How to Find a Doctor: Advanced

This is the second part of our Piece on How to Find a Doctor. It mainly addresses concerns and issues of those living with HIV but we also discuss bigger issues like privacy, types of medical providers, ending a relationship with a provider…and more.

Again, we can’t tell you what type of doctor you need, we can only give you guidance. And remember, as a gay male, you always have the right to change your mind.

Let’s begin,

I’m HIV+, what about me?

For the average gay male, HIV is the greatest reason he seeks regular medical care. When you factor in testing, every sexually active gay man has HIV on the brain when he sees a doctor. The honest truth is that we’re all effected/affected/infected by HIV. But if you know you have HIV, finding the right and proper medical provider is truly the difference between life and death. Far too often, guys go untested and untreated for this manageable illness but claim “negative” status for various reasons, including stigma. But this is the point when you do some soul searching and get your shit together. Real talk. A major hospital in Atlanta alone is reporting 50% of HIV cases are also AIDS cases. As a community we have to start getting right with this illness, and that begins with testing but if you are infected your doctor and pharmacists need to be your bffs.

red ribbonGMJ has created a few Pieces on HIV, where we go deep into the woods to help you understand this illness, including this one called HIV 101. But, in this section we just want to focus on how to find a doctor and pharmacy and any other medical providers you may need.

HIV rarely travels alone. This means you may be co-infected with another STD like herpes. Finding a doctor that is able to not only work with you regarding HIV but also able to assist in other STDs and medical issues should be a priority. HIV is also shown to age the body, inside and out, so you need a doctor that can help you with side effects from the illness and the medications.

Speaking of medications, it’s not uncommon for guys to change meds over the course of their life for various reasons. Poz guys need doctors that are up-to-date on the latest and best medications but also able to assist in deciding which is right for them. Once you move away from the basics, how your doctor talks and treats you is important. From terminology to expectations, you must decide for your self where your comfort level begins and ends.

Maintaining your medication regiment is key to getting to undetectable but also for your overall health. Your doctor should be an ally not adversary in reaching your goals.

Ok, I get it. Now just tell me how to find a doctor

Let’s begin to agree on a few important facts about doctors and your health. Doctors, Nurses, and Physicians Assistants are human beings just like you and me. They aren’t all knowing, imperfect, or godly. They make mistakes, have biases and may even discriminate against active and potential patients.

Secondly, the practice of medicine is a science, but it is far from exact and we, as members of the human race, are still learning so much everyday about our bodies, how they work and what medications should/shouldn’t be used.

Mental health issues, including depression, loneliness, and isolation are common with Poz guys but also undiagnosed within the general gay male community, so look for a provider that is knowledgeable about these facts, can diagnose and prescribe medication as necessary, but a separate Therapist/Psychiatrist may be necessary.

We’re all wrapped in skin. For some Poz guys, the illness or medications can cause skin irritations. You may need a Dermatologist as part of your team.

Proper dental care is important, so get in that dental chair at least twice yearly!

The older sets of medications have been known to create long term damage to the body, your doctor and pharmacist are great resources in combating this issue. This should include medical care and treatment but also healthy ways to replenish vital nutrients and vitamins the meds deplete.

Beauty may be in the eyes of the beholder but your self-esteem may be related to some long term side effects. Your primary physician may recommend some products and services available to you, as well as dermatologists to assist with facial wasting and body fat redistribution.

Not all Poz guys are the same. Different backgrounds make for different people. Find a doctor that sees you as an individual not an illness.

Finally, your health is YOUR PERSONAL RESPONSIBILITY! From what you eat, how you exercise, your sexual life, mental health screenings and dental care, think of your body like a car. The better maintained, the better it will perform for you. Your mechanic, in this case doctor, cannot do the work for you. You must own this responsibility. So when choosing a medical team, it is in your best interest to think of yourself as the lead member. You’ll make all of the final decisions, because if something goes wrong, you are the one that will bear the consequences. And please remember, it’s not the age, but the milage that counts.

Types of medical providers

We can break down the most common types of medical providers into three categories. Which one you choose should be based on your lifestyle, location, knowledge of gay male health and any other heath issues you might have. Personal preference is the name of the game. But remember, one of your rights as a gay male, is to change your mind. Any choice you make can be changed whenever you want.

Traditional doctors office
This is what most of us are familiar with. White coat, waiting room with outdated magazines, nurses calling you to be weighed, ending at the front desk…and a co-pay. Depending on where you live, there are many of these type that are either gay practitioners, or gay friendly. These smaller offices are known for intimate care and a desire for long-lasting relationships.

