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Primary Care of Patients With Human Immunodeficiency Virus InfectionThe Physician's Perspective
Ronald M. Epstein, MD;
Michael Christie, MD;
Richard Frankel, PhD;
Sally Rousseau, MA;
Cleveland Shields, PhD;
Geoffrey Williams, MD;
Anthony L. Suchman, MD
Arch Fam Med. 1993;2(2):159-167.
Abstract
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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.
Author Affiliations
From the Departments of Family Medicine (Drs Epstein, Christie, and Shields and Ms Rousseau), Internal Medicine (Drs Frankel, Williams, and Suchman), Psychiatry (Drs Epstein, Shields, and Suchman), and Psychology (Dr Williams), Highland Hospital, Rochester, NY; The Program for Biopsychosocial Studies (Drs Epstein, Christie, Frankel, Shields, Williams, and Suchman, and Ms Rousseau); and University of Rochester (NY) School of Medicine (Drs Epstein, Christie, Frankel, Shields, Williams, and Suchman, and Ms Rousseau).
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