bike mike Posted March 10, 2012 Share Posted March 10, 2012 .if y'all are reading this and gaining something from it, I wouldn't mind a touch of the feedback. Steve I enjoy reading about your experiences as a PA student. Sheds some light on what PA students face in class and clinic. As someone who hopes to be a PA student sooner rather than later I appreciate it. Thank you for taking the time to post. Link to comment Share on other sites More sharing options...
Just Steve Posted March 13, 2012 Author Share Posted March 13, 2012 Sorry to say but there isn't much to update this week. Finals are Thursday, Friday, Monday, Tuesday, then Spring Break. Can't. Freaking. Wait. I've been having a very difficult time leaving home every weekend and could really use some down time from the grind. It's not overly difficult, just time consuming. Today's lecture was about ethics. As with most philosophical topics, the deeper you go, the more blurry things look. It dovetailed nicely with the reflective essay I turned in this morning. The essay was discussing HIV and the treatment of patients who are 1. Non compliant with meds 2. Sought the disease on purpose 3. Knowingly spread the disease 4. Vocalized they wanted the disease to draw public assistance (social security) with free housing and medical care. 4. Continue to engage in high risk sexual activities. Short of treating someone one who is convicted of pre meditated assault on a minor, I can't think of a much more difficult patient. Referral of patient is not an option..how do you handle it? Please feel free to discuss openly here... Link to comment Share on other sites More sharing options...
Just Steve Posted March 13, 2012 Author Share Posted March 13, 2012 Sorry to say but there isn't much to update this week. Finals are Thursday, Friday, Monday, Tuesday, then Spring Break. Can't. Freaking. Wait. I've been having a very difficult time leaving home every weekend and could really use some down time from the grind. It's not overly difficult, just time consuming. Today's lecture was about ethics. As with most philosophical topics, the deeper you go, the more blurry things look. It dovetailed nicely with the reflective essay I turned in this morning. The essay was discussing HIV and the treatment of patients who are 1. Non compliant with meds 2. Sought the disease on purpose 3. Knowingly spread the disease 4. Vocalized they wanted the disease to draw public assistance (social security) with free housing and medical care. 4. Continue to engage in high risk sexual activities. Short of treating someone one who is convicted of pre meditated assault on a minor, I can't think of a much more difficult patient. Referral of patient is not an option..how do you handle it? Please feel free to discuss openly here... Link to comment Share on other sites More sharing options...
IdahoPA Posted March 13, 2012 Share Posted March 13, 2012 Wow, I cannot imagine the mindset of someone who would willingly infect themselves with a virus known to be so lethal. And to knowingly spread it? Devious. I would be leery to treat such a patient because if someone has such little respect for his/her own body, he/she will certainly have no regard for my safety and that's not really a situation I'd want to be in. (Though I get that I will be seeing these patients, too.) Link to comment Share on other sites More sharing options...
IdahoPA Posted March 13, 2012 Share Posted March 13, 2012 Wow, I cannot imagine the mindset of someone who would willingly infect themselves with a virus known to be so lethal. And to knowingly spread it? Devious. I would be leery to treat such a patient because if someone has such little respect for his/her own body, he/she will certainly have no regard for my safety and that's not really a situation I'd want to be in. (Though I get that I will be seeing these patients, too.) Link to comment Share on other sites More sharing options...
beautifulday Posted March 13, 2012 Share Posted March 13, 2012 I think it's interesting that someone wanting to draw public assistance would be non-compliant with meds. Do they get more money the sicker they are, or is the money based on the diagnosis alone? And it makes me wonder what kind of dysfunctional history they have that would lead them to a decision to become infected. I think they would be interesting and frustrating people to treat. In your research, how frequently did you find people with this type of situation? Link to comment Share on other sites More sharing options...
beautifulday Posted March 13, 2012 Share Posted March 13, 2012 I think it's interesting that someone wanting to draw public assistance would be non-compliant with meds. Do they get more money the sicker they are, or is the money based on the diagnosis alone? And it makes me wonder what kind of dysfunctional history they have that would lead them to a decision to become infected. I think they would be interesting and frustrating people to treat. In your research, how frequently did you find people with this type of situation? Link to comment Share on other sites More sharing options...
