We’re all on the same side’: relationships between general practitioners and their patients and peers in HIV medicine

HIV Australia | Vol. 12 No. 1 | March 2014

By Christy Newman Asha Persson, John de Wit and Michael Kidd

Christy Newman, Asha Persson, John de Wit and Michael Kidd examine relationships between general practitioners and their patients and peers in HIV medicine

Over the last few years, our research team travelled around Australia to interview general practitioners (GPs) about their experiences in providing care to people with HIV. We published a number of articles exploring the motivations of GPs to become and stay involved in this field, whether in providing general health care to people with HIV, or pursuing additional training and accreditation to prescribe HIV medications. ¹

Throughout these interviews, we heard first-hand accounts of how meaningful these GPs found it to play a role in managing the health of patients with HIV. This was not only due to the intellectual challenges of HIV medicine, or the professional opportunities of developing a special interest in HIV and sexual health. Again and again, and across a diversity of geographic settings, GPs told us it was the relationships they had formed over time with both patients and peers that made this a rewarding field of clinical practice.

In this article, we’ve reproduced some of the quotes on relationships that we have published in the peer reviewed literature (with full references at the end if you’d like to read more). This is organised this into two main sections, to capture the meanings ascribed to relationships between GPs and their patients, and between GPs and their peers.

Relationships with patients

In the ‘early years’ of the HIV epidemic, GPs witnessed the deaths of sometimes very high numbers of patients, as well as friends and colleagues, through AIDS-related illnesses. One of the strategies GPs identified as helping them remain involved in providing HIV care through and beyond those years was to draw strength from their relationships with patients:

What’s actually kept me here, it’s the patients … True, I have my life outside here, which is far more important … But you wouldn’t have stuck around all these years unless … you were really getting something out of it. ² (p.736)

Since that time, GPs have played a central role in responding to the many developments in HIV medicine, and many have pursued the unique opportunity in Australia for GPs to be accredited as an ‘HIV s100 prescriber’. Having the option to provide both general and treatment-related care was viewed as particularly helpful in building close and trusting relationships with HIV patients:

I’m often the person that will be delivering a diagnosis. And for me it’s a privilege to be able to give that diagnosis and then say, “But … I can help you to look after this and we don’t have to send you off to someone else” … So it can all just be … like a one stop shop for me, for my patients.³ (p.8)

Providing continuity of care was also highly valued by these GPs as this made it possible to build long-term relationships with patients, and ‘travel with them’ through their different stages of life and the different eras of HIV medicine:

It’s lovely because you sort of grow and age with them and get to know them quite well. Seeing the medications get better and seeing people live much longer than you thought [they] were going to is very rewarding. ⁴ (p.7)

This sense of trust and intimacy was seen to challenge the notion that clinical encounters feature an impersonal distance between doctor and patient. On the contrary, the ‘bond’ with patients reported by GPs in this study was viewed as a distinctive and treasured feature of this field:

Well, the relationships that you establish with patients that can, that’s very special I think … It’s a very personal practice. I mean people let you into their lives and it’s extraordinary what they tell you and what you share … You develop wonderful relationships with people. ⁵

Relationships with peers

Although general practitioners often work in group practices, and know some of the other GPs working in their local area, it can be challenging to find the time and opportunities to forge professional connections in this field of medicine. For this reason, the GPs who took part in our research greatly appreciated the professional relationships they had formed through HIV medicine:

I wouldn’t know a handful of general practitioners from my area but I know about fifty HIV GPs because we all see each other a lot. And … that’s a very nice part I think. There’s a bit of a club feel. ⁶(p.8)

Beyond simply offering an opportunity to expand their professional networks, these connections were seen to offer
a sense of camaraderie and shared clinical purpose:

[I]t’s also rewarding to be involved with other health professionals that are highly motivated to engage in an area of challenge and significant difficulty… I think there’s quite a degree of collegiality or camaraderie amongst fellow prescribers. ⁷ (p.8)

While not all of the GPs we interviewed felt this supported and connected, in most cases the sense of belonging afforded through association with the field of HIV medicine was seen to provide essential motivation and encouragement to remain engaged over time:

[T]he collegiality of the area is far and away what’s kept me in it … I think it’s all a bit of a club and we’re all on the same side. ⁸ (p.8)

This idea of HIV medicine as a ‘bit of a club’ encompassed a broader range of health and medical professionals beyond general practice, including the specialist providers contributing to HIV medicine in hospitals and sexual health clinics, and the practice nurses who so often played an essential role in shaping a comprehensive and cohesive community HIV care ‘team’.

Conclusion

In examining the motivations of GPs to provide care to people with HIV over time, relationships were consistently identified as a primary driver, and as a unique feature of this field of practice. While these relationships were described as intimate, providing deep internal strength and encouragement to stay involved over time, they also revealed the value GPs placed on feeling part of a team and of having a sense of belonging with a community of patients and a community of peers.

Acknowledgements

Many thanks to the clinicians who took part, the three Chief Investigators not named as authors on this article (Peter Canavan, Robert Reynolds, Susan Kippax) and the broader study team (Max Hopwood, Jeanne Ellard, Levinia Crooks AM, Ian Watts, Ronald McCoy, Linda Forbes, Tim Stern, Catherine Pell, Scott Lockhart, Mark Bloch, Marilyn McMurchie OAM, William Donohue, David Ellis).

The study was funded by a Project Grant (568632) from the National Health and Medical Research Council. In addition to competitive grant funding schemes, Centre for Social Research in Health projects are partly or fully funded by the Australian Government Department of Health.

References

1 Newman, C., Kidd, M., Kippax, S., Reynolds, R., Canavan, P., de Wit, J. (2013). Managing HIV in general practice. National Centre in HIV Social Research, University of New South Wales, Sydney.

2 Newman, C., Reynolds, R., Gray, R., Canavan, P., de Wit, J., McMurchie, et al. (2013). Surviving an epidemic: Australian GPs on caring for people with HIV and AIDS in the ‘early years’. Australian Family Physician, 42(10), 734–738.

3 Newman, C., Persson, A., de Wit, J., Reynolds, R., Canavan, P., Kippax, S., et al. (2013). At the coalface and the cutting edge: general practitioners’ accounts of the rewards of engaging with HIV medicine. BMC Family Practice, 14(39). doi:10.1186/1471-2296-14-39

4 ibid.

5 Persson, A., Newman, C., Hopwood, M., Kidd, M., Canavan, P., Kippax, S., et al. (online first). No Ordinary Mainstream Illness: How HIV Doctors Perceive the Virus. Qualitative Health Research. doi:10.1177/1049732313514139

6 Newman, C., Persson, A., et al., (2013), op. cit.

7 ibid.

8 ibid.