and knowledge won’t
go away. To cope effectively, doctors must learn how each
Don’t push your patient
person wants to be treated, particularly in regards to degree
and form of collaboration in their healing process. Don’t push patients to begin treatment before s/he is ready
to commit. Starting a regimen is a big step and will change
many things in a patient’s life.
Describe both sides of the issues For example, taking pills every day is a constant remind-
Doctors have always known that there are two or more er of HIV. Disclosure is often an issue: your patient may be
viewpoints on most issues. Be prepared to describe the reluctant to begin therapy that must be taken around their
family or at work.
© project inform 1375 Mission Street san francisco, ca 94103-2621 415-558-8669 www.projectinform.org
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January 2010
However, patients can’t expect their pect patients to “wait and see” indefi- Changing doctors should be reached
doctors to heartily support rem- nitely while the research proceeds. only as a last resort, and only when it’s
edies for which there’s no supporting Sometimes doctors and patients clear that you both cannot accept the
evidence. Nor can patients realisti- must question whether it’s possible other’s part in the relationship. Each
cally expect their doctors to give the to continue their relationship. It’s of us must ultimately find the combi-
same credence to highly experimental possible to maintain the relationship nation of patient + doctor + approach
drugs as they would to better proven while disagreeing and continuing to that makes a cooperative relationship
therapies. And doctors shouldn’t ex- communicate over the differences. possible.
toll-free national hiv/aids treatment hotline 1-800-822-7422 local & international 415-558-9051 monday–Friday 10–4 pacific time