Erasing stigma...

Posted by Kristen Gardner at Friday, June 29, 2012

I just finished week 1 of my "Community" rotation. I am at a Walgreens Pharmacy located within the Howard Brown Medical Center (HBMC) for most of the week except when we travel to Mercy Hospital for the afternoon shift on Tuesdays and Fridays aka our clinic days. The HBMC provides healthcare to lesbian, gay, bisexual, transgendered, and queer clients many of whom have HIV/AIDS but not all. On the other hand, we only see patients with HIV/AIDS at the clinic.

I was asked a question the other day about my rotation experience. "Does your rotation make you sad?" My gut instinct was no, but I questioned the appropriateness of this. I was quickly reminded of an interaction my rotation buddy had with a patient and his family member. The patient's mother was frustrated because a clinician said, "I am sorry you have to come here for your care." Although slightly different, I believe the principle of both situations is similar. Patients, especially with illnesses that are stigmatized such as mental illness and HIV/AIDS, do not want your sympathy if there is no reason for it beyond the diagnosis. They simply want respect from healthcare providers and a promise to manage their illness just as you would someone with any other medical condition. Expressing sympathy, especially in populations previously described where the patient is clinically stable and healthy, could make the patient question if they should feel ashamed and further stigmatizes these conditions. Also, this mindset may potentially prevent patients from attending follow-up appointments.

On another note: I am enjoying this rotation for multiple reasons!

1) I am provided with the opportunity to counsel patients ALL THE TIME through new to therapy calls, new medication counseling, and opportunities at the clinic when the team decides to switch or intensify therapy due to suboptimal virologic response (HIV RNA either not dropping by 1 log in 4 weeks after ART initiated or the viral load has increased after virologic response (HIV RNA < 200) was previously achieved with ART.

2) I learn interesting things from this patient population such as there is a market to sell hormones on the street (and I only thought we needed to worry about illicit street drugs and prescription pain killers!)

3) how to approach a counseling scenario with a transgendered patient when you are unsure of their "preferred" name

4) I feel more comfortable with the fact that I have taken an Oath and follow a Code of Ethics where I care for patients regardless of whether or not I agree with decisions they have made.

I am posting links to the Oath of a Pharmacist and the American Pharmacists Association Code of Ethics because a little reminder never hurts!

I will be continuing to slowly read throughout the 240 page guidelines for HIV/AIDS until my next post.... :)