Corpsman2PA Posted March 13, 2012 Share Posted March 13, 2012 Short of treating someone one who is convicted of pre meditated assault on a minor, I can't think of a much more difficult patient. Referral of patient is not an option..how do you handle it? Please feel free to discuss openly here... One would think there is a huge underlying psychological issue going on. I would probably dive into some history with them and figure out the cause of their careless behavior with my 'mental health' hat on rather than just putting band-aids on their issues and hoping they go away. I'm also not sure what the laws are, but I would think an intentional spread of HIV is an illegal offense of some sort? Link to comment Share on other sites More sharing options...
Corpsman2PA Posted March 13, 2012 Share Posted March 13, 2012 Short of treating someone one who is convicted of pre meditated assault on a minor, I can't think of a much more difficult patient. Referral of patient is not an option..how do you handle it? Please feel free to discuss openly here... One would think there is a huge underlying psychological issue going on. I would probably dive into some history with them and figure out the cause of their careless behavior with my 'mental health' hat on rather than just putting band-aids on their issues and hoping they go away. I'm also not sure what the laws are, but I would think an intentional spread of HIV is an illegal offense of some sort? Link to comment Share on other sites More sharing options...
IdahoPA Posted March 13, 2012 Share Posted March 13, 2012 ^It's definitely illegal. A few years ago, a man here was arrested for knowingly sleeping with women without disclosing his status. http://newyorklawschool.typepad.com/leonardlink/2008/06/hiv-criminal-la.html Link to comment Share on other sites More sharing options...
IdahoPA Posted March 13, 2012 Share Posted March 13, 2012 ^It's definitely illegal. A few years ago, a man here was arrested for knowingly sleeping with women without disclosing his status. http://newyorklawschool.typepad.com/leonardlink/2008/06/hiv-criminal-la.html Link to comment Share on other sites More sharing options...
Just Steve Posted March 13, 2012 Author Share Posted March 13, 2012 I don't have the answer to any of it...not sure there is an answer. Mental illness is definitely an underlying factor but is there a cure or reasonable treatment for it? If so, how do you get them to comply with treatment? Take away their rights and imprison them? We know how beneficial incarceration is for mental illness. Forced injections? Would it be therapeutic? Does the court system have room or desire to tackle the issue of deciding that it was in fact this person who infected the victim or did that "victim" contract the disease via another vector ie: IVDU or MSM (men having sex with men)? The local RN who runs the local HIV clinic is unable to quantify how many guys are infected because they seek it but it is common enough that they have named them "bug chasers" and recognize it as a risk factor. Link to comment Share on other sites More sharing options...
Just Steve Posted March 13, 2012 Author Share Posted March 13, 2012 I don't have the answer to any of it...not sure there is an answer. Mental illness is definitely an underlying factor but is there a cure or reasonable treatment for it? If so, how do you get them to comply with treatment? Take away their rights and imprison them? We know how beneficial incarceration is for mental illness. Forced injections? Would it be therapeutic? Does the court system have room or desire to tackle the issue of deciding that it was in fact this person who infected the victim or did that "victim" contract the disease via another vector ie: IVDU or MSM (men having sex with men)? The local RN who runs the local HIV clinic is unable to quantify how many guys are infected because they seek it but it is common enough that they have named them "bug chasers" and recognize it as a risk factor. Link to comment Share on other sites More sharing options...
beautifulday Posted March 14, 2012 Share Posted March 14, 2012 wow, that's sad. i don't think a person should be forced to comply with treatment unless they've been deemed incompetent legally, and can be treated in a psychiatric facility. and even then i think it's something that as professionals we should always be questionning and reviewing. i definitely think if i had a patient in this situation i would try to find them treatment with a mental health therapist. you make some good points about the limitations of the legal system regarding prosecution of someone infecting another person. it would be very difficult to prove. Link to comment Share on other sites More sharing options...
beautifulday Posted March 14, 2012 Share Posted March 14, 2012 wow, that's sad. i don't think a person should be forced to comply with treatment unless they've been deemed incompetent legally, and can be treated in a psychiatric facility. and even then i think it's something that as professionals we should always be questionning and reviewing. i definitely think if i had a patient in this situation i would try to find them treatment with a mental health therapist. you make some good points about the limitations of the legal system regarding prosecution of someone infecting another person. it would be very difficult to prove. Link to comment Share on other sites More sharing options...
