Primary care of patients with human immunodeficiency virus infection. The physician's perspective
R. M. Epstein, M. Christie, R. Frankel, S. Rousseau, C. Shields, G. Williams and A. L. Suchman
Department of Family Medicine, Highland Hospital, Rochester, NY.
OBJECTIVE: To examine physicians' perceptions, motivations, and influences
on their willingness to care for patients with human immunodeficiency virus
(HIV). DESIGN: Interviews with 30 physicians. Qualitative content and
narrative analyses were performed. SETTINGS: Community-based primary care
practices in six moderate-sized cities in the northeastern United States
with at least a moderate incidence or prevalence of reported acquired
immunodeficiency syndrome cases. PARTICIPANTS: Thirty community-based
primary care physicians who had cared for at least two patients with HIV
during the previous 2 years. MAIN OUTCOME MEASURE: Qualitative study
designed to provide rich descriptive data. RESULTS: Care of patients with
HIV was regarded as part of the scope of primary care, and was perceived to
be similar to the care of patients with other chronic illnesses. Many
physicians were motivated by personal rewards in taking care of patients,
intellectual challenge, and desire to serve the underserved. Most believed
that practicing physicians have an ethical obligation to care for all
patients, regardless of diagnosis. No one "type" of physician could be
identified who provides care to patients with HIV. CONCLUSIONS: Primary
care physicians can apply their skills in the management of other chronic
diseases to the care of patients with HIV. Practicing physicians can find
caring for patients with HIV rewarding, stimulating, and enjoyable.
Educational programs for physicians need to emphasize psychosocial aspects
of HIV care. In addition, physicians need opportunities to recognize and
deal effectively with their own emotional responses to the care of patients
with HIV.
