July 2002 • Volume 8 • Number 7 |
 Children's toys are commonplace at the Stanley Jackson Clinic, which takes a multidisciplinary approach to treating patients with HIV, as well as their families. |
Sometimes when a person becomes chronically ill, the family gets lost in the health care equation. One clinic is challenging this unfortunate happenstance, though, when it comes to treating families with HIV.
That's right, families.
HIV and AIDS do not affect one person in isolation, says FP Steven Bromer, M.D., director of the Stanley Jackson Clinic at San Francisco General Hospital. The treatment should reflect that, he says. Families are torn apart by news of HIV infection and the realities of living with the disease.
Thought to be the first of its kind, the clinic is named for a longtime patient of Bromer's and "long-term survivor" of HIV who died in 1998. Jackson, Bromer recalls, was a construction worker who helped build the new San Francisco General Hospital and, as a patient, helped train several generations of family practice residents.
A different perspective
The National HIV/AIDS Clinicians' Consultation Center, run by the University of California, San Francisco-Community Health Network Family Practice Residency, started the family clinic a year ago to better meet the needs of those who are shortchanged by the traditional delivery of HIV care. This is not to say that subspecialists are eschewed.
"There will always be a role for (other) specialists because HIV treatment gets complicated," says Bromer. "But a young family has many issues."
One of these issues is disclosure. Here's a typical scenario that brings people to the clinic: A woman, newly pregnant, learns that she is HIV-positive. Suddenly she is struggling with the prospect of disclosing the news to the rest of her family -- and her partner. She's also worried about the potential for peripartum exposure of her newborn. These patients are in need of social help as well as medical expertise.
"We try to counsel patients about if, when and how to disclose," says Bromer. "The ramifications of disclosure may rever- berate through relationships for months or years."
The clinic's multidisciplinary approach to care has much to offer families such as these. The clinic provides nursing; case management; substance use counseling; family therapy; and support from HIV specialists in adult, child and maternity care.
"It's an innovative approach to HIV care," says second-year family practice resident Matt Symkowick, M.D., of the UCSF-CHN Family Practice Residency. And above and beyond the multidisciplinary benefits, the clinic offers a drop-in opportunity for patients on Friday mornings, which has helped Symkowick in managing one of his patients who was referred from San Francisco General Hospital's Family Health Center.
"Subtle" clinic
You won't find any obvious signs that the Stanley Jackson facility is an HIV clinic. "These patients are in the early stages of identifying with being HIV-positive," says Bromer. "They're trying to normalize the experience."
Being able to bring their families to the clinic is part of making the visit as "normal" as possible.
 Staff at the Stanley Jackson Clinic check lab results on a new patient with HIV. Clockwise from top: clinic director Steve Bromer, M.D.; Kirsten Day-Thomas, M.D.; Matt Symkowick, M.D.; and Pat Mitchnick, R.N. |
At the clinic, one physician is assigned to a family, and a concerted effort is made to bring in the whole family. Caregivers' needs are addressed alongside those of the patient with HIV, alongside those of any children.
Another typical care scenario: A parent is diagnosed with HIV, and a grandmother steps in to hold a family together. However, the grandmother herself may be grappling with diabetes or hypertension and may neglect her own care.
Having one physician follow a family is an asset when it comes to ensuring caregivers' health needs are addressed and patients are adhering to antiviral medication regimens, says Bromer.
FP's role in HIV care
In starting this family clinic, Bromer is going against a trend toward subspecialization in the treatment of HIV and AIDS. He would like to see more family physicians think about what role they can play in HIV care.
The family physician can strengthen HIV care by developing a comprehensive family assessment from a family systems perspective, says Bromer. This will help identify the family's strengths and challenges that impact disease management and self-care.
"I had a number of patients whose daughters or sons died of HIV, and I saw the continuing ramifications," said Bromer. "I wanted to better address their needs. I have a strong belief that family physicians are well-suited to take care of families with HIV."
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Copyright © 2002 by American Academy of Family Physicians.