Clinics
Many large cities have created government controlled and operated health clinics, which primarily assist the poor, uninsured or a specific demographic, like gay males. Depending on where you live, you may have many options. For example, cities like New York and Philadelphia have healthcare clinics located all around and in various neighborhoods.

Non-profit medical centers
These come in two groupings, but both are very similar, with a few exceptions.

1. LGBTQIA non-profits, which operate healthcare centers. These are usually all encompassing providers with access to medical doctors as well as dentists and even therapists. Some go deeper and provide non-traditional services such as yoga, meditation, group meetings, alcohol and drug counseling and even drop-in centers with computer access.

2. Hospitals In many midsize and large cities, hospitals have learned to adapt to the needs of their community and provide medical centers, inside of the hospital, with many of the benefits of LGBTQIA facilities ,but are usually, but not always, geared towards those who are HIV positive and their partners. If you aren’t HIV positive, there are still some hospital clinics which will provide you with the care you seek, but you must do your homework regarding their gay friendliness and knowledge. Hospital medical centers are also one of the larger providers as they can handle substantive medical issues such as surgeries and in-patient mental health treatment programs.

We cannot tell you which one to choose, as they all have their own separate pros and cons and vary from not only state to state, city to city but also from doctor to doctor. This is why factoring in your personal comfort and knowledge is key.

This is also a good news, bad news, worse news scenario.

The Good News

Within the last generation, there’ve been great strides in everything from medical knowledge of the human body, access to primary care, The Affordable Care Act and even a greater level of social acceptability of gays and civil rights. As our community is seen more as “average” than abnormal, our health issues are becoming more of a central focus, and not just about HIV/AIDS. Thankfully, this particular healthcare issue has seen its own positive changes with medication, treatment and prevention options such as PrEP/PEP, and is no longer a guaranteed death sentence.

We also, as a society, have greater access to information from not only the United States, but the entire world, and modern history. This affords us the ability to compare and contrast information and studies from one country to another. Or in the case of gay males, review studies about our bodies and health, which haven’t been conducted in our home country.

The Bad News

medicationEven though HIV/AIDS treatments have come a long way, access to these medications, knowledge of what they do and don’t do remains a part of social debate and criticism. HIV stigma is still a major issue facing those who are positive within our community but also within the medical profession. And if that wasn’t bad enough, every other STD is on the rise as well. From herpes and syphilis to HPV, gay male sexual practices haven’t altered enough to stem the tide.

A full generation and a half have grown up with the central concept of condoms only, fear and sex-shaming. None of which have worked in reducing the number of HIV infections, hovering around 50,000 yearly, or any other STD for that matter. But it’s still considered the standard message for gay males in the United States.

Along with this, the marriage equality debate took a lot of attention away from HIV/AIDS healthcare and gay male healthcare in general, as a new generation of guys became sexually active, but not sexually aware and educated. Some considered new medications to be an excuse to engage in risky behaviors, as others couldn’t wait to play the blame game and throw around terms like “irresponsible” and “this is because they didn’t live through the deaths of the AIDS crisis”.

The Worse News

Not only has the national focus shifted from addressing HIV, we also live in a culture which doesn’t teach gay males sexual education or discuss the other medical issues gay males have, such as prostate, anal and testicular cancer. Mental heath concerns loom large for gay males and drug/alcohol usage are almost mainstays of our community. Added to that is the high rate of homophobia and racism within the medical field married with a lack of knowledge about our bodies and health concerns. A 2014 released study from the Black AIDS Institute, shows just how lacking in knowledge many of our primary care providers are.

Finally, there is the major issue of social media and peer pressure. Because we gays love our Internet, we post and comment on many healthcare issues, without actual facts or knowledge. There’s a great amount of “I know a guy, who knows a guy, and this is what happened to him”, or “ you should do what I say you should do even though I’m not a doctor, healthcare professional or friend”. These posts in comment sections across the country detract from the actual scientific progress we’ve made, while also shaming the decisions that guys want to make for themselves. So called slut shaming, Truvada whore, barebacker and interviews/statements from gay celebrities about healthcare, without any professional knowledge keeps us in the dark, increases fear but also cause eventual health concerns. This is coupled with the outrageous amount of poz-phobia littered among gay dating profile sites. In short many of us, are our brothers’ worst enemies.

When choosing a medical team, you should keep all of this information in mind and make these decisions before you find yourself scrambling for a doctor.

What resources are there to assist me in finding a doctor?

Many cities have gay publications, newspapers and so-called “fag rags” which have listings for gay owned, operated or friendly physicians. The larger the city, the more providers you will find. There are a few large, glossy magazines which cater to the LGBTQIA community that also have adverts in the back, and are very handy in helping you find offices that, at the very least, want your pink dollars.

