My patient last week was HIV+.  He volunteered the information — neither I nor my partner had thought to ask — and he has been asymptomatic since his diagnosis in the mid-1980s.  But in doing his write-up just now, I realized that the most likely explanation for his symptoms is an opportunistic infection.  Meaning his HIV is turning into AIDS.  Maybe his long latency period means he’ll have a slower course.  Maybe not.  We never get a chance to follow up on these patients, so it’s a little like reading the first half of a novel and never getting the chance to finish it.

Obviously, we should have asked about HIV status; that’s a given for everyone.  Sometimes, I feel like history-taking would be better done on an intake questionnaire.  We were told that the best way to ask about sexual orientation is a blunt “Men, women, or both?”  My preceptor, who was present during our interview of Mr. M. last week, did it much more humanely when she asked him “Do you have a sexual preference?”  Still, it’s an awkward question to ask.

I keep reminding myself that confidence will come with practice.  I’ve been lucky that all my patients so far have been cooperative and generally pleasant.  Next year on the wards, I’m sure I’ll get a better taste of “real-world” medicine —  at least as it’s practiced at an urban tertiary care teaching hospital.  Mmm, maybe not so real-world after all.


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