HIV infection directly or indirectly affects virtually every organ of the body, and no physician, regardless of training, can alone treat all the conditions associated with HIV infection. As a result, people with HIV infection, especially people with AIDS, are likely to be referred to such specialists as neurologists, psychiatrists, oncologists, gastroenterologists, ophthalmologists, dermatologists, and pulmonary specialists. Referrals to such specialists almost always come from the primary care physician or the AIDS physician. These physicians will select specialists based on the reputation of the specialist within the medical community, on their previous interactions with the specialist, and on the specialist’s specific interest or expertise in AIDS.
Choosing a Physician-What is the best way for someone with HIV infection to go about selecting a physician? Begin by asking your primary care physician if he or she feels comfortable caring for a person with HIV infection. If not, ask for an appropriate referral: the medical community has an effective communication network, and your physician will either know or can easily find out who has a good reputation within the profession for the care of people with HIV infection. Physicians are the best source of advice about other physicians.
If you do not already have a primary care physician, another source of information is by word of mouth from other people with HIV infection, although some caution is called for here: watch out for people who confuse medical competence with a good bedside manner. What impresses patients and what impresses physicians are often quite different, and your highest priority is competent and comprehensive care.
Other sources are AIDS hotlines, community organizations devoted to AIDS, nurses, and the centers that run tests for antibodies to HIV. The yellow pages may have listings for physicians with a special interest in AIDS, but the relevant listings are more likely to be of physicians
specializing in infectious diseases. You can then contact the infectious disease specialists directly and ask for either an appointment or a referral; they will know well the available local resources for treating HIV infection. City, county, and state medical societies often have lists of physicians with specialized interests; however, these lists may reflect those who have paid their dues and need the patients, rather than those who offer high-quality services.
In general, to choose a physician, ask another physician, check certification, be cautious about a physician who advertises medical services, find out his or her reputation among their peers, and look for a physician who has privileges to admit patients to a good hospital. Hospitals review physicians carefully before allowing them the privilege of admitting patients, and hospitals of good quality will accept only reputable physicians.
Some people with HIV infection select an AIDS physician for conditions related to HIV infection, and continue to see their primary care physicians for all other conditions. To repeat, primary care physicians are increasingly treating people with HIV infection during the earlier stages and calling in infectious disease specialists or AIDS physicians when treatment becomes more complicated or specialized. Either plan for medical care is appropriate.
Regardless of what kind of physician you see or where you live, if you have questions about your medical care, you can ask for a second opinion or get a consultation with another physician. That is, you can go to another physician or clinic that specializes in the treatment of AIDS and ask to have the program of your medical care reviewed. To have the program reviewed thoroughly, you need to bring (or send) copies of all your hospital records and your physician’s office records. These records will include the results of x-rays, scans, biopsies, and any other tests, plus the diagnoses and treatments. This not only simplifies the consultation but prevents unnecessary duplication of visits or tests.
You need not worry that you will offend your own physician by asking for such a consultation. In normal medical practice, second opinions are often encouraged and, for many procedures, are sometimes required. Moreover, given the seriousness of HIV infection and the speed with which recommendations for treatment change, second opinions are often considered a very good idea.