Just Steve Posted March 14, 2012 Author Share Posted March 14, 2012 So let's add a twist...the legal system has decided to take away the person's rights and place them in a long term inpatient health care facility for the purpose of mental health treatment to somehow convince them to stop trying to infect others. We all know that men have sex with men while institutionalized. We have now introduced a known HIV + patient with a known history of having non disclosure, unsafe sex. 1. How do we warn other patients not to have sex with this person without violating the provider/patient confidentiality? 2. Does this justify legal castration? 3. How do we pay for it all? HIV drug cocktails can run a couple of thousand per MONTH per patient. That speaks nothing to the cost of inpatient stays. 4. Will the system be responsible (financially culpable) for any other patients who become infected by this patient? 5. Does the "system" have a legal obligation to protect citizens from predators like this patient? 6. If no obligation exists, then how can we justify institutionalizing the patient? 7. If the obligation does exist then what is the consequence for not protecting the citizen and again, is the system then somehow financially culpable? 8. If we divert a large sum of money from a relatively small coffer, what other publicly funded health care programs are we prepared to cut? and this is just one disease among hundreds of potential killers... we could do the same round of fun discussions on topics such as obesity, smokers, non compliant diabetics... These are some of the things that roll through my head while I stare out the classroom window during lecture. Link to comment Share on other sites More sharing options...
Just Steve Posted March 14, 2012 Author Share Posted March 14, 2012 So let's add a twist...the legal system has decided to take away the person's rights and place them in a long term inpatient health care facility for the purpose of mental health treatment to somehow convince them to stop trying to infect others. We all know that men have sex with men while institutionalized. We have now introduced a known HIV + patient with a known history of having non disclosure, unsafe sex. 1. How do we warn other patients not to have sex with this person without violating the provider/patient confidentiality? 2. Does this justify legal castration? 3. How do we pay for it all? HIV drug cocktails can run a couple of thousand per MONTH per patient. That speaks nothing to the cost of inpatient stays. 4. Will the system be responsible (financially culpable) for any other patients who become infected by this patient? 5. Does the "system" have a legal obligation to protect citizens from predators like this patient? 6. If no obligation exists, then how can we justify institutionalizing the patient? 7. If the obligation does exist then what is the consequence for not protecting the citizen and again, is the system then somehow financially culpable? 8. If we divert a large sum of money from a relatively small coffer, what other publicly funded health care programs are we prepared to cut? and this is just one disease among hundreds of potential killers... we could do the same round of fun discussions on topics such as obesity, smokers, non compliant diabetics... These are some of the things that roll through my head while I stare out the classroom window during lecture. Link to comment Share on other sites More sharing options...
Just Steve Posted March 14, 2012 Author Share Posted March 14, 2012 HIV codes their own replication different in each host. Care providers work to find a med combo that increases the patient's CD4 count and decrease the viral load. If that patient is exposed to another strain of HIV then the patient's once effective med combo could be rendered ineffective and in essence, sets them back to ground zero with dealing with the disease. Link to comment Share on other sites More sharing options...
Just Steve Posted March 14, 2012 Author Share Posted March 14, 2012 HIV codes their own replication different in each host. Care providers work to find a med combo that increases the patient's CD4 count and decrease the viral load. If that patient is exposed to another strain of HIV then the patient's once effective med combo could be rendered ineffective and in essence, sets them back to ground zero with dealing with the disease. Link to comment Share on other sites More sharing options...
RachelH Posted March 14, 2012 Share Posted March 14, 2012 Just Steve, I love reading this thread. I started a few months ago when I was in the applying and waiting to see stage. Now I've interviewed, been accepted, and waiting to start school in June. I really enjoy reading about what you have been going through, how you make it work with a wife and children, and are still successful in your studies. I will be moving across the country with my husband and 1 year old son, but I have so much support and know that if so many others with families can do it so can I. I'm partly very excited, but also partly terrified. Good luck with the rest of your didactic year and keep the postings coming! Link to comment Share on other sites More sharing options...
RachelH Posted March 14, 2012 Share Posted March 14, 2012 Just Steve, I love reading this thread. I started a few months ago when I was in the applying and waiting to see stage. Now I've interviewed, been accepted, and waiting to start school in June. I really enjoy reading about what you have been going through, how you make it work with a wife and children, and are still successful in your studies. I will be moving across the country with my husband and 1 year old son, but I have so much support and know that if so many others with families can do it so can I. I'm partly very excited, but also partly terrified. Good luck with the rest of your didactic year and keep the postings coming! Link to comment Share on other sites More sharing options...
