Sunday, March 17, 2013

Email 286: On Choosing a Private HIV Doctor


Dear Pozzie Pinoy:

 I was diagnosed positive in November 2012. Since then I’ve been striving to co-exist with the virus. There have been bad days and good days: bad when I obsess about how the diagnosis would affect and limit my life; good whenever I don’t think about it and live life normally. It’s also good whenever I realize how precious life is because of my diagnosis.

 Your blog has helped me keep going. It is a reminder that I am not alone with this virus, in this challenge. Thank you.

I am not on ARVs yet although my CD4 count at the time my baseline was counted (also in November) was in the neighborhood of 390. I’m keeping my fingers crossed it hasn’t gone down in the meantime, although with the stress given by the diagnosis and work, I’m also being realistic: I may have to start ARVs  by my next CD4 test, which is in May this year. Hopefully, the ARVs and their side-effects will not be so bad and I can live a relatively normal life. My worst fear is having to quit my job, or getting fired, because of the side-effects. 

 My question is about getting a private doctor. I am confident we have excellent HIV/AIDS doctors, our own doctors who are knowledgeable of the realities of the Filipino positive, who are aware of the drugs we have available. Because let’s face it, as we are a developing country we don’t get the advanced ARVs  available in the wealthier countries,  which have minimal side effects. I heard from a Filipino doctor practicing in the US that our first-line ARVs here are their fourth-line ARVs. 

 But going back to my original question. Pozzie, I plan to get a private doctor, with RITM as my hub. My dilemma right now is choosing the right one.

 I understand that choosing the right private doctor is very critical. I need a doctor I can trust, who will be respectful of my need for privacy. I want a doctor who’s sympathetic to their patients, knows how to communicate well, will listen and will have time for me when needed. I need a doctor who’s not exhausted with having so many HIV+ patients that he or she treat us as just bodies in a factory line up.  

 I need a doctor I can be on friendly terms with, or at least relate to. Because he or she will have to help keep my spirits up for my adherence. Because our relationship will be for life.  
I called the clinic of one HIV/AIDS specialist who’s connected with the RITM; however, I was told that before I could schedule an appointment, the clinic would have to get my files from the RITM. Actually, this doctor is preferable because she has a clinic somewhere in Quezon City that's a stone's throw away from me. But my concern is, I’m not even sure at this point if I would get her as my private doctor. I need to talk to her first so I get a feel of what it would be like to have her as a private doctor. I need to know first if we would be a good fit, if we would make a good team.

 I need your advise. I plan kasi to meet as many HIV/AIDS doctors that people recommend and then choose from them--is this doable? Is it ok  to schedule separate appointments with the doctors without them getting my records from the RITM? Nakakahiya kasi kung palipat-lipat ang records ko while I'm still in the process of choosing. 

 I would also appreciate it so much if you could privately recommend some doctors.
Thank you so much, Pozzie, and more power, and may God bless us all.


XXX




POZZIEPINOY’S RESPONSE


Hi XXX.

Thank you for your email. Thank you also for the kind words about the blog. I am glad that somehow you are being helped by it and is reminding you that you are not alone with your struggle with HIV.

Let me respond to your concerns in the order that you asked them.

First, I am glad that you are not on ARV's yet. Although your CD4 is still above the cut off, you can still boost up your immune system and increase your CD4. You can read these blog entries below:


Second, about your concern about the side effects. Although some PLHIV's have reactions to ARV's, some don't. Some have mild to very minimal while others do have serious side effects. However, the good HIV doctors in the country know what to do so don't worry too much. Just prepare yourself and just remind yourself to always listen to what the doctors tell you to do. 

Third, you won't get fired and you don't have to quit because of your side effects. Not unless of course you are a public figure that your job requires you to be on tip top shape or have a beautiful skin for you to do your job. You can take a few weeks off if you want until your body is stable enough for you to go back to work. Some PLHIV's still continued their jobs even with side effects. Some PLHIV's cover their rashes with long sleeves or even make up, so it is really up to you how you can manage the side effects.

Fourth, our ARV's still belong to the first 2 lines of treatment like in all the other countries in the world. The only difference is one, that we are getting the generics brand which is cheaper than those from the 1st world countries; second, we are not getting the all in one pill which of course is so expensive, instead we are still prescribed with 3 separate pills for our cocktail and third, not all ARV's are available in the hubs. But our medicines are still the same in function like those in the rest of the world. We just don't have other options, as the others are expensive and that the ARV's are not available in the pharmacies. Also, what we don't have here is the 3rd line regimen so our doctors are only prescribing up to the second line of treatment. We all should be thankful as we are getting free medicines from the Global Fund. Imagine the ARV's cost, around $2000 per month if we are going to purchase them on our own. Can we all afford around P80,000 every month for the rest of our lives? 

Fifth, if you plan to get a private doctor and you plan to stay in RITM-ARG as your hub, make sure that your doctor is affiliated with the hub or else they won't allow you to get your medicines there. 

Let me now dissect your concerns with the HIV doctors.

1. I agree with you that in the government HIV/AIDS Treatment hubs, the doctors may be exhausted with a lot of patients and you may feel that you are in a factory line. However, let me tell you that if an HIV doctor has a lot of HIV patients. I am pretty sure that he or she will have the BETTER experience that an HIV doctor with less patients. I used to have another private doctor when I first got diagnosed. However, because of limited exposure to HIV patients, I wasn't given the proper advice so I switched to an HIV doctor who belongs to a hub. You can check out my story in:


The HIV doctors in the hubs may get tired because of the long lines of patients everyday, but I still do believe that they are the best ones who can tackle all your concerns. One tip though whenever you have consultation with a hub doctor, list down all the things that you want to ask so that they can be addressed by the doctors.

2. Of course if you would want to have a private doctor, you will need to pull out all your records from the treatment hub, unless of course you have copies of all your lab tests. I for one, ask the hub for my own copy for my own record so in case I want to switch to another hub, then I don't have to produce the original ones from my previous hub.

3. I agree with you that your private doctor should be:
    a. empathic and friendly
    b. has a clinic near you
    c. readily accessible
    d. a good motivator and counsellor

4.  I do believe that all HIV doctors in the country are good but of course, it is up to you to choose the best if you want a private doctor. Since you are in the scouting stage, try calling each hub and get recommendations. You can set up appointments and get the feel of each doctor.

However, if your CD4 is maintained at 390 or gets higher in May for your 2nd series of labs, in my honest opinion, just stick to your hub doctor for the meantime as one, you don't have to spend anything for consultation fees and second, I know he or she will just tell you to just stay healthy, avoid infections, take vaccinations and vitamins and have a normal lifestyle.

I hope I was able to answer your concerns. Feel free to email me again if you have other questions.


Stay healthy,
Pozziepinoy




"WE ARE ALL IN THIS TOGETHER.
NO PLHIV is alone with his or her struggle with HIV!"

-Pozziepinoy-



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