CHARTING THE COURSE

Establishing clear goals for each visit you have with a patient-including the baseline evaluation-is an important component of care.

CYNTHIA RIVERA, MD: I’d like to know a little bit more about what your goals are with that initial evaluation.

DERRICK BUTLER, MD: I want to come out of that evaluation with a good portrait of that patient, you know, really understanding all aspects of their life and that individual so that I can then tailor my therapy and my approach to adherence, so understanding how much support that patient is probably going to need, say, from support staff. I’m a big believer in really that first contact with the HIV provider can set that patient up either in, I think, a positive direction toward their journey with HIV treatment or actually can send them–derail them, and they may not come back to care for six months. 

LEANDRO MENA, MD: I’ve seen patients that come to initial visit, they get seen by four or five different people, and they leave because they couldn’t understand what was going on. So as a clinician dedicating enough time and going back to the, not rushing through the visit, and making sure you’re telling, you know, this person is going to see you, this is the reason why, and this is your team. We’re all working together with you to make sure that you do well. 

CYNTHIA RIVERA, MD: It’s important to make the patient feel like this is done in an unhurried setting, that we’re sitting down, we have time to discuss all of these things, make sure that any misunderstandings you may have about treatment or anything you want to clarify, that the patients know where they are in the spectrum, like you mentioned of infection as far as their immune health, their viremia, degree of viremia, low, high, what treatments they’re going to be starting, and any emotional support that needs to be provided for the patient when they’re initially learning about not only an initial diagnosis, but where they fall into the spectrum of immune deficiency with HIV. 

DERRICK BUTLER, MD: Some patients who may have issues with health literacy, I’m going to need to dial down maybe some of the language I’m using or put it in terms that the patient can really understand. 

CYNTHIA RIVERA, MD: So it sounds like you’re assessing what is happening as you’re going through that initial visit and taking them through what is going to be taking place in future visits and what kind of evaluation you need in order to make sure that they’re taken care of properly. We’ve assessed readiness in our patients and not only emotional readiness, but we make sure that our patients understand that they are infected with HIV and they need to be on treatment because not only potential for worsening immune health, but also transmission. And I think at that point, that’s when we discuss regimens. That’s when we really get into, okay, these are the regimens that are available to you, and let’s start you on a regimen that’s tolerable for you, convenient, and make sure that we are also discussing any medications that we need to give depending on the immune health or lack thereof of the patient to prevent opportunistic infections. 

LEANDRO MENA, MD: Yeah, I agree, I think initial visit is a unique moment where you have the opportunity to create a basis for successful therapeutic relationship that is going to last for many months, for many years. It’s a unique opportunity for you to get to know the patient by asking and getting to know them. You know, showing the patient that you care for them. So what do you do to earn that trust is, I think, a key opportunity that you have to take advantage in that initial visit.