Just Steve Posted March 14, 2012 Author Share Posted March 14, 2012 Ever hear the term "road head fever"? It's a term I heard my wife mention in regards the building anxiety a person has when they are nearing their destination....you just want to be there, be done with the trip...push push push on, skipping breaks, food, sleep all for the purpose of completing your journey.....well I got that so bad right now it makes me wanna come unglued. Finals tomorrow, Friday, Monday and Tuesday, then spring break. I. Can't. Wait. I also can't concentrate for squat. Sometimes I wish I could just take a med to help me concentrate. But then I get freaked out that I'd concentrate on the wrong thing and would be a total lost soul. Ok...one page at a time. Study on... Link to comment Share on other sites More sharing options...
Just Steve Posted March 14, 2012 Author Share Posted March 14, 2012 Ever hear the term "road head fever"? It's a term I heard my wife mention in regards the building anxiety a person has when they are nearing their destination....you just want to be there, be done with the trip...push push push on, skipping breaks, food, sleep all for the purpose of completing your journey.....well I got that so bad right now it makes me wanna come unglued. Finals tomorrow, Friday, Monday and Tuesday, then spring break. I. Can't. Wait. I also can't concentrate for squat. Sometimes I wish I could just take a med to help me concentrate. But then I get freaked out that I'd concentrate on the wrong thing and would be a total lost soul. Ok...one page at a time. Study on... Link to comment Share on other sites More sharing options...
beautifulday Posted March 15, 2012 Share Posted March 15, 2012 those are some good questions, just steve. i don't have any answers, but i'm going to try to tackle a few of them. 1. How do we warn other patients not to have sex with this person without violating the provider/patient confidentiality? I think you could probably do individual education with all the patients about safety (especially in light of what you posted about exposure to different strains) without violating confidentiality. 2. Does this justify legal castration? I would lean toward no. There are so many variables and I have to believe that there are treatment options for people who violate others in this kind of way. Otherwise, what kind of society do we have? They have mental/emotional issues that they need help with, and not just to keep them from infecting others but also to deal with what led them to seek being infected in the first place. 3. How do we pay for it all? No idea. I live in Texas and we're doing a pathetic job with mental health care. I don't know what the answer is. I don't think we put enough money into rehabilitation. 4. Will the system be responsible (financially culpable) for any other patients who become infected by this patient? Not if the other patients are properly educated. If they still choose to have sex wtih the person, that's their choice. It doesn't mean that the person doing the infecting can't still be held responsible, but I don't think the facility or system would be financially culpable to the victims if they were properly educated/warned ahead of time. 5. Does the "system" have a legal obligation to protect citizens from predators like this patient? 6. If no obligation exists, then how can we justify institutionalizing the patient? 7. If the obligation does exist then what is the consequence for not protecting the citizen and again, is the system then somehow financially culpable? 8. If we divert a large sum of money from a relatively small coffer, what other publicly funded health care programs are we prepared to cut? I think there is an obligation, just as there is an obligation to protect citizens from people who commit crimes. Education of the public is a key here too. Link to comment Share on other sites More sharing options...
beautifulday Posted March 15, 2012 Share Posted March 15, 2012 those are some good questions, just steve. i don't have any answers, but i'm going to try to tackle a few of them. 1. How do we warn other patients not to have sex with this person without violating the provider/patient confidentiality? I think you could probably do individual education with all the patients about safety (especially in light of what you posted about exposure to different strains) without violating confidentiality. 2. Does this justify legal castration? I would lean toward no. There are so many variables and I have to believe that there are treatment options for people who violate others in this kind of way. Otherwise, what kind of society do we have? They have mental/emotional issues that they need help with, and not just to keep them from infecting others but also to deal with what led them to seek being infected in the first place. 3. How do we pay for it all? No idea. I live in Texas and we're doing a pathetic job with mental health care. I don't know what the answer is. I don't think we put enough money into rehabilitation. 4. Will the system be responsible (financially culpable) for any other patients who become infected by this patient? Not if the other patients are properly educated. If they still choose to have sex wtih the person, that's their choice. It doesn't mean that the person doing the infecting can't still be held responsible, but I don't think the facility or system would be financially culpable to the victims if they were properly educated/warned ahead of time. 5. Does the "system" have a legal obligation to protect citizens from predators like this patient? 6. If no obligation exists, then how can we justify institutionalizing the patient? 7. If the obligation does exist then what is the consequence for not protecting the citizen and again, is the system then somehow financially culpable? 8. If we divert a large sum of money from a relatively small coffer, what other publicly funded health care programs are we prepared to cut? I think there is an obligation, just as there is an obligation to protect citizens from people who commit crimes. Education of the public is a key here too. Link to comment Share on other sites More sharing options...
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