A secondary option is your local Gay/Lesbian Center. If you have one in your area, they might have providers on sight or can provide a list of doctors that they recommend for their clients. If you’re able to speak to someone face-to-face, this would be a great opportunity to ask them for some specific recommendations, as they may have experiences with some over others.

A surprising resource is your local pharmacist. They deal with doctors everyday. If you have a gay area or one that is known to deal with the gay community, ask him/her who they might recommend. Pharmacists are the silent backbone of the medical community and are adapt at everything from medication to insurance, so make sure that they are part of your team.

Friends, and loved ones are also another great option. Everyone knows someone that has a great doctor that they just wont shut up about. Ask some basic questions and begin making appointments. Remember to shop around and pick the one that makes you feel the most comfortable. And don’t be afraid of offending the person who recommend them, if you find that he/she is not a good fit for your needs. This is about you, not them.

Finally, there is the Internet. This is our modern day phone book, and many practitioners that cater to our community are more than willing to let it be known on the web.

What’s New at the Zoo?

Modern technology hasn’t left the doctor’s office behind. From patient log-in portals, which allow users to access their medical records, to e-scripts, which are sent from the provider directly to the pharmacist, new innovations are happening everyday.

One of the largest, and one you should ask about when screening doctor’s, is about medical record sharing databases. This allows all of your doctors to access your complete medical record. For example, your dentist doesn’t have to ask you which medications you are on because it is all linked within your e-file. This new technology helps when you have multiple providers in one office, and don’t want mistakes or misinformation regarding prescriptions or medical symptoms. Also, its great not having to repeat yourself every time you see a provider.

Not all offices have these innovations yet, but many states, like New York are creating data bases to be shared across provider networks. We at GMJ support anything that makes the trip to the doctor easier and more convenient.

When its time to break-up with your doctor

Many of us have already been there. Many more of you will join this sad hearts club. At first everything was great but then something changed. He/she is not as attentive as they were at the beginning. It’s difficult to get them on the phone, or they never seem to have as much time for you. Maybe your actual doctor left the practice, new polices were implemented, the front desk staff became rude or inattentive, maybe you just raised your standards, but either way…it is time to go. There are 50 ways to leave your lover, and all of them are options for leaving a doctor, but here are a few tips.

• This was still a relationship. Remember that. And just like the ex you see walking down the street, you might run into your former doctor again. He/she might even join the new practice you attend. So leave like a gentleman. Explain what your concerns are and part on a positive note.

• Once you’ve found a new medical provider, ask to have your medical records sent over to the new office. Many will do this free of charge, others might charge up to $1 a page. Ask about pricing before hand, and if you could have a copy free of charge to take with you.

• Don’t second guess yourself. Just like finding a doctor took work and effort, leaving should be done in the same manner. Don’t make a hasty move. Be sure it’s the right one for you at the right time. If you’ve done this, don’t look back. Move forward and enjoy the new facilities that you deserve.

• Don’t publicly bad mouth your old doctors’ office. The medical community is very small, physicians attend conferences together and move around a lot, so take care. We’ve all heard the stories about people being black balled.

• Finally, remember that not only was this a healthcare decision, it was also a business one. Check all of your records, and co-pays. Don’t leave with debt and make sure you say “thank you” as you close the door behind you, because you never know when, where or how you might meet those people in the future.

Your Medical Records, Privacy and HIPAA Laws

HIPAA, which stands for the American Health Insurance Portability and Accountability Act of 1996 is a Federally established series of rules and regulations which regulate your personal privacy rights as they relate to your healthcare and medical information. This basically means that you have rights about who see’s, knows and is able to receive or share information about your healthcare, illnesses and insurance information. These rights even extend to your ability to have access to view and copy your personal medical files. People with HIV are also given further protections under the Americans with Disabilities Act, which we cover in our HIV/AIDS Primer.

Because we are based out of New York, we have placed a link below to the Western New York Law Center page on this topic, which has done a great job of breaking down HIPAA and answering many, if not most of the questions you might ask. The information provided is basically the same from state to state, as this is a Federal Law, but some states have increased provisions for your protection. We advise doing a search for your state’s HIPAA law structure to be sure of your rights and protections.
HIPPA 101
HIPPA from the U.S. Department of Health and Human Services

Hopefully you found this Piece to be a good start to building your medical team. One last thing to remember is that no matter what anyone tells you, you have options. Don’t get bullied into being somewhere that isn’t treating you as special as you are. You deserve better. This includes getting a second opinion on any surgeries or other major medical events. Your life might just depend on it.