Tuesday, May 01, 2007

AIDS and the Therapeutic Use of Self

At a recent professional talk on various aspects of HIV and AIDS, the presenter---a doctor who works with infected patients---disclosed early in his presentation that he himself has been infected since the early 1980's. He described how he shares his diagnosis with his patients, using his experience and understanding of the disease, its symptoms, and its treatments to relate empathically to his patients.

During the question-and-answer period, I asked the well-spoken doctor if he indeed discloses his status to every patient, or if he does so on a case-by-case basis. He responded that he generally discloses to every patient, with a few exceptions, and that the effect of such self-disclosure can be profound in terms of patients' ability to be forthright and honest with him about their challenges, doubts, and fears.

I asked him if he had done any writing about this very important experience as a doctor with AIDS, and he replied that it had crossed his mind but had yet to come to fruition. Encouraging him to do so, I reminded him that his very valuable insight into the lives of patients with HIV and AIDS was something no other medical professional could possibly match, and that his perspective would be a gift to patients and providers worldwide. He seemed to hear my suggestion and perhaps those words will take wing in his heart.

At one time or another, most healthcare professionals feel a desire to disclose a personal struggle to patients, often with the goal of helping a patient to see that the provider can personally relate to the patient's challenges. I have myself shared openly with some patients about my struggles with depression (when I am sure that that information will actually be helpful), and much more easily share my diagnoses of hyperlipidemia, reflux disease, and chronic pain. When a patient knows that the professional sitting across from him or her takes that same medication or experiences those same symptoms, the resulting mutual understanding can sometimes bridge a gap which otherwise would remain a yawning chasm of personal disconnection and clinical distance.

The healthcare professional must be circumspect in the practice of self-disclosure, use it with caution, and be absolutely certain that such sharing is being communicated strictly for the benefit of the patient, not for some unrecognized need of the provider for sympathy or credibility.

This doctor, I feel, has performed a service for his patients, demonstrating by his good health, attitude, and successful long-term survival with AIDS, that the term "chronic illness" can now be used as a descriptor for AIDS. As the good doctor stated, after 25 years of infection, he is now an "AIDS Geezer", more likely to die from heart disease than complications of AIDS. As the population of perinatally infected children with AIDS declines precipitously (in the industrialized world, at least), the number of elderly individuals living with the disease will continue to rise, creating a new sub-specialty area of AIDS Gerontology. The fact that infected people are now living for decades is a testament to the fact that scientific research, political will, and citizen activism have truly made strides of astronomical proportions possible.

I learned a lesson while listening to this gentleman speak, and that lesson of the judicious practice of the therapeutic use of self can have a far-reaching and profound effect on the lives of both patients and providers. I will not throw caution to the wind, however I will carefully consider how my carefully chosen disclosure may, at times, be a key to deeper understanding, and perhaps, improved clinical outcomes.
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