Let me just state I have already had three venti-sized skinny vanilla lattes and it is only 11:30am. This morning has been one of those physically rough ones. Woke up early, ahead of my two-day long meeting, to work out. I had even put on my life is good t-shirt. I was sleepy but pumped. I got down to the exercise facility and all the machines were taken. The horror! I was in immediate despair. I had taken recently to working out both in the morning and evening and my primary care doctor had readily endorsed that plan. See, I am in great health apparently (despite my love of sweets, carbs and cheese) and it is namely because I work out A LOT. So, working out is wired in me to combat the sugars and starches that I readily bring into my blood stream.
My sheer panic at not being able to work out and the day-long meeting discussion I’ve been mired in, got me thinking about the role of doctors; especially in light of healthcare reform and the wide use of the internet for health information. In the Latino community, doctors are fairly idolized and treated with much respect. Medical doctors are treated with so much respect, that even beauty products are marketed by having someone in a lab coat pose with them.
There have been many heated discussions (especially in New York) around the concept of Provider Prevails: namely in lay terms that healthcare provider’s informed thoughts and guidance around care and treatment should supersede all political and insurance policies. Nationally, as encouraged by the media, we often get emotionally worked up around this issue. Americans don’t want government interfering with healthcare options, regimens, and plans. By now, we are familiar with those signs from a few years ago that peppered community forums that stated “government keep your hands off of my Medicare.” The joke is that the government is the biggest insurance agent (i.e. Medicare) in this country with a rather large army. Make of that what you will. I think in the abstract sense we can all agree that a doctor’s informed opinion should guide our treatment plans when we are so unfortunate to be ill or have a chronic health condition. But is the doctor always right?
The discussions I was part of today centered around HIV and how treatment is prevention. By making treatment the cornerstone of reaching an AIDS-free generation, we are putting a great onus on healthcare providers, hospitals and clinical settings. HIV/AIDS, over the past 30 years in the United States, has been namely addressed in community settings such as community based organizations (CBOs) who purportedly understand the local community’s needs and motivations. With the looming shifts due to healthcare reform, many wonder about the long-term sustainability of CBOs. But let’s go back to the medical doctor issue.
When we argue that medical doctors should prevail we should always keep in mind the following: Are providers up-to-date on the latest guidelines; what is their belief in the guidelines, how does stigma impact guidance and what is the cultural understanding and comfort with both the ever-shifting population and the specific illness being presented.
How many of you have ever been offered an HIV test by your primary care doctor? How many of you have ever had a doctor follow up with you three months after a diagnosis for which you were given medications, to check in and see how you are adhering to your medication? How many of you have been asked about your eating habits? In Georgia, in a recent survey, local health officials said that they spend a very low amount of time on monitoring the community’s health status. Many doctors will readily admit (well, in an anonymous survey) that they have great discomfort with HIV/AIDS, sex, sexuality, HPV, even cancer. There used to be a time when people were jack of all trades but everything is niched to death now and the medical field consists of one area of specialization after another. The general practitioner, the first line of defense, may not be ready to handle what is to come. I was visiting an organization where we heard the heart-wrenching story of an HIV-positive man living in a rural area. He ended up in a general hospital after suffering through a mild heart attack. But what nearly killed him was their lack of understanding of HIV and how to provide him with medications. They didn’t have an HIV specialist on staff and were trying frantically to call various other hospitals to figure out how to treat him. Thirty years into the HIV/AIDS epidemic and a hospital was totally at a lost as to how to provide him with care because his HIV status was seen as something that deserves specialized attention (which is great to have doctors that deeply understand it) to the point of general practitioners not being able to help. With the healthcare reform changes that will be coming more individuals will be going to community health centers that will quickly have to learn about all these other disease states. Think about it: the healthcare system may not be all that in tune with public health best practices.
So, at this point in my meeting (I have been paying attention, I swear), I have had two bags of chips, gummies, and some peanuts. Not the healthiest day-that’s for sure. Perhaps our nation would be in better health if we didn’t have so many long meetings that we had to find our way through one way or another. In light of healthcare reform, can my general practitioner prescribe an antidote to the long, drawn out meeting; Pretty Please!?!