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Is Experience With Human Immunodeficiency Virus Disease Related to Clinical Practice?
Arch Fam Med. 1999;8:509.
This article is rich in points about family physicians and how they function with new, uncommon diseases and the provision of patient care access. In keeping with the stated philosophy of family physicians, the physicians in this study with lower knowledge of human immunodeficiency virus (HIV) treatment recognized they were uncomfortable treating patients with HIV and wanted consultative help. Having 4 patients with HIV in the last 6 months, a number many may consider small, was sufficient to have more knowledge and confidence (we learn from and about our patients). This is consistent with findings in a different study where urban physicians were classified as having least, moderate, or most experience with acquired immunodeficiency syndrome (AIDS).1 For that study, little residency training but more than 5 patients with AIDS or much residency training but 2 to 5 patients was classified as most experience; the patients of physicians with most experience had a lower mortality rate. Thus it would appear that 4 to 5 patients is sufficient to increase confidence, competence, and outcomes in the care of patients with HIV or AIDS.
The relatively low numbers needed to improve outcomes should not be unexpected. There should be some cross-competence, ie, many aspects of HIV disease are similar to other problems. For example, antibiotics used for many of the problems in HIV disease are used to treat other problems seen by family physicians. Family physicians may readily recognize thrush, having seen it in infants many times. On the other hand, there are many aspects of HIV disease that are currently relatively unique, such as the use of viral titers, but learnable. Family physicians may also have trouble recognizing Kaposi sarcoma, which they are unlikely to have seen firsthand, but should recognize the need to perform a biopsy of the lesions.
It is also reassuring that some of the physicians were undertaking special effort to be able to provide care for these patients and were getting referrals from other family physicians with less knowledge and confidence. Family physician–to–family physician referral is common within family physician groups, and can be helpful between practices, particularly in rural areas where access for patients to care from specialists may not be readily available. However, there will always be patients who do not have access, refuse to go to other physicians, deny their illness, or do not wish to be treated for their illness; thus, there will always be some patients seeing physicians with low volume and low confidence. These physicians need support.
Without a planned, rational health care system, family physicians both recognize their limitations and are working to provide quality care for their patients with HIV.
Marjorie A. Bowman, MD, MPA
Editor
REFERENCES
1. Kitahata MM, Koepsell TD, Deyo RA, Maxwell CL, et al. Physicians' experience with the acquired immunodeficiency syndrome as a factor in patients' survival. N Engl J Med. 1996;334:701-706.
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