BUILDING THE BEST RELATIONSHIP WITH YOUR CLINIC/HEALTH CARE PROVIDERS 1

The healthcare team 2

How important is a good relationship with your health care team? Think of it like buying a pair of shoes for a long journey! Response to ART depends on:  access to HIV testing and ART [1]  your adherence to ART [1]  how you use your clinic [1] Your relationship with your clinic affects how likely you are to take up an offer to start ART [2,3] 3 [1] Expert Opinion of author Robert Fieldhouse as well as the BEST Advisory Board and Review Committee; agreed on 24th September 2009 [2] Misener et al, West J Nurs Res1998;20: [3] Maisels et al, AIDS Patient Care STDS 2001;15(4):

How do I build the best relationship? A positive experience and good outcomes in clinic may be affected by the relationship you have with your health care workers Information is the key to this exchange:  Information that you provide  Information that the health care worker provides If you feel comfortable with your health care provider you are more likely to describe your situation better 4 Expert Opinion of author Robert Fieldhouse as well as the BEST Advisory Board and Review Committee; agreed on 24th September 2009

A good health care worker will… Listen, provide you a range of opinions and explain things to you Receiving advice, reassurance, information and support from your health care worker in a non- judgmental way can have a significant impact on your quality of life, satisfaction of health care and increase ART adherence [1] 5 [1] Ong L et al. Soc Sci Med 1995;40(7):

Let’s think about different consultation styles “What do you reckon, doc?” 6

If you are in the driving seat… “You’re paid to do what I tell you!” 7

If doctor knows best… “How many times do I have to tell you to lose weight?” 8

If doctor knows best… Historically, in many societies, the doctor takes on the role of the ‘parent’ You are likely to assume a more submissive role The doctor is the ‘expert’ and you are ‘expected to co-operate’ The encounter is controlled as an interview to reach a diagnosis 9 Expert Opinion of author Robert Fieldhouse as well as the BEST Advisory Board and Review Committee; agreed on 24th September 2009

In a person-centred consultation You are encouraged to air your own feelings and concerns, enabling active participation in decision making [1] The health care worker uses open-ended questions to encourage discussion [2] You are able to access a number of experts [2] You can challenge your clinic if it becomes an issue that you see a different doctor every visit [2] You and the health care worker recognise that HIV is more than just an illness; it impacts on family, friends, work, sexual and social life [2] [1] Little P et al. BMJ 2001;323:908–911 [2] Expert Opinion of author Robert Fieldhouse as well as the BEST Advisory Board and Review Committee; agreed on 24th September

Shifting the balance of power HIV changed the way that doctors and people living with a chronic illness interacted [1] 1983 Denver Principles – empowered the person living with disease [2] Activist-doctors Activist people with chronic disease [1] Better informed people do better, visit the doctor less and make health care more cost-effective [3] 11 [1] Expert Opinion of author Brian West as well as the BEST Advisory Board and Review Committee; agreed on 24th September 2009 [2] Denver Principles Project. See Accessed May 2014http:// [3] Bodenheimer T et al. JAMA 2002;288(15):

Partnership is the key Help your health care workers to give you the best service Clinics are busy, doctors are human beings too 12

What affects our ability to influence a medical consultation? Our sex/gender [1] Our social and educational achievement level [2] Whether we belong to an ethnic minority [3] If we do not share a native language [3] Our sexual orientation/identity (LGBT) [4] If we simply don’t know the questions to ask… 13 [1] Shiels C et al. Fam Pract2006;23(2): [2] Baker D W et al. Am J Public Health 1997;87(6): [3] Ferguson W J et al. Fam Med 2002;34(5): [4] Feldman, M D & Christensen J F (1998)Lesbian, Gay, Bisexual and Transgender (LGBT) Patients in Behavioural Medicine in Primary Care: A Practical Guide pp. 122

What can I do to make the most of my appointment? Be prepared!  Get advice from a community treatment information provider  Don’t miss your hospital appointments  Make a list of top 3 questions  Ask for your blood results in advance  Make notes during your consultation  Speak to the nurse/pharmacist if you are uncertain about anything  Doctors work under huge pressure, do your bit to be organised  Ask the clinic for tips on how best to be prepared 14 Expert Opinion of author Robert Fieldhouse as well as the BEST Advisory Board and Review Committee; agreed on 24th September 2009

What if I don’t have a good relationship with my health care team? Find a health care worker who understands you Change your doctor Make a complaint As a last resort, consider changing clinic 15 Expert Opinion of author Robert Fieldhouse as well as the BEST Advisory Board and Review Committee; agreed on 24th September 2009

Using other health care workers You may need to use other health care workers including dentists [1] In some countries people living with HIV are treated by Primary Care Doctors who are skilled in multiple diseases [2] Community-based organisations may help you find a HIV-aware Primary Care Doctor or an HIV-friendly dentist who can support the care you receive from your HIV specialist [1] 16 [1] Expert Opinion of author Robert Fieldhouse as well as the BEST Advisory Board and Review Committee; agreed on 24th September 2009 [2] Madge S et al. HIV in Primary Care brochure. Medical Foundation for AIDS and Sexual